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Angina is a chest pain - an uncomfortable feeling in the chest that is usually brought on by exercise or emotional upset. For some people it is hardly a pain at all, but for others severe. Angina is a built-in warning device that your heart is trying to do too much and that you must rest. Also called angina pectoris. Many people wrongly imagine that angina and related heart disease affect men only. One in four women die through heart disease.
Angina is most often caused by the gradual narrowing of the arteries of the heart by materials being deposited in their walls. Over many years these deposits increase until their size restricts the flow of blood. When a person is at rest and their heart is beating at its normal resting rate, sufficient blood passes into each heart muscle. Under exercise or strong emotion the heart is put under strain and must beat faster, and blood pressure may rise. People in good health and/or training for sports can cope. For others, considerably increased exercise means the flow of blood and the oxygen it carries are not sufficient to meet the increased demand of the heart muscles, which then cannot function properly, producing angina.
The commonest complaint is an uncomfortable feeling of a heaviness or tightness in the middle of the chest. The pain may spread to the left shoulder, left arm and hand; neck, throat, jaw, back and/or stomach. The patient may be short of breath, and/or feel weak and/or anxious.

Angina may take either of two forms.

  • Stable angina occurs with exercise, or emotional upset and subsides after a few minutes rest. Stable angina is more likely when walking quickly, walking uphill, when carrying a heavy weight, or when you are upset.
  • Unstable angina is unrelated to exercise - unpredictable, coming and going even when the patient is resting. It is much more serious than stable angina. A clot, called a thrombus, may have formed, eg plaque in a coronary artery partially or completely blocking it - an acute life-threatening event. Most people do not realise the severity and that it might lead to death. Unstable angina is more common than breast cancer, or than multiple sclerosis.

Both forms of angina typically produce similar chest pain as above. The difference is that stable angina responds immediately to a few minutes rest and there is no lasting damage done to the heart muscle.
what to do
Anyone who unexpectedly gets such pain or symptoms should rest immediately; and call an ambulance if either:
  • it is not stable angina; or
  • if both it is stable angina that the patient has had before and understands, and it does not respond within a few minutes to rest.

If you have had angina before, you may have glyceryl trinitrate GTN - the commonest drug for angina. It is usually sucked as a tablet or sprayed under the tongue, and can stop an angina attack quickly. You should always carry your GTN and use it if you think an attack is likely to come on.

If you get angina pain, stop whatever you are doing, sit down, and spray under your tongue. If that first GTN does not relieve the pain, after 5 minutes you should repeat the dose, and again at 10 minutes. If you still have angina pain after 15 minutes, ask someone to take you to a hospital A&E, or dial 999 or 112.

Both tablets and spray can be bought without prescription. Tablets keep eight weeks. A spray canister holds 200 doses and keeps three years.

further treatment
A doctor can usually diagnose angina from what you say the pain feels like, where it is, and what brings it on. Other tests may be needed - an electrocardiograph ECG while doing an exercise stress test on a treadmill; coronary angiography; checking a blood sample for cholesterol and other substances; and a monitor that can be worn for a day or a week.
In some people, having the following correct is enough: not overweight, not excess alcohol or any drugs, blood pressure, cholesterol levels, regular exercise, avoiding stress, knowing how to relax, not smoking, and diet - particularly avoiding saturated fats.

Those who have had a heart condition usually should take low-dose 75mg aspirin to reduce the stickiness of the blood, so decreasing the chance of a clot, heart attack, or stroke. Aspirin should be taken at bedtime not in the morning to fit the body's 24-hour rhythm. In about 2% to 4% of patients aspirin causes stomach or digestive pain, and their doctor may change them to some other drug - eg clopidogrel, an antiplatelet drug. They may also need drugs that improve blood flow, lower cholesterol, and/or limit the work on the heart. People who have not had a heart condition should not take low-dose aspirin - it doesn't help. Contact your doctor if your angina attacks become more frequent or more severe - especially important if your angina develops at rest or on minimal exertion, or if GTN seems to become less effective.

Supported as a service to patient care by A.Menarini Pharma UK SRL who reviewed content. Editorial control remained entirely with The British Cardiac Patients Association. Copyright © 2010 British Cardiac Patients Association;