angina overview for patients

Overview

Angina is a term for chest pain or discomfort that happens when your heart muscle does not get enough blood and oxygen. It is usually a symptom of an underlying heart problem, most commonly coronary artery disease, where the blood vessels leading to your heart become narrowed or blocked.

Angina is quite common, especially among older adults and people with risk factors for heart disease. It affects millions of people worldwide.

Angina can affect anyone, but it is more likely in men over 50 and women over 55, and in people who smoke, have diabetes, high blood pressure, or high cholesterol.

Symptoms

Common symptoms

• Chest pain or discomfort that may feel like pressure, squeezing, heaviness, or tightness.
• Pain that may spread to your shoulder, arm, neck, jaw, back, or upper belly.
• Shortness of breath, often along with the chest pain.

Symptoms in children

• Angina is rare in children, but if it happens, they may complain of chest pain or discomfort, or they may look pale, sweaty, or irritable.
• Children might not describe the feeling clearly, so they may just say their chest hurts or they feel tired.

Symptoms in older adults

• Older adults may not notice typical chest pain. Instead, they may feel short of breath, unusually tired, or weak.
• They may also have pain in the upper abdomen or between the shoulder blades.

Causes

Main causes

• Narrowing of the coronary arteries due to a build-up of fatty deposits called plaque (atherosclerosis).
• Spasms or squeezing of the coronary artery, which can also reduce blood flow.

Risk factors

• Age (over 45 in men, over 55 in women).
• Smoking or exposure to second-hand smoke.
• Diabetes, high blood pressure, or high cholesterol.
• Obesity or an inactive lifestyle.
• Family history of early heart disease.

When to see a doctor

See a doctor urgently if:

• If you have chest pain that is new, unexpected, or lasting more than a few minutes, call your local emergency number right away.
• If your angina becomes more frequent, more severe, or happens at rest.

Book a routine appointment if:

• If you have risk factors for heart disease and have never been checked, schedule a routine appointment with your GP (family doctor).
• If you have stable angina that is managed, you should have regular follow-up, usually every 6 to 12 months.

Diagnosis

Doctors diagnose angina by talking to you about your symptoms, asking about your medical and family history, and doing a physical exam. They may also order tests to check how well your heart is working.

Tests that may be done

• Electrocardiogram (ECG or EKG) to measure the heart's electrical activity.
• Blood tests, including tests for heart enzymes that may suggest a heart attack.
• An exercise stress test, where you walk on a treadmill while your heart is monitored.
• Coronary angiography, a dye test to see blockages in the heart arteries.
• Imaging tests like a CT scan or MRI of your heart.

What to expect at your appointment

During diagnosis, the doctor will likely ask about when your symptoms happen, what makes them better or worse, and whether you have other risk factors. You may need several tests, but most are painless. Don't be afraid to ask the doctor to explain what is happening.

Treatment

Treatment for angina aims to relieve symptoms, slow down the build-up of plaque, and reduce your risk of a heart attack. It usually involves a combination of lifestyle changes and medicines. Sometimes, procedures are needed to restore blood flow.

Self-care at home

• Stop smoking and avoid second-hand smoke.
• Eat a heart-healthy diet low in salt, unhealthy fats, and added sugars.
• Take regular physical activity, as advised by your healthcare team.
• Learn to manage stress and find healthy ways to cope.

Medical treatments

Your doctor may prescribe medicines to widen blood vessels, lower blood pressure, reduce cholesterol, or prevent blood clots. These are not named here – always ask your doctor or pharmacist about the medicines you are taking. Take them exactly as prescribed and never stop suddenly without talking to your doctor.

When is surgery considered?

If medicines and lifestyle changes are not enough, or if your blockages are severe, your doctor may recommend a procedure such as coronary angioplasty and stenting (a small mesh tube that props the artery open) or coronary bypass surgery (using a healthy blood vessel to create a new route around a blocked artery). These decisions are made with your heart team.

Living with this condition

Living with angina means learning the warning signs, knowing what triggers your symptoms, and keeping a good relationship with your healthcare team. You can still enjoy many daily activities, but you may need to plan ahead and pace yourself.

Lifestyle tips

• Aim for more activity, but work with your doctor to find the right level for you.
• Maintain a healthy weight.
• Limit alcohol.
• Keep regular appointments and take your prescribed medicines as directed.

Diet and exercise

A heart-healthy diet includes plenty of vegetables, fruits, whole grains, lean proteins, and healthy fats, while limiting salt, red meat, and sugary drinks. Exercise can improve blood flow and reduce stress – try for 30 minutes of moderate activity most days, unless your doctor tells you otherwise.

Mental health and emotional wellbeing

Angina can cause anxiety or low mood, which is completely understandable. It's important to talk about your feelings. Some people feel overwhelmed by the diagnosis, but support from loved ones, a counsellor, or a cardiac rehabilitation group can help.

Prevention

You can lower your risk of angina or help stop it from getting worse by controlling your blood pressure, cholesterol, blood sugar, and weight, and by not smoking.

Screening programmes

Regular health checks can catch risk factors early. Let your doctor check your blood pressure, cholesterol, and blood sugar, especially if you have a family history or other risk factors.

Complications

If left untreated

• Angina can lead to a heart attack, where part of the heart muscle is damaged due to lack of blood flow.
• It can also cause heart failure (the heart pumping less effectively) or dangerous heart rhythm problems.

Long-term outlook

Angina is often a long-term condition, but many people manage it well and live full, active lives. With timely treatment, a care plan, and healthy choices, the outlook is generally positive. Working closely with your healthcare team is the best way to stay ahead.

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