Living with angina

Overview

Angina is a type of chest pain or discomfort that happens when your heart muscle does not get enough oxygen-rich blood. It is a symptom of a heart problem, usually a narrowing of the blood vessels that feed the heart. Angina is not a heart attack, but it is a warning sign that your heart needs more care and protection.

Yes, angina is fairly common, especially in people over 50 and those with heart disease risk factors like high blood pressure, high cholesterol, or diabetes. It affects millions of adults worldwide.

Angina can affect anyone, but it is more common in older adults, men, and people with a family history of early heart disease. You are also more likely to develop angina if you smoke, have diabetes, or are physically inactive.

Symptoms

Common symptoms

• Chest pain or discomfort – often described as pressure, squeezing, heaviness, or a tight band around the chest
• Pain that may spread to the arms, neck, jaw, shoulder, or back
• A feeling of breathlessness or tiredness with activity
• Symptoms that usually last a few minutes and improve with rest
• Discomfort that can also feel like indigestion or fullness

Symptoms in children

• Angina is very rare in children. If a child has chest pain or discomfort during activity, it is important to have them seen by a doctor to find the cause.

Symptoms in older adults

• Older adults may not feel classic chest pain. They may instead experience breathlessness, extreme fatigue, dizziness, or discomfort in the back or stomach.
• Symptoms may seem less specific and can be mistaken for indigestion or general tiredness, so it is important to seek medical advice.

Causes

Main causes

• Atherosclerosis – a build-up of fatty plaques inside the coronary arteries, narrowing them
• A temporary spasm of a coronary artery, which can also reduce blood flow
• The heart muscle needing more oxygen during exertion than the narrowed arteries can deliver

Risk factors

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Being overweight or obese
• Lack of physical activity
• Family history of early heart disease
• Age – risk increases over 50

When to see a doctor

See a doctor urgently if:

• If you have any new or unexplained chest pain, seek medical attention the same day.
• If your chest pain happens at rest, comes more often, or is more severe than usual, get urgent medical help.
• If your usual way of relieving angina (such as resting) is no longer helping, contact your doctor urgently.

Book a routine appointment if:

• If you occasionally feel chest pain when you are active and it goes away when you rest, talk to your doctor as soon as possible to get it checked.
• If you have risk factors for heart disease and would like to know your risk, make a routine appointment to discuss it.

Diagnosis

A doctor will ask about your symptoms, medical history, and lifestyle. They will also listen to your heart, check your blood pressure, and may order tests to see how well your heart is working and whether blood flow is limited.

Tests that may be done

• Electrocardiogram (ECG) – a painless test that records the electrical activity of your heart
• Blood tests – to check your cholesterol, blood sugar, and other markers of heart health
• Exercise stress test – to see how your heart responds to physical activity
• Echocardiogram – an ultrasound that looks at the structure and pumping function of your heart
• Coronary angiogram – a special X-ray using dye to show any blockages in the heart arteries

What to expect at your appointment

Your doctor may refer you to a heart specialist for further testing. These tests are usually painless and done as an outpatient. You will have time to ask questions and discuss the results with your care team before agreeing on a treatment plan.

Treatment

Treatment for angina aims to relieve symptoms, slow down the underlying heart disease, and prevent heart attacks. Your plan will be personal to you and will likely include heart-healthy lifestyle changes, medicines, and sometimes a procedure to improve blood flow.

Self-care at home

• Learn what triggers your angina and plan ahead – for example, take rest breaks during activity.
• Carry your rescue medicine with you at all times and know exactly when and how to use it.
• Avoid heavy meals, especially before physical activity.
• Dress warmly in cold weather and avoid sudden exertion.
• Stop smoking and take steps to manage stress.

Medical treatments

Several types of medicines are used to manage angina. Some are taken at the time of symptoms to relieve pain quickly, while others are taken every day to prevent attacks and protect your heart. Your doctor will explain how each medicine works, how to use it, and what side effects to look out for. Never stop or change your medicine without talking to your doctor first.

When is surgery considered?

If medicines are not controlling your symptoms, a heart specialist may recommend a procedure to improve blood flow. These include angioplasty (using a tiny balloon to open a narrowed artery, often with a small mesh tube called a stent) or bypass surgery (using a blood vessel from another part of your body to create a new route around a blocked artery). These are common procedures, and your team will discuss the risks and benefits with you before deciding.

Living with this condition

Living with angina means finding a balance between staying active and allowing your heart to rest. Learn to spot your warning signs, keep your medicines close, and don't ignore changes in your symptoms. With practice, you will feel more in control.

Lifestyle tips

• Stop smoking – this is one of the best things you can do for your heart.
• Stay active within your limits – a cardiac rehabilitation team can help you find a safe routine.
• Reach and maintain a healthy weight.
• Manage stress with relaxation techniques, hobbies, or talking to a trusted person.
• Limit alcohol and avoid recreational drugs.
• Attend regular check-ups and take your medicines as prescribed.

Diet and exercise

Eat a heart-healthy diet with plenty of vegetables, fruit, whole grains, and healthy fats like olive oil. Choose lean proteins such as chicken or fish, and cut down on salt, sugar, and processed foods. For exercise, aim for moderate activities like walking, cycling, or swimming – but always follow your doctor's advice on what is right for you. Ask about cardiac rehabilitation, which offers safe, structured exercise and education.

Mental health and emotional wellbeing

Living with angina can be stressful. You may feel anxious about having a heart attack or frustrated by your limits. These feelings are normal and you should not be ashamed of them. Talk to your doctor or a counsellor, and consider joining a support group. If you ever have thoughts of harming yourself or suicidal thoughts, seek immediate help from a crisis line, your local emergency department, or call your local emergency number.

Prevention

You cannot always prevent angina completely, but you can dramatically lower your risk of it worsening or leading to a heart attack. The same heart-healthy habits used in treatment – quitting smoking, eating well, staying active, and controlling blood pressure and cholesterol – are also the best prevention.

Vaccines

Keeping your vaccinations up to date, including the flu vaccine and pneumonia vaccine, is recommended because infections can put extra strain on your heart. Ask your doctor or pharmacist what is recommended for you.

Screening programmes

Regular check-ups to measure blood pressure, cholesterol, and blood sugar are important. If you have a family history of early heart disease, talk to your doctor about whether earlier or more frequent screening is right for you.

Complications

If left untreated

• Heart attack – if a fatty plaque breaks open and fully blocks a heart artery
• Unstable angina – more severe and unpredictable chest pain that raises your risk of a heart attack
• Arrhythmias – abnormal heart rhythms that can be dangerous
• Heart failure – if the heart muscle becomes weaker over time due to poor blood flow

Long-term outlook

The outlook for angina has improved greatly. With modern treatments, a healthy lifestyle, and good support, many people live long, fulfilling lives. Take your medicines as prescribed, stay connected with your care team, and be kind to yourself. You are taking the right steps by reading this and asking questions about your health.

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