Angina: Everything you need to know
This article has been medically reviewed and update by: Hussain Abdeh MPharm: 2211840
Updated on: 11/06/2021
Angina is chest pain that is caused by a reduced blood flow to the heart muscle. It can be a worrying condition, especially as it shares some signs and symptoms with having a heart attack or stroke. This makes it important to research facts about angina and familiarise yourself with its causes and treatment.
Not all chest pain is a sign of angina, so you should always see your doctor as soon as possible to rule out any other conditions. Angina is not usually life-threatening and can normally be controlled by medicines such as beta-blockers, calcium channel blockers or statins, which you can buy from Medicine Direct after an online consultation with a certified doctor.
What is angina?
In common with other heart conditions, angina is chest pain (called ischemic chest pain), which may also come with shortness of breath, nausea, sweating, dizziness and pain or discomfort in your shoulder arms, neck, jaw, or back.
The pain is caused by an interruption to the blood flowing to your heart muscles.
Various factors can make this problem more likely, such as increasing age, poor diet or lifestyle, smoking and a lack of exercise.
The good news is that angina is not life-threatening. It is possible to control it with medication and changes in your lifestyle.
However, angina can be an early warning sign. Having problems with blood flow to your heart could lead to far worse risks, including a stroke or heart attack.
Angina is generally categorised in two ways: stable and unstable.
Stable angina is when your pain is triggered by something easy to identify, such as stress or overexertion. The pain eases in minutes once you rest and relax. This form of angina can be controlled with medicine, such as statins or beta blockers.
Unstable angina is the most unpredictable version of this medical condition. Attacks can be sudden and have no clear explanation, and they may not be as easy to control with rest. Unstable angina may also be an indicator that you will have a heart attack soon.
Some people have stable angina for a while and then it changes into a more unstable form of the condition.
What causes Angina?
Angina is a form of coronary artery disease, which refers to conditions impacting on the functioning of your heart. It is caused by a reduced blood flow to the heart muscle.
Angina, over time; can develop from a condition called atherosclerosis. This is the medical term for when your arteries become clogged up due to a build-up of fatty substances known as atheroma or plaque.
- Fatty foods and an unhealthy diet
The more of these fatty substances there are, the more your coronary arteries will narrow and harden.
Variant angina is when the main artery to your heart (the coronary artery) goes into spasm because of this process.
There is also something called microvascular angina. This is when your arteries look normal when tested (no fatty substances can be detected) but they still sometimes interrupt the blood flow.
Having your arteries restricted in this way interferes with the way your heart muscles work, making it difficult for this vital organ to do its job properly. Blood pumped around your body contains oxygen, which is what every part of your body needs to function.
What causes plaques to form in your arteries?
There is evidence that a family history of conditions like angina increases an individual’s risk of developing it themselves.
Other ways you increase your risk of angina (and other atherosclerosis medical issues) include eating badly and not exercising enough. Smoking can also contribute.
In a nutshell, your lifestyle is generally believed to be what puts you at most risk from angina, though your chances of developing this condition increase as you get older too.
Symptoms of angina
The main symptoms of angina is chest pain.
This pain can take different forms, and its severity depends to some degree on your resistance level. What one person sees as ‘discomfort’ could potentially be severe pain to another.
It pays to be alert to any degree of pain in your chest, as angina could be a dull, heavy feeling or the sensation of tightness across your chest.
Angina pain could also spread to your left arm, and into your neck, jaw and back.
Other angina symptoms include feelings of nausea or finding that you are struggling to breathe.
The triggers for angina symptoms could be stress – or getting very upset – or doing something physically demanding. It is also worth noting that angina symptoms can be more likely during the cold weather or if you eat a large meal.
If you have not been diagnosed with angina but get any of the symptoms, you should stop what you are doing and rest. If the symptoms do not go away after a few minutes, call 999 as the chest pain may be a sign that you are having a heart attack or stroke.
How is angina diagnosed?
One of the ways you can tell you have angina is to consider what you were doing before the pain began. As mentioned, often physical exertion or an episode of feeling upset or anxious can trigger an angina attack.
Also, angina pain may well pass in minutes once you rest.
Other heart conditions may not have these clear triggers and the pain could be constant even when resting.
Clearly, the best way to know if you have angina is to seek help and advice from a medical professional. This should be done as a matter of urgency. They will take a full medical history and ask all the relevant questions. They will also do tests, such as an ECG or heart scan.
If they do reach a diagnosis of angina, they can help you to find the right treatment and suggest ways to self-manage the condition. They will prescribe an angina treatment medication to help you control your symptoms. A doctor may also recommend lifestyle changes you can make to reduce your angina pain and the risk factors associated with angina.
It is important to note that if your chest pains do not ease after a few minutes of rest, you must call 999. You need immediate help as this could be a heart attack or stroke.
Also, seek immediate medical advice if you have a diagnosis for angina and you feel your attacks are becoming more frequent or severe.
Angina Risk Factors
There are several factors that can increase your risk of developing angina or coronary artery disease.
If you have already been diagnosed with angina, the following risk factors can also make your symptoms much worse:
- High blood pressure - Hypertension makes it harder for blood to flow through your arteries and can also cause long term damage to them such as hardening. Angina coupled with a high blood pressure can really reduce the blood flow to the heart.
- Lifestyle choices such as obesity caused by a poor diet.
- Smoking - Chewing or smoking tobacco, or prolonged exposure to second-hand smoke damages your arteries' walls, including the coronary arteries. This allows cholesterol to build up and block the blood flow to the heart muscle. This puts you at a greater risk of heart disease and angina.
- Diabetes - this is one of the main causes of Coronary Artery Disease which leads to Angina and can also cause high cholesterol levels
- Stress - Stress can increase make you more prone to angina, as well as put you at an increased risk of heart disease, strokes, and heart attacks. Surges of stress and/or anger can raise your blood pressure. The hormones produced when you are stressed can also narrow your coronary arteries and make angina worse.
- High cholesterol levels - In the right levels, it keeps your body functioning in a healthy and normal way. However, if you have an excessively high level of these lipids, it can lead to serious health conditions such as narrowing of the coronary arteries, heart attacks and strokes.
- A lack of exercise - Leading an inactive lifestyle increases your risk of a number of serious conditions, including angina, high blood pressure, heart disease, type 2 diabetes, high cholesterol and obesity. Speak to your doctor about a healthy exercise programme; this will stop you from over-exerting yourself, which may make your angina chest pain worse.
- Genetics - A family history of coronary artery disease will put you at an increased risk of developing Angina
- Old age - Naturally, men over the age of 45 are at a greater risk of developing angina, as are women over the age of 55.
Angina treatment and medications
Generally, people with angina will need to take medications to control the problem for the rest of their lives.
This includes medications to achieve three purposes.
The first is to alleviate the symptoms of angina; to make you feel less pain and discomfort.
Another type of medication for angina is preventative such as beta-blockers; it will make it less likely for you to have future attacks (including nitrates). Propranolol is the most commonly prescribed beta blocker to prevent angina and a number of other heart related conditions.
Thirdly, you could be prescribed medications to prevent your angina from putting you at risk from strokes and heart attacks such as statins that lower high cholesterol levels.
In severe cases of coronary heart disease, surgical intervention is required. This includes coronary angioplasty or heart bypass surgery to free up blood flow when the risk to life is significant.
There are positive lifestyle steps that make your angina medication more effective and that help to avoid attacks or worsening complications.
This includes having a healthy, well-balanced diet. It is also highly recommended that you engage in gentle, low impact exercise. Things like walking and slow swimming can avoid triggering an angina attack but are excellent for improving your circulation, heart strength and general level of fitness.
Diet and exercise can help you to manage your weight too, as being overweight can be a factor in all forms of coronary heart disease.
Stopping smoking and reducing your alcohol intake can also be important when living with angina.
