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Health Topics: /Angina (Chest Pain)

What Is Angina?

If you have a feeling of pressure or a squeezing in your chest, it may be angina. It can feel like a heart attack, but often it's a warning sign from your heart.

There's a lot you can do to stop it from happening. Usually, medicine along with lifestyle changes can control angina. If it's more severe, you may need surgery, too. Or you may need a stent, a tiny tube that props open arteries.

The chest pain you feel with angina happens because there isn't enough bloodflowing to part of your heart. It's a symptom of heart disease, and it's caused when something blocks the arteries that bring oxygen-rich blood to your heart.

Angina usually goes away quickly, but it can be a symptom of a life-threatening heart problem. Call your doctor if you have angina. It's important to find out what's going on and to talk about what you can do to avoid a heart attack in the future.

There are different types of angina:

Stable angina is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn't a heart attack, but it's a sign that you're more likely to have one in the future. Tell your doctor if this happens to you.

Unstable angina. It happens while you're at rest or not very active. The pain can be strong and long lasting, and can come back again and again. It can be a signal that you're about to have a heart attack, so see a doctor right away.

Prinzmetal's angina (also called variant angina) is rare. It might happen at night during sleep or while at rest. The heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.

Causes

Angina is usually caused by heart disease. A fatty substance called plaque builds up in the arteries, blocking blood flow to the heart muscle. This forces the heart to work with less oxygen, and that causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.

Other less common causes of chest pain include:

·         A blockage in a major artery of the lungs(pulmonary embolism)

·         An enlarged or thickened heart (hypertrophic cardiomyopathy)

·         Narrowing of the valve in the main part of the heart (aortic stenosis)

·         Swelling of the sac around the heart (pericarditis)

·         Tearing in the wall of the aorta, the largest artery in your body (aortic dissection)

Symptoms

Chest pain is the symptom, but it affects people differently. You may feel:

·         Aching

·         Burning

·         Discomfort

·         Feeling of fullness in the chest

·         Heaviness

·         Pressure

·         Squeezing

You are likely to have pain behind your breastbone, but it can spread to your shoulders, arms, neck, throat, jaw, or back.

It's possible to mistake an aching or burning for heartburn or gas.

Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat or back. You may also have shortness of breath,sweating, or dizziness.

One study found women were more likely to use the words "pressing" or "crushing" to describe the feeling.

Stable angina often gets better with rest. Unstable angina may not -- and could get worse.

Getting a Diagnosis

If you've been having chest pain, it's important to see your doctor, even if it goes away.

Your doctor will want to know:

·         How have you been feeling?

·         Where have you had pain?

·         How strong would you say it was?

·         How long did it last?

·         What were you doing when it started?

·         Did it come back?

·         Have you felt this before?

·         When did you begin having chest pain?

·         Have you ever had a heart attack or heart surgery?

·         Does anyone in your family have heart disease?

·         Do you have any other medical conditions?

Your doctor may recommend these tests:

·         Exercise stress test. You run on a treadmill or pedal a stationary bike while the doctor checks your heart rate, blood pressure, symptoms, and changes in your heart's rhythm.

·         Electrocardiogram (EKG). It measures electrical signals from your heart to show how it's beating. Health workers attach small metal discs or stickers called electrodes to your chest, arms, and legs. With each heartbeat, an electric signal records how it’s working. The test only takes a few minutes, and it's painless. You can get an EKG at a doctor's office or the hospital.

·         Coronary angiography. A thin tube called a catheter is threaded through a large blood vessel, usually one in your groin or wrist. The doctor injects dye through the tube, which travels to the arteries of your heart. As the dye moves, X-rays show how well your blood is flowing. X-rays use low doses of radiation to make images of the heart. You usually get these tests at a hospital and have to schedule it ahead of time. You may get a mild medicine to calm you beforehand.

·         Computed tomography angiography. This test also checks how well blood flows through the arteries to your heart. You'll first get an injection of dye through a vein. Then X-rays are taken from different angles to create a three-dimensional image of your heart. Each scan takes just a few seconds and is painless. It can be done at a hospital or an outpatient clinic.

You may also have blood tests to check for fat, cholesterol, sugar, and proteins that put you at higher risk for heart disease.

·         Questions for Your DoctorDo I need any more tests?

·         What type of angina do I have?

·         Do I have heart damage?

·         What treatment do you recommend?

·         How will it make me feel?

·         What can I do to try to prevent a heart attack?

·         Are there activities I shouldn't do?

·         Will changing my diet help?                                                                                                                                               Angina is a term used for chest pain caused by reduced blood flow to the heart muscle. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Angina is chest pain that occurs when the blood supply to the muscles of the heart is restricted. It usually happens because the arteries supplying the heart become hardened and narrowed.

