Angina

Angina is chest pain that happens when the blood supply to your heart is restricted. This occurs because the blood vessels around the heart have become narrowed or blocked.

The main symptom of angina is chest pain. This pain can:

• feel like a dull pain, an ache, or a "heavy" or "tight" feeling in your chest
• spread to your arms, neck, jaw or back
• be triggered by physical exertion

Angina itself is not life threatening, but chest pain that goes on for a long time can be a symptom of a heart attack.

You or someone else has symptoms like:

• central chest pain, or discomfort in the chest that doesn't go away. It may feel like pressure, tightness or squeezing
• pain that spreads down the left arm, or both arms, or to the neck, jaw, back or stomach
• unconsciousness
• seizures or fitting
• difficulty breathing (snoring or rasping)
• chest pain together with breathlessness, nausea and sweating

See your doctor if:

• you don't have a diagnosis of angina, and you get chest pain when you exercise that eases after a few minutes of rest
• you've been diagnosed with angina, and your symptoms are becoming more frequent or are coming on when you're at rest

If your doctor's chamber is closed, call a doctor or the 16263 health line.

To diagnose angina, the doctor will assess you, and you may need to have several tests.

You will also be asked some questions about:

• the symptoms you experienced
• if there were any triggers for the pain
• your family's medical history
• lifestyle risk factors (like smoking, for example)

You might also be given some tests to find out if you already have heart disease, or if you're at risk of it. These can include:

• measuring your weight
• measuring your blood pressure
• taking blood to check cholesterol levels, diabetes or anaemia

If the doctor thinks you have angina, you might be referred to a hospital for some more tests. These might include:

• electrocardiogram (ECG), which measures the rhythms and electrical activity of the heart
• exercise tolerance test (ETT), which measures the activity of the heart during exercise
• myocardial perfusion scan (MPS or MYoview), which measures how well blood is reaching the heart
• coronary angiography, which shows whether your coronary arteries are narrow and how severe any blockages are
• blood tests, which help to identify increased enzyme levels (troponin) that are released when the heart is damaged

There are 2 main types of angina: stable angina and unstable angina.

Stable angina is the more common one. An attack often has a trigger, such as physical activity or stress. The symptoms usually last only a few minutes after exercise or stress, and they can ease with rest or with a medicine called Glyceryl trinitrate (GTN).

Unstable angina is less predictable. Attacks can come on without any clear trigger. They may also last longer and carry on even when you are resting.

Sometimes chest pain starts suddenly and it isn't clear whether unstable angina or a heart attack is the cause. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS).

If you have stable angina, your doctor may give you medicine for two purposes:

• to prevent and treat angina attacks
• to reduce your risk of a heart attack

Your doctor may give you nitrates if you have stable angina. They relax the muscles in your blood vessels, so blood can pass through more easily.

You might be given nitrates as:

• slow release tablets
• a fast acting spray or tablet

Glyceryl trinitrate (GTN) is usually given as a fast acting spray or as tablets. Keep it with you at all times. When an episode of angina starts, you can use the spray or place the tablet under your tongue. The pain should ease within a few minutes.

You can repeat the dose after 5 minutes if the pain has not gone away. After the second dose, wait another 5 minutes. Should the pain still be there, call an ambulance.

Beta blockers work mainly by slowing down your heart.

Calcium channel blockers relax the arteries, which increases the blood supply to the heart muscle.

If you can't have beta blockers or calcium channel blockers, you may be given another medicine instead. Your doctor will talk this through with you.

Your doctor might give you some medicines to lower the risk of more serious heart and blood vessel problems. These could include:

• a low dose of aspirin to prevent blood clots
• statins to reduce your cholesterol (blood fats) level
• ACE inhibitors to reduce your blood pressure

If your angina symptoms get worse over a short period of time, it can be a sign of a more acute coronary syndrome. Phone 999 and ask for urgent medical help.

Unstable angina is when symptoms develop unpredictably. If you have it, you'll need certain medicines. They prevent blood clots and lower your risk of having a heart attack.

You may be given:

• low-dose aspirin
• clopidogrel
• Ticagrelor

Surgery may be recommended if you keep having angina attacks despite medical treatment. It may also be recommended if tests show you're at high risk of having a heart attack.

In a coronary artery bypass graft (CABG), the surgeon takes a section of blood vessel from another part of your body. That piece is then used to re-route blood around a blocked or narrow section of artery.

Percutaneous coronary intervention (PCI) is where a narrowed section of artery is widened using a balloon and a tiny tube called a stent. You may also hear it called a coronary angioplasty.