Angina and Chest Pain

Angina is the symptom that is caused by narrowing of the coronary arteries. Angina is usually felt as heaviness or dull ache in the chest, arms or throat and is usually brought on by exertion or emotional upset. Symptoms however be very variable and not everyone is the same; for example some may just get angina just in the arm or in the jaw. The symptoms usually are relieved by rest within  a few minutes. Doctors and nurses often will ask about 'chest pain', by which they mean any discomfort as described here as well as more severe pains. Brief stabbing pains in the chest are very rarely angina.

Angina that is predictable and comes on at certain times is known as stable angina. Stable angina needs appropriate investigation and treatment described below. Symptoms that then become more frequent or start earlier during exercise may need additional investigation or treatment and you should see your doctor.

Angina that comes on at rest or lasts for more than 10 - 15 minutes may be unstable angina or possibly a heart attack (myocardial infarction), requiring urgent medical attention. These may also be called an 'acute coronary syndrome'.


What causes angina?

Angina is a symptom resulting from problems with the blood supply to the heart muscle. The heart muscle is supplied with blood carrying oxygen and nutrients by the coronary arteries. These arteries can be furred up by a process called atherosclerosis, where atheroma or fatty deposits line the wall of the arteries, and calcium deposits often follow. When at rest the heart muscle does not have much work to do and can cope, but on when exercising the heart muscle has to work harder and needs more blood - the narrowing can prevent the blood flow from increasing, leading  to angina, telling the body to rest and allowing the heart to recover.



What causes coronary artery disease?

Coronary artery disease or atherosclerosis is mainly a build up of cholesterol within the lining of the coronary arteries. This is more likely to occur with:

Diabetes
High blood pressure
High cholesterol levels
Smoking
Obesity or being overweight
A family history of coronary heart disease


What investigations might be needed to diagnose angina?

Your doctor may feel that the diagnosis is of angina from your symptoms. He will listen to your heart and lungs, though very often there will be nothing unusual to here. Tests will be done to look at risk factors such as cholesterol and sugar levels. More specific tests to make the diagnosis are:

Resting ECG and exercise ECG
Stress echocardiography
Coronary angiography
CT angiography



How is angina treated?

Angina treatment varies depends on the severity of the symptoms and the degree of coronary artery disease, though all patients should make appropriate lifestyle modifications (a healthy diet, weight loss where appropriate, not smoking and regular exercise).



 - Medications for angina

Medications are often prescribed to help with symptoms, to protect the heart and reduce the risk of heart attacks. Commonly used medications are:

  • Nitroglycerin (GTN): this comes in spray or tablet form to pop under the tongue during symptoms to settle then quickly by dilating or relaxing the arteries of the heart to improve blood flow and relieve angina attacks
     
  • Aspirin: this thins the blood slightly to reduce the risk of blood clots
     
  • Isosorbide mononitrate: this is a longer acting version of GTN, taken in table form daily, which can improve angina and reduce the frequency of angina attacks. These can be in the form of tablets or patches and are very effective. Their main side effect is headache, but this often disappears once the nitrate has been taken for a few days.
     
  • Beta-blockers: these work by slowing down the heart rate and prevent the heart from over working.
     
  • Calcium channel blockers: these relax the arteries and improve blood flow, helping with angina
     
  • Nicorandil: similar to nitrates
     
  • Ivabradine: this is a relatively new medication, which slows the heart down and stops it overworking. It is a little like beta-blockers and can be used instead of them in those who cannot take beta-blockers


 
 - Angioplasty and stent implantation

In this procedure the arteries are stretched and metal coil called a stent expanded into the artery to keep it open. For more see 'Angioplasty and stent insertion'.


 - Coronary Artery Bypass Graft (CABG) surgery

Coronary artery narrowing or blockages are bypassed with a section of vein taken from the leg or using arteries from behind the breast bone or from the forearm. See under 'Procedures'.

Please note:

Every effort has been made to ensure that the information on this website is up-to-date and accurate. However, it is intended to serve as a guide only. Symptoms may vary and if you have any medical concerns you should always consult a healthcare professional