The pain and discomfort of angina feels like a dull, heavy or tight pain in the chest that can sometimes spread to the left arm, neck, jaw or back.

The pain is usually triggered by physical activity or stress and typically only lasts for a few minutes. This is often referred to as an angina attack.

Read more about the symptoms of angina.

When to seek medical help

Dial 999 to request an ambulance if you experience chest pain and you haven't previously been diagnosed with a heart problem.

If you have an angina attack and you've previously been diagnosed with the condition, take the medication prescribed for you (glyceryl trinitrate). A second dose can be taken after five minutes if the first dose doesn't have any effect. If there's no improvement five minutes after the second dose, call 999 and ask for an ambulance.

Types of angina

The two main types of angina are stable angina and unstable angina.

  • stable angina – where angina attacks are brought on by an obvious trigger (such as exercise) and improve with medication and rest
  • unstable angina – where angina attacks are more unpredictable, occurring with no obvious trigger and continuing despite resting

Stable angina isn't life-threatening on its own. However, it's a serious warning sign that you're at increased risk of developing a life-threatening heart attack or stroke.

Some people develop unstable angina after previously having stable angina, while others experience unstable angina with no history of having angina before.

Unstable angina should be regarded as a medical emergency, because it's a sign that the function of your heart has suddenly and rapidly deteriorated, increasing your risk of having a heart attack or stroke.

Read more about diagnosing angina.

Why angina happens

Most cases of angina are caused by atherosclerosis, which is the hardening and narrowing of arteries as a result of a build-up of fatty substances known as plaques. This can restrict the blood supply to the heart and trigger the symptoms of angina.

Advanced age, smoking, obesity and eating a diet high in saturated fats all increase your risk of developing atherosclerosis.

Read more about the causes of angina.

 

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  • Treatment

    Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine along with lifestyle changes can often help blood flow better and control symptoms.

    Your doctor might prescribe medicines to:

    ·         Widen blood vessels, allowing more blood to flow to the heart

    ·         Slow the heart down so it doesn't have to work as hard

    ·         Relax blood vessels to let more blood flow to the heart

    ·         Prevent blood clots from forming

    If medicines aren't enough to treat your angina, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:

    ·         Angioplasty/stenting. During this procedure, the doctor threads a tiny tube with a balloon inside through a blood vessel and up to your heart. Then he inserts and inflates the balloon inside the narrowed artery to widen it and restore blood flow. A mesh tube called a stent may be left inside the artery to help keep it open. The procedure usually takes less than 2 hours. You will most likely stay overnight at the hospital.

    ·         Coronary artery bypass grafting (CABG), or bypass surgery. The surgeon takes healthy arteries or veins from another part of your body and uses them to bypass the blocked or narrowed blood vessels. You can expect to stay in the hospital about a week after this procedure. You'll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. You'll then move to a regular room to recover.

    Taking Care of Yourself

    You can continue to lead an active life, but it's important that you listen to your body. If you feel pain, stop what you are doing and rest. Know what triggers your angina, like stress or intense exercise. And try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often.

    These lifestyle changes can help protect your heart:

    ·         Stop smoking. It can damage your blood vessels and increase your heart disease risk.

    ·         Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. If those are out of normal range, it can raise your chance for heart disease. Eat mainlyfruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.

    ·         Use stress-relieving measures likemeditation, deep breathing, or yoga to relax.

    ·         Exercise most days of the week.

    ·         See your doctor regularly.

    If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Don't wait. Quick treatment is very important. It can protect you from more damage.

    What to Expect

    Angina raises your risk of having a heart attack. But it is treatable. Consider it a warning sign and make smart choices for yourself.

    Talking with others who also have it may help you gain insights and tips to help you feel better.

    Your family, too, may need support to help them understand your angina. They'll want to know what they can do to help.

     

    Treating angina

    Treatment for angina aims to relieve the symptoms during an angina attack, reduce the number of angina attacks that a person has, and reduce the risk of a heart attack or stroke happening.

    A number of medications can be used to try to achieve this. Some of these are only taken when needed, while others are taken every day.

    Surgery to widen or bypass the narrowed arteries may be recommended if the symptoms don't respond to medication.

    Read more about treating angina.

    Complications

    A major concern for people with angina is that their atherosclerosis will continue to get worse. This can lead to the blood supply to their heart becoming blocked, which could trigger a heart attack. Similarly, a blockage of the blood supply to the brain could trigger a stroke.

    Each year it's estimated that 1 in every 100 people with stable angina will have a fatal heart attack or stroke, and as many as 1 in 40 people will have a non-fatal heart attack or stroke.

