Heart Conditions Angina

Overview

Angina (say: an-JY-nuh) is chest pain or discomfort that comes on when your heart muscle is not getting enough blood and oxygen. It is not a disease on its own — it is a warning signal that something is limiting the blood supply to your heart, most often narrowed heart arteries. Angina usually feels like tightness, pressure, heaviness or squeezing in the chest, and it often eases within a few minutes with rest.

Yes, angina is common. It is one of the most frequent reasons people visit their doctor with chest discomfort, and it affects millions of people worldwide. Rates rise steadily with age and are higher in people who smoke or who have diabetes, high blood pressure or high cholesterol.

Angina is most common in men over about 55 and women over about 65, but it can happen much earlier. It is more likely in people who smoke, have diabetes, high blood pressure, high cholesterol, kidney disease or a strong family history of heart disease. In the UK, people of South Asian heritage tend to develop heart disease at younger ages, and people of Black African or Caribbean heritage often have higher rates of high blood pressure. Anyone can get angina — including younger adults and, rarely, children with certain heart conditions.

Symptoms

Common symptoms

• Tightness, pressure, heaviness, squeezing or a band-like ache in the middle of the chest
• Discomfort spreading to the left or both arms, the neck, jaw, throat, back or upper stomach
• Breathlessness, especially with activity
• Feeling sweaty, clammy or sick (nauseous)
• Light-headedness or dizziness
• A feeling of unusual tiredness or 'heaviness' during exertion
• Symptoms that come on with effort, cold weather, emotional upset or after a big meal, and ease within a few minutes of resting
• Some people get only breathlessness or indigestion-like discomfort and no classic chest pain — this is more common in women, older adults and people with diabetes

Symptoms in children

• Angina from narrowed heart arteries is very rare in children; chest pain in childhood usually has other causes such as muscle strain, coughs and colds, or anxiety
• A child with a known heart condition, or one who was treated for Kawasaki disease as a baby, may rarely have chest pain linked to the heart
• Children often cannot describe the pain — look for reluctance to play, becoming breathless quickly, or going pale and sweaty during activity
• Any child with chest pain during exercise, fainting, or a strong family history of early heart disease should be checked by a doctor

Symptoms in older adults

• Symptoms can be vaguer: breathlessness, extreme tiredness, indigestion-like discomfort or a general 'not feeling right' rather than clear chest pain
• Confusion, dizziness on standing, or a sudden drop in energy can sometimes be the main sign
• Older adults often have other conditions, such as arthritis or lung disease, which can make activity-related pain harder to interpret
• Medicines for other conditions can affect heart rate and blood pressure, so regular reviews with a doctor or pharmacist are helpful

Causes

Main causes

• Coronary artery disease: fatty deposits (plaque) build up inside the arteries that feed the heart muscle, narrowing them so less blood gets through when the heart works harder
• Coronary artery spasm: a heart artery suddenly tightens, briefly reducing blood flow, sometimes at rest or at night
• Microvascular angina: the tiny blood vessels feeding the heart do not work properly, even though the big arteries look clear
• Heart valve problems, especially narrowing of the aortic valve, which strain the heart
• Thickened heart muscle (cardiomyopathy) or a very fast, sustained heart rhythm
• Other strains on the heart such as severe anaemia (low blood count), an overactive thyroid, or very high blood pressure

Risk factors

• Smoking or using tobacco, including vaping and shisha
• High blood pressure
• High cholesterol, especially raised 'bad' cholesterol and low 'good' cholesterol
• Type 1 or type 2 diabetes, and pre-diabetes
• Being overweight or carrying extra weight around the middle
• Not being physically active
• A diet high in salt, saturated fat and processed foods, and low in fruit and vegetables
• Drinking too much alcohol
• Long-term stress and poor sleep
• A close family member with heart disease at a young age (under 55 for a father or brother, under 65 for a mother or sister)
• Increasing age and being male, or having gone through the menopause
• Chronic kidney disease, inflammatory conditions such as rheumatoid arthritis, and untreated sleep apnoea

When to see a doctor

See a doctor urgently if:

• Chest pain or pressure that is new, severe, or lasts more than a few minutes at rest — call emergency services
• A sudden change in your usual angina pattern: more frequent, more intense, brought on by less activity, or now at rest
• Chest pain with fainting, severe breathlessness, or a racing or irregular heartbeat
• You feel very unwell, sweaty and clammy with chest discomfort

Book a routine appointment if:

• You have chest discomfort, breathlessness or unusual tiredness on exertion that settles with rest — book a GP appointment promptly, even if you think it is nothing
• You have been diagnosed with angina and your symptoms are slowly changing, or you are limiting your life because of them
• You have risk factors such as diabetes, high blood pressure or a strong family history and have not had a recent check-up
• You want to review your lifestyle, activity level or how well your risk factors are controlled
• You feel anxious or low about your heart symptoms and want to talk it through

Diagnosis

Your doctor will start by asking about your symptoms: what the discomfort feels like, where it spreads, what brings it on, how long it lasts and what relieves it. They will ask about your health, medicines and family history, then examine you, checking your blood pressure, pulse, heart sounds and looking for other causes. Based on this, they will arrange tests and may refer you to a heart specialist (a cardiologist). The aim is to confirm whether your heart is short of blood, how narrowed the arteries are, and what is driving it.

Tests that may be done

• Blood tests to check cholesterol, blood sugar, kidney function, thyroid and blood count, and to look for signs of heart strain
• An ECG (electrocardiogram): sticky patches on the chest record the heart's electrical pattern in a few minutes
• An exercise ECG: you walk on a treadmill or cycle while your heart is monitored, to see how it behaves when working hard
• An ambulatory ECG: a portable monitor worn for 24 hours or more to catch symptoms that come and go
• An echocardiogram: an ultrasound scan of the heart that shows its size, pumping action and valves
• A CT coronary angiogram: a detailed scan that shows the heart arteries and any narrowing
• Coronary angiography: a thin tube is passed to the heart through a blood vessel in the wrist or groin, and dye is used to take X-ray pictures of the arteries — this is the most detailed test and can be done alongside treatment
• A stress MRI or perfusion scan in some cases, to see blood flow to the heart muscle

What to expect at your appointment

Diagnosis usually takes more than one appointment. Some tests are quick and done at your GP surgery or local hospital; others need a hospital visit and a few weeks' wait. You may be asked not to eat beforehand, or to stop certain medicines for a day — always check with the team. It helps to keep a simple diary of when symptoms happen, what you were doing, how long they lasted and what helped. Bring a list of your medicines and any family history of heart problems. Ask questions if anything is unclear; written information and a chance to bring someone with you can make the process easier.

Treatment

Treatment for angina has three aims: to relieve your symptoms so you can live normally, to protect your heart from a future heart attack or heart failure, and to treat whatever is causing the problem. Most people need a combination of lifestyle changes, medicines and regular review — and, for some, a procedure to improve blood flow. Treatment is usually lifelong and is adjusted as things change.

Self-care at home

• Stop smoking — this is the single biggest thing you can do for your heart, and your doctor or pharmacist can offer free support and treatments to help
• Learn your own pattern: note what brings on your symptoms and how long they take to settle, so you can pace yourself
• Rest and stop what you are doing when symptoms start; sit down and stay calm until they pass
• Keep any 'rescue' medicine your doctor has prescribed with you at all times, and use it exactly as explained
• Tell family, friends and colleagues what to do if you have chest pain, and where your medicine is kept
• Eat a heart-healthy diet and keep to a healthy weight
• Build activity up gradually, and avoid sudden strenuous effort in cold wind or straight after a heavy meal
• Limit alcohol and avoid recreational drugs, which can strain the heart
• Go to all your review appointments, and ask your pharmacist to check any new medicines — including cold and flu remedies — for interactions
• Keep up to date with vaccinations recommended for people with heart conditions

Medical treatments

Your doctor will usually prescribe a combination of medicines, each doing a different job: some relieve an angina episode quickly when it starts; some slow the heart and lower its workload so it needs less oxygen; some lower blood pressure; some lower cholesterol and help stabilise the fatty deposits in the arteries; some reduce the chance of blood clots forming; and others keep blood sugar controlled if you have diabetes. You may also be given a daily low-dose aspirin-type medicine or another blood-thinner if appropriate. It can take a few weeks to find the right combination, and doses are adjusted over time. Never stop or change a heart medicine on your own — speak to your doctor or pharmacist first. This article does not recommend specific medicines; your healthcare team will choose what suits you.

When is surgery considered?

If symptoms are not well controlled with lifestyle changes and medicines, or if tests show a tight narrowing in an important artery, your cardiologist may recommend a procedure. The two main options are angioplasty, where a small balloon is used to widen the artery and often a fine mesh tube (stent) is left in place to keep it open, and coronary artery bypass surgery, where a blood vessel taken from elsewhere in the body is used to route blood around the blocked section. Both are done by specialist teams, usually after a full discussion of benefits and risks. Many people feel a big improvement in symptoms afterwards and still need to keep taking medicines and following a heart-healthy lifestyle.

