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Angina

This factsheet is for people who have angina or who want to know more about it. Angina describes the pain and chest tightness, and sometimes breathlessness or choking feeling, caused when blood flow in the arteries that supply the heart is restricted.

Angina is a symptom of coronary heart disease.

Angina pain

An episode of angina pain typically starts when you are doing some sort of physical exercise. It may feel like a heavy weight or a tightening across the upper chest. Angina pain is especially likely to occur when walking after a meal. Anger or stress also tends to makes it worse.

The pain can move to the neck, throat or arms - making you feel that you are choking or that both arms are dead weights. The pain doesn't usually last for more than a few minutes and goes fairly quickly after resting. Indigestion and angina are often confused. As well as the pain, there may be breathlessness, sweatiness and a sense of fear.

Angina affects about one in 50 people. It can often be controlled with a combination of medication and lifestyle changes.

Illustration showing blood supply to the heart

Causes

Angina happens when the heart isn't getting enough blood to supply it with the oxygen and nutrients that it needs. This is usually because the coronary arteries - the vessels that supply the heart with blood - have become furred up with fatty deposits, a process called atherosclerosis (coronary heart disease).

The diagram above shows the blood supply of the heart, including the coronary arteries. Angina tends to happen when extra demands are placed on the heart, such as during physical exertion. This is because the heart needs more oxygen at these times.

Aside from atherosclerosis, other rarer problems can also lead to angina, including:

Types of angina

There are three main types of angina:

Stable angina

Stable angina is associated with coronary heart disease, and is brought on by exertion. In this case, the angina pain usually lasts for only a few minutes. After resting, the pain subsides, but it may return when the effort begins again. This is usually well controlled with medication.

Unstable angina

With unstable angina, the pain comes on after only a little effort (such as just taking a few steps) or even when the person is resting. It is usually the result of a severe narrowing in a coronary artery, and may lead to a heart attack if it isn't treated. If you get sudden chest pain like this, you should call the emergency services and your GP. If your chest pain is coming on with less and less exercise over a relatively short period of time, this is also a cause of concern and you should contact your GP.

Variant angina

This rare type of angina occurs without warning. It is due to spasm of a coronary artery. Your doctor may need to make detailed investigations to diagnose this type of angina. During an attack, there can be irregularities in the heart's normal rhythm.

Heart attack

If a coronary artery becomes completely blocked, the section of heart muscle supplied by that artery will die, unless the blockage is relieved quickly. This is a heart attack (myocardial infarction, or MI), and the pain is more severe and prolonged than angina and is not relieved by usual angina treatment. Someone having a heart attack may also feel sick, breathless and sweaty, and may vomit. Sometimes, however, there are no symptoms at all. If you suspect someone is having a heart attack, call 000.

Who gets angina?

Angina is more common in men than women, and the likelihood of getting it increases as you get older. You're also more prone to getting angina if you:

In some cases angina can run in the family, so if a close relative has had angina, you may be at a greater risk of getting it too.

Diagnosis

If you have developed a pain in the chest, especially if it fits the description at the beginning of this factsheet, you should visit your GP as soon as possible.

Your GP will ask you all about the pain and then examine you. He or she will listen to your heart and chest, check your blood pressure, and look for any signs of anaemia.

Tests

You may also need to have some hospital tests before your doctor can be sure that your symptoms are angina. These can include:

Treatment

The conditions that make angina more likely to occur, such as high blood pressure, will be treated as well as the angina symptoms.

Medicines

Aspirin. A small daily dose of this is often prescribed as it lowers the risk of having a heart attack. However, aspirin increases the risk of stomach problems such as ulcers or indigestion, so it is not suitable for everyone. Ask you GP for more advice about whether you should take aspirin.

Beta-blockers (eg Atenolol, Bisoprolol). These slow the heart rate and the pumping power of the heart. This reduces the hearts demand for oxygen. Beta-blockers aren't suitable for people with asthma.

Glyceryl trinitrate (GTN). This is a short acting nitrate prescribed to provide relief during attacks. It comes as a spray (used in the mouth) or tablets (placed under the tongue) to take when an angina episode starts. It works by relaxing coronary arteries so that more blood can flow through them and reach the heart muscle.

Long-acting nitrates (eg isosorbide mononitrate). These widen the coronary arteries to improve blood flow to the heart. They are available as pills or patches.

Calcium channel blockers (eg nifedipine). These relax the coronary arteries and other blood vessels, and reduce the force of the contraction of the heart.

Potassium channel activators (eg nicorandil). These relax coronary arteries to increase blood flow.

Angioplasty or surgery

For people with angina, surgery or angioplasty may be the best treatment.

Angioplasty (also known as percutaneous coronary intervention or PCI). A collapsed balloon is threaded through the blood vessels until it reaches the arteries of the heart. The balloon is inflated to widen the blocked coronary artery. A stent (flexible mesh tube) is sometimes inserted to help keep the artery open afterwards. This sometimes releases a drug that helps to keep the blood vessel open.

Coronary artery bypass graft (CABG). Vessels from the legs or the chest are used to bypass the blockage. This is open-heart surgery and requires a longer stay in hospital.

Prevention

If you have angina there are several practical steps that you can take to help prevent attacks and help stop it from progressing to more serious forms of coronary heart disease or a heart attack.

Further information

Search for "angina" on healthinsite.gov.au

Sources

The information on this factsheet is intended to be a guide only and is not intended to be nor should be relied on as a substitute for professional medical advice. It is also not intended to be for medical diagnosis or treatment. BUPA Australia makes no warranties or representations regarding the quality, accuracy or completeness of the information. BUPA Australia is not liable to readers of the information for any loss or damage suffered arising out of the use of or reliance on the information, except that which can be excluded by law.