angina ultrasound explained

Overview

Angina is a type of chest pain or discomfort that happens when your heart muscle doesn't get enough oxygen-rich blood. An 'angina ultrasound' usually refers to an echocardiogram (a heart ultrasound) that is done to help find out if you have angina and how your heart is working. Sometimes it is a stress echo, where your heart is exercised (by walking on a treadmill or with medicine) and then scanned to look for areas that don't get enough blood flow.

Yes, angina is common. In the UK, about 1 in 10 people over 65 have angina. It affects more than 2 million people in the UK alone.

Angina mostly affects adults, especially those over 50. It is more common in men than women, but after menopause the risk for women increases. People with a family history of heart disease, high blood pressure, high cholesterol, diabetes, or who smoke are more likely to develop angina.

Symptoms

Common symptoms

• Chest pain or discomfort that feels like pressure, squeezing, heaviness, or tightness.
• Pain that may also be felt in your arms, neck, jaw, shoulder, or back.
• Shortness of breath, especially during physical activity or emotional stress.
• Fatigue, nausea, or feeling faint.

Symptoms in children

• Angina is very rare in children. When it does occur, it is usually due to a congenital heart condition or Kawasaki disease. Symptoms include chest pain during exercise or activity, shortness of breath, and unusual tiredness.

Symptoms in older adults

• Older adults may experience angina without typical chest pain. Instead, they might have shortness of breath, indigestion, nausea, lightheadedness, or extreme fatigue. Some may feel discomfort only in the upper back or shoulders.

Causes

Main causes

• The most common cause is coronary artery disease, where fatty deposits (plaque) narrow the arteries that supply blood to your heart.
• Other causes include a blood clot in a heart artery, coronary artery spasm (temporary tightening), or an abnormal heart rhythm.
• Any condition that increases the heart's need for oxygen or lowers oxygen supply can bring on angina.

Risk factors

• High blood pressure.
• High cholesterol levels.
• Smoking or tobacco use.
• Diabetes.
• Being overweight or physically inactive.
• Unhealthy diet (high in saturated fats, salt, and sugars).
• Heavy alcohol use.
• A family history of early heart disease.

When to see a doctor

See a doctor urgently if:

• If you have new, unexplained chest pain or discomfort that lasts more than a few minutes.
• If your usual angina symptoms become more frequent, severe, or happen at rest.
• If you have chest pain along with shortness of breath, sweating, or dizziness — seek same-day medical care or call your doctor.

Book a routine appointment if:

• If you have risk factors for heart disease and want to discuss how to lower your risk.
• If you experience mild chest discomfort during activity that goes away with rest.
• If you need a follow-up for a known heart condition or after a test like an angina ultrasound.

Diagnosis

Diagnosis starts with a review of your symptoms, medical history, and a physical exam. Your doctor may then order tests to see if your heart is getting enough blood. An angina ultrasound (echocardiogram) is a key test that can be done at rest or during exercise to look at your heart's pumping function and blood flow.

Tests that may be done

• Electrocardiogram (ECG) — a quick, painless test that records your heart's electrical activity.
• Stress test — you exercise on a treadmill or stationary bike while your heart is monitored.
• Echocardiogram (ultrasound of the heart) — uses sound waves to create moving images of your heart.
• Coronary angiography — a dye is injected into your blood vessels to show blockages on X-rays.

What to expect at your appointment

For a standard echo, you lie on a bed while a technician moves a small wand (transducer) over your chest. It is painless and takes about 30 minutes. For a stress echo, you exercise or receive medicine to make your heart work harder, and images are taken before and after. The doctor will explain the results to you.

Treatment

Treatment for angina focuses on reducing symptoms, preventing heart attacks, and slowing the progression of artery disease. It usually involves lifestyle changes, medications, and sometimes procedures. The specific plan depends on the type and severity of your angina.

Self-care at home

• Quit smoking and avoid tobacco smoke.
• Eat a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins.
• Get regular physical activity (ask your doctor what is safe for you).
• Maintain a healthy weight.
• Manage stress with relaxation techniques or hobbies.

Medical treatments

Doctors often prescribe medicines to relieve pain during angina attacks (such as nitrate sprays or tablets) and medicines to prevent attacks and reduce heart risk, like antiplatelet drugs, statins (to lower cholesterol), beta-blockers (to slow heart rate), or calcium channel blockers (to relax blood vessels). Always take your medicines exactly as prescribed.

When is surgery considered?

If lifestyle changes and medicines are not enough, a procedure may be recommended. Options include angioplasty and stenting (inserting a small mesh tube to open a blocked artery) or coronary artery bypass grafting (creating a new route for blood flow around a blockage). Your doctor will discuss risks and benefits.

Living with this condition

Living with angina means managing your symptoms and reducing your risk of a heart attack. Carry your angina medication with you, follow your treatment plan, and avoid heavy physical activity or extreme stress that triggers pain. Keep a symptom diary to share with your doctor.

Lifestyle tips

• Eat a balanced diet low in saturated fats, salt, and added sugars.
• Exercise regularly with activities like walking, swimming, or cycling (after checking with your doctor).
• Avoid large, heavy meals and limit alcohol.
• Learn relaxation techniques to manage stress.
• Get enough sleep.

Diet and exercise

A heart-healthy diet includes plenty of fruits, vegetables, whole grains, fish, and healthy fats (like olive oil). Limit red meat, processed foods, and sugary drinks. Exercise can be as simple as walking for 30 minutes most days. Always warm up and cool down, and stop if you feel chest pain or shortness of breath.

Mental health and emotional wellbeing

Angina can cause anxiety or depression due to fear of chest pain or a heart attack. It is normal to feel worried. Talk to your doctor or a mental health professional if these feelings affect your daily life. If you are in crisis, contact your local mental health helpline.

Prevention

You cannot change some risk factors like age or family history, but many cases of angina can be prevented or delayed with a healthy lifestyle. Managing blood pressure, cholesterol, diabetes, and not smoking are the most important steps.

Vaccines

While there is no vaccine for angina, getting vaccinated against flu and pneumonia can help prevent serious infections that might stress your heart. Ask your doctor which vaccines are right for you.

Screening programmes

Routine screening for heart disease is not recommended for everyone. However, if you have a strong family history or major risk factors, your doctor may recommend regular check-ups, blood pressure checks, and cholesterol tests starting earlier.

Complications

If left untreated

• Heart attack (myocardial infarction) — when a blockage fully stops blood flow to part of your heart.
• Heart failure — the heart becomes too weak to pump blood effectively.
• Arrhythmias — abnormal heart rhythms that can be life-threatening.
• Sudden cardiac arrest — the heart stops beating properly.

Long-term outlook

With proper treatment and lifestyle changes, many people with angina live long, active lives. Angina can often be well controlled, and the risk of a heart attack can be greatly reduced. It is important to work closely with your healthcare team and follow your care plan.

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