Living with this condition

Most people with well-controlled angina carry on working, driving, travelling and enjoying life. The key is pacing: spread heavy tasks out, warm up before activity, avoid rushing, and take breaks before you get symptoms rather than after. Keep your rescue medicine with you, tell the people around you how to help, and plan ahead for cold weather, hills, stairs and heavy shopping. If your symptoms become more predictable or less frequent, that is a good sign — but do not assume you can stop your medicines. Many people find that a routine of regular, gentle activity actually reduces how often angina comes on.

Lifestyle tips

• Stop smoking completely, and avoid other people's smoke
• Aim for regular moderate activity such as brisk walking, cycling or swimming, built up gradually — ask your team about cardiac rehabilitation, which is a supervised exercise and education programme that helps a great deal
• Keep alcohol within recommended limits and have several alcohol-free days a week
• Get enough sleep and treat snoring or daytime sleepiness — sleep apnoea puts strain on the heart
• Manage stress with breathing exercises, hobbies, talking therapies or whatever helps you switch off
• Keep blood pressure, cholesterol and blood sugar within the targets your doctor sets
• Take your medicines as prescribed and use a pill organiser or phone reminder if you forget
• Weigh yourself now and then, and tell your doctor if your weight changes quickly or your ankles swell

Diet and exercise

Eating well for angina means plenty of vegetables, fruit, beans, lentils, nuts, whole grains and oily fish, with olive or rapeseed oil instead of butter and lard. Cut down on salt, processed meats, pastries, crisps, sugary drinks and takeaways. These changes lower blood pressure and cholesterol and help with weight. For exercise, aim for something you enjoy and can do most days — a 20 to 30 minute walk is plenty to start. Warm up slowly, cool down gently, and stop if you get chest discomfort; rest until it settles. Avoid sudden bursts of effort, such as sprinting for a bus or shovelling snow, until your team says it is safe. A supervised cardiac rehabilitation programme is the safest and most effective way to build fitness after a heart event.

Mental health and emotional wellbeing

It is very common to feel anxious after chest pain — many people worry that every twinge is a heart attack, or become afraid of exercise and start avoiding things they used to do. Some feel low, frustrated or angry at their body. These feelings are understandable and treatable. Talking to your GP, a counsellor or a psychologist can help, and so can cardiac rehabilitation and peer support groups. If you feel hopeless, cannot sleep, or have thoughts of harming yourself, please reach out for help straight away — contact your local crisis line, your doctor, or your local emergency number if you feel unsafe. You do not have to cope alone.

Prevention

Largely, yes. The same things that reduce your risk of heart disease also prevent angina from developing or getting worse: not smoking, keeping blood pressure and cholesterol in a healthy range, controlling diabetes, eating well, staying active, keeping to a healthy weight and limiting alcohol. Even small changes add up, and it is never too late to start — the benefits begin within weeks.

Vaccines

People with heart conditions are usually advised to have a yearly flu vaccine and to keep up to date with recommended vaccinations for heart and lung health, such as those for pneumonia and COVID-19. Ask your GP surgery or pharmacist which ones are recommended for you.

Screening programmes

In the UK, adults aged 40 to 74 without an existing heart condition are usually invited for an NHS Health Check every five years, which includes blood pressure and cholesterol tests and an estimate of heart risk. Blood pressure can also be checked free at many pharmacies. If you have diabetes or kidney disease you will have regular heart risk reviews. Ask your doctor when your checks are due.

Complications

If left untreated

• Unstable angina, where symptoms become unpredictable and happen at rest — this needs emergency assessment
• Heart attack (myocardial infarction), when an artery becomes fully blocked and heart muscle is damaged
• Heart failure, where the heart becomes weaker and fluid builds up, causing breathlessness and swelling
• Dangerous heart rhythms, which can cause collapse or cardiac arrest
• Worsening quality of life, with limits on work, travel and everyday activities
• Anxiety and low mood, which can become a problem in their own right

Long-term outlook

The outlook for people with angina is generally good, especially when it is diagnosed early and treated. Many people live full, active lives for many years with a combination of medicines, lifestyle changes and, for some, a procedure to improve blood flow. Treatment has improved a great deal, and most people find their symptoms become manageable. Keeping appointments, taking medicines as prescribed and asking for help early when something changes makes the biggest difference.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.