    You can considerably reduce your risk of developing these complications by making lifestyle changes. For example, if you're obese and you smoke, you can significantly reduce your risk by stopping smoking and maintaining a healthy weight.

  • Complications of angina 

    Heart attacks and strokes are the most serious complications of angina.

    The stress of living with a long-term condition can also have an impact on your emotional health.

    Heart attack

    Most cases of angina are caused by fatty deposits (plaques) building up on the inside walls of the blood vessels leading to the heart.

    There's a small chance one of the plaques will break away, causing a blood clot to form. The blood clot can then block the supply of oxygen-rich blood to the muscles of the heart, causing extensive damage to the heart muscles and triggering a heart attack.

    The risk of having a heart attack depends on a number of things, such as age, blood pressure and the extent of the blockage.

    Depending on these factors, the risk of having a heart attack in any given year can range from less than 1 in 100 to 1 in 12. It's always possible to lower this risk by making lifestyle changes (see preventing angina for more information).

    Symptoms of a heart attack include:

    • chest pain – the pain is usually in the centre of your chest and can feel like a sensation of pressure, tightness or squeezing
    • pain in other parts of your body – it can feel as if the pain is travelling from your chest to your arm (usually the left arm, but it can affect both arms), jaw, neck, back and abdomen
    • shortness of breath 
    • nausea 
    • an overwhelming sense of anxiety (similar to having a panic attack)

    You should dial 999 immediately if you suspect a heart attack.

    Heart attacks are treated using a combination of medication to improve the blood flow to the heart and surgery to bypass the blockage (coronary artery bypass graft) or widen the artery (percutaneous coronary intervention).

    Stroke

    If you have fatty plaques clogging up the arteries to your heart, you may also have plaques clogging up the main blood vessel that supplies your brain with blood (the carotid artery).

    If one of the plaques ruptures, it could cause a blood clot to develop, blocking the supply of blood to your brain and triggering a stroke.

    As with a heart attack, you can reduce your risk of having a stroke by making lifestyle changes.

    The main symptoms of a stroke can be remembered using the word FAST, which stands for Face-Arms-Speech-Time.

    • Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have drooped
    • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
    • Speech – the person’s speech may be slurred or garbled, or the person may not be able to talk at all, despite appearing to be awake
    • Time – it's time to dial 999 immediately if you notice any of these signs or symptoms

    A stroke can be treated using medication to dissolve the blood clot, and surgery to unblock the carotid artery.

    Stress, anxiety and depression

    Living with a condition such as angina can cause feelings of stress and anxiety in some people, which can lead to symptoms of depression. You may be feeling depressed if, during the last month:

    • you have often felt down, depressed or hopeless
    • you have little interest or pleasure in doing things

    • Preventing angina 

      Having a healthy lifestyle is the most effective way of reducing your risk of angina.

      If you already have angina, making lifestyle changes also helps prevent your symptoms getting worse and reduces your risk of having a heart attack or stroke.

      The best way to achieve this is to eat a healthy, balanced diet, try to keep your blood pressure at a healthy level, and avoid smoking. This will lower your blood pressure, reduce your cholesterol levels and strengthen your heart.

      Healthy diet

      An unhealthy diet high in saturated fat and salt increases your risk of developing angina, and increases your risk of a heart attack or stroke.

      A diet that includes plenty of fruit and vegetables and lots of fibre, such as wholegrain rice, bread and pasta, can help reduce this risk.

      Fruit and vegetables are full of vitamins, minerals and fibre, and help keep your body in good condition. You should aim to eat five 80g portions of fruit and vegetables every day.

      Read more about good food, healthy eating and getting your 5 A DAY.

      Cutting down on saturated fat

      Eating high-fat foods can cause fatty plaques to build up in your arteries. You can help prevent this by avoiding foods that contain saturated fats.

      Foods high in saturated fat include:

      • meat pies
      • sausages and fatty cuts of meat
      • butter
      • ghee – a type of butter often used in Indian cooking
      • lard
      • cream
      • hard cheese
      • cakes and biscuits
      • food that contains coconut or palm oil

      Eating a small amount of unsaturated fat increases the level of good cholesterol and helps reduce any blockage in your arteries. Foods high in unsaturated fat include:

      • oily fish
      • avocados
      • nuts and seeds
      • sunflower, rapeseed and olive oil

      For more information, see facts about fat and eat less saturated fat.

      Cutting down on salt

      You should also cut down on the amount of salt in your food, as it can raise your blood pressure.

      You should aim to eat less than 6g (0.2oz) of salt a day, which is about a teