Angina

Angina is discomfort or pain in the chest that occurs when the heart muscle is not getting enough oxygen-rich blood. It is not a disease in itself but a symptom of an underlying heart problem, most often coronary artery disease, in which the arteries supplying the heart become narrowed by fatty deposits.

Angina is a warning that the heart is under strain and is a signal that heart disease is present and needs attention. Recognizing and assessing it helps reduce the risk of a heart attack.

Stable angina is the most common type. It is triggered by a predictable amount of physical exertion or emotional stress, lasts only a few minutes, and eases with rest or angina medication.

Unstable angina is more serious. It can occur at rest, is new, or is more frequent, severe, or easily triggered than before, and does not settle predictably with rest. Unstable angina is a medical emergency, because it can mean a heart attack is developing.

The main symptom is chest pain or a feeling of tightness, heaviness, or pressure in the chest. It may spread to the arms, neck, jaw, back, or stomach. Some people also feel breathless, tired, or nauseated.

In stable angina these symptoms come on with exertion and pass with rest. Pain that comes on at rest, lasts more than a few minutes, or does not ease with your usual angina medication should be treated as an emergency.

Angina is usually caused by coronary artery disease, where the arteries supplying the heart are narrowed by fatty deposits, so blood flow cannot increase enough when the heart needs to work harder.

The same factors that cause coronary artery disease raise the risk of angina: smoking, high blood pressure, high cholesterol, diabetes, being overweight, physical inactivity, and a family history of heart disease.

A doctor assesses your symptoms and risk factors and examines you. Tests may include an electrocardiogram (ECG), an exercise (stress) test to see how the heart copes with exertion, and blood tests.

To look directly at the coronary arteries, a CT coronary angiogram or an invasive coronary angiography may be arranged. These show whether and where the arteries are narrowed, which guides treatment.

Treatment has two aims: relieving symptoms and reducing the risk of a heart attack. Medicines are central — including a fast-acting spray or tablet (glyceryl trinitrate) that eases an angina attack, and other medicines that reduce how hard the heart works and protect against clots and further artery narrowing.

Where arteries are significantly narrowed, procedures can restore blood flow: coronary angioplasty and stenting (opening the artery with a balloon and stent) or, for some people, coronary bypass surgery. Alongside this, managing risk factors — stopping smoking, controlling blood pressure, cholesterol, and diabetes, and staying active — is essential.

Many people with stable angina lead full, active lives once it is diagnosed and treated, with symptoms well controlled by medication and lifestyle changes and, where needed, procedures to open the arteries. Because angina reflects underlying heart disease, ongoing care to lower the risk of a heart attack is important.

The best way to prevent angina is to protect the heart's arteries: not smoking, keeping blood pressure and cholesterol controlled, managing diabetes, staying active, eating well, and maintaining a healthy weight.