angina risks and benefits for patients

Overview

Angina is a type of chest pain or discomfort that happens when your heart muscle doesn't get enough oxygen-rich blood. It is a symptom of an underlying heart condition, usually coronary artery disease (narrowing of the arteries that supply blood to the heart). Angina is not a heart attack, but it can be a warning sign that you are at higher risk for a heart attack.

Yes, angina is common. Millions of people worldwide live with angina. It is especially common in older adults and those with risk factors like high blood pressure or diabetes.

Angina affects both men and women. It is more common in people over 50, but younger adults can also develop it, especially if they have risk factors like smoking, obesity, or a family history of heart disease.

Symptoms

Common symptoms

• Chest pain or discomfort that feels like pressure, squeezing, fullness, or aching
• Pain that may spread to the shoulders, arms, neck, jaw, or back
• Shortness of breath
• Fatigue or weakness
• Nausea or indigestion

Symptoms in children

• Angina is very rare in children. However, if a child has a heart condition present at birth (congenital heart disease) or Kawasaki disease, they may experience chest pain or shortness of breath during exercise.

Symptoms in older adults

• Older adults may have less typical symptoms, such as unusual tiredness, weakness, or shortness of breath without obvious chest pain.
• Pain may be in the upper back or shoulders rather than the chest.
• Older adults with dementia may have difficulty describing their symptoms.

Causes

Main causes

• Angina is most often caused by coronary artery disease, where fatty deposits (plaque) build up in the arteries, narrowing them and reducing blood flow to the heart muscle.
• Sometimes angina can be caused by a temporary spasm of the arteries, called variant angina.
• Other heart conditions like aortic stenosis (narrowing of the heart valve) can also lead to angina.

Risk factors

• High blood pressure
• High cholesterol
• Smoking or tobacco use
• Diabetes
• Obesity
• Lack of physical activity
• Unhealthy diet high in saturated fats and salt
• Family history of heart disease
• Older age (over 45 for men, over 55 for women)
• Chronic stress or depression

When to see a doctor

See a doctor urgently if:

• If you have chest pain or discomfort that is new, unexplained, or different from your usual angina symptoms
• If your angina symptoms happen more often, last longer, or occur when you are resting
• If your chest pain does not go away after taking your prescribed medication or after resting for a few minutes
• If you experience any of the emergency symptoms listed above

Book a routine appointment if:

• If you have been diagnosed with angina and need a medication review or check-up
• If you have risk factors and want to discuss ways to lower your heart disease risk
• If you have mild, occasional chest discomfort that comes on during exercise and goes away with rest

Diagnosis

Your doctor will ask about your symptoms, medical history, and risk factors. They will listen to your heart and lungs, check your blood pressure, and may order tests to see how well your heart is working.

Tests that may be done

• Electrocardiogram (ECG) – a quick, painless test that records the electrical activity of your heart.
• Blood tests – to check for substances that may indicate heart damage or risk factors like cholesterol.
• Exercise stress test – you walk on a treadmill while your heart activity is monitored.
• Echocardiogram – an ultrasound of your heart to see its structure and function.
• Coronary angiography – a dye and X-ray test to see the inside of your coronary arteries.

What to expect at your appointment

Most tests are non-invasive (painless and without cutting the skin). An angiography is a small procedure done in a hospital. Your doctor will explain each test and what the results mean for your treatment plan.

Treatment

Treatment for angina aims to relieve symptoms, slow the progression of heart disease, and reduce the risk of heart attack and stroke. A combination of lifestyle changes, medications, and sometimes procedures can help you live well with angina.

Self-care at home

• Quit smoking – this is the single most important step you can take.
• Eat a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins.
• Be physically active – aim for at least 150 minutes of moderate activity per week, such as brisk walking, after checking with your doctor.
• Manage stress through relaxation techniques like deep breathing or meditation.
• Keep a healthy weight – even a small loss can help.
• Limit alcohol to recommended amounts.

Medical treatments

Medicines are often prescribed to help manage angina. These may include medications that relax blood vessels, reduce the heart's workload, or help prevent blood clots. Your doctor will decide which medicines are best for you based on your specific situation. It is important to take them exactly as prescribed and to discuss any side effects.

When is surgery considered?

If lifestyle changes and medications are not enough, or if your arteries are severely narrowed, a doctor may recommend a procedure like angioplasty (opening the artery with a balloon and placing a small tube called a stent) or coronary artery bypass grafting (bypass surgery) to improve blood flow to the heart.

Living with this condition

Living with angina means learning to listen to your body. You can still do most daily activities, but you may need to pace yourself. Carry your prescribed medication at all times and know what to do if symptoms occur. Keep a symptom diary to share with your doctor.

Lifestyle tips

• Take your medications regularly and never stop without consulting your doctor.
• Learn your triggers – such as heavy meals, cold weather, or stress – and plan around them.
• Avoid sudden intense activity, especially after a meal.
• Carry a water bottle and stay hydrated.
• Tell your family and friends about your condition so they can help in an emergency.

Diet and exercise

A heart-healthy diet is key. Focus on fruits, vegetables, whole grains, fish, and lean meats. Limit salt, sugar, and unhealthy fats. Exercise is safe and helpful for most people with stable angina. Start slowly and build up. Your doctor or a cardiac rehabilitation team can guide you with a safe exercise plan.

Mental health and emotional wellbeing

Living with a chronic condition like angina can cause anxiety, worry, or depression. It is normal to feel this way. Talking to a counsellor, joining a support group, or practicing relaxation exercises can help. If you feel overwhelmed, tell your doctor – they can point you to extra support.

Prevention

You can reduce your risk of angina by making heart-healthy choices. Not all cases are preventable, especially if you have a strong family history, but adopting a healthy lifestyle lowers your chances. If you already have angina, these steps can help prevent it from getting worse and reduce your risk of heart attack.

Vaccines

Having your annual flu vaccine and staying up to date with other recommended vaccines can help prevent infections that might stress your heart. Talk to your doctor about which vaccines are right for you.

Screening programmes

Screening for high blood pressure, high cholesterol, and diabetes can help catch risk factors early. If you are over 40, the NHS offers a free health check in England that includes these tests. Ask your healthcare provider how often you should be screened based on your personal risk.

Complications

If left untreated

• Unstable angina – angina that becomes more frequent, occurs at rest, or lasts longer, increasing the risk of heart attack.
• Heart attack – if a blood clot completely blocks a narrowed artery, it can damage the heart muscle.
• Heart failure – long-term lack of blood flow can weaken the heart muscle.
• Arrhythmias – irregular heartbeats that can be dangerous.

Long-term outlook

With the right treatment and lifestyle changes, many people with angina lead full, active lives and reduce their risk of complications. Angina is a serious condition, but it is also manageable. Your healthcare team will work with you to create a plan that helps you feel better and stay healthy.

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