If you have other medical conditions, managing them properly can help avoid angina attacks too. This includes careful control of blood glucose if you have diabetes and getting help if your blood pressure is consistently high.
Frequently Asked Questions
What does an angina attack feel like?
The symptoms of angina are like those of a heart attack or a stroke.
The most common symptom of angina is chest pain. The chest pain may be angina if:
- It spreads to your left arm, neck, jaw or back
- It is triggered by stress or physical activity
- The chest feels dull, tight, or heavy (some people may have a sharp stabbing pain, especially women)
- The pain stops within a few minutes of resting
Other symptoms that you may experience during an attack of angina include feeling sick, feeling breathless, feeling very tired and pain in your lower chest or stomach that is similar to indigestion.
If you suffer any of these symptoms and have not been diagnosed with angina, you must call 999 if the symptoms do not go away after a few minutes. You may be having a heart attack.
If you are not allergic to aspirin, and there is some within easy reach, chew 1 tablet while you wait for an ambulance.
If you have been diagnosed with angina, stop what you are doing and rest and take the medicine you were prescribed to treat angina. If the problem does not stop after 5 minutes, take a second dose.
If the symptoms are still there five minutes after taking a second dose, call 999.
What are the causes of angina?
Angina is usually caused by the arteries that supply blood to the heart muscle becoming narrower due to a build-up of fatty substances. This problem is known as atherosclerosis.
However, other causes of angina can include genetics and lifestyle choices, such as:
- Having a family history of atherosclerosis, or other heart problems such as heart disease.
- Eating an unhealthy diet
- Not getting enough exercise on a regular basis
- Drinking too much alcohol
- Increasing age (men over the age of 45 and women over the age of 55 are more likely to suffer from one type of angina or another)
How serious is angina?
If angina is well controlled, there is no reason why people who suffer from it cannot live a relatively normal life.
Making healthy lifestyle changes is crucial to lowering the seriousness of angina and reducing the risk of a heart attack.
Certain lifestyle changes you can make to help to reduce the severity of angina include:
- Taking regular physical activity
- Cutting down on how much alcohol you drink
- Stopping smoking if you smoke
- Eat a balanced diet
- Losing weight if you are overweight
Can angina just go away?
Sometimes, an angina attack goes away on its own, but you may need to take medication to stop the pain.
It is important to remember that, while there are different types of angina, it is not a syndrome. It is a chest pain that is the symptom of an underlying problem, most probably coronary artery disease.
For this reason, it is very important that you visit your doctor to discover the cause of angina chest pain and the problem behind it. This will reduce your risk of heart attacks and other coronary problems.
When you are prescribed a medication for angina, you will likely need to take it for the rest of your life. Making positive lifestyle changes and taking your medicine as instructed by your doctor will help to keep your angina stable and allow you to live a relatively normal life.
What are the 3 types of angina?
There are three different types of angina:
- Stable angina is the most common type of angina. This normally occurs when the heart is having to work harder than usual. Stable angina can normally be controlled by resting and using a prescription medicine. The pain associated with stable angina is generally triggered by something that can be easy to identify, such as overexertion or emotional stress.
- Variant angina is rare and occurs while you are resting. This condition can be helped with medicine.
- Unstable angina is the most dangerous form of angina. It can occur without physical exertion and does not follow any pattern. Unstable angina does not go away with medical treatment or rest like stable angina. Unstable angina is usually a warning sign that you may suffer a heart attack soon.
How important is it to get angina diagnosed?
If you are suffering any pain or discomfort in your chest, it is imperative that you speak to your doctor. Any chest pain or discomfort may not just be angina, it may be a far more serious problem that could be life-threatening.
Getting angina diagnosed as early as possible means that you may be able to prevent far more serious conditions in the future, including strokes, heart attacks or heart disease.
Your doctor may need to prescribe you medication that you are required to take for the rest of your life to control angina. Usually, people who are diagnosed with this problem can lead a normal and healthy life, with their angina being controlled by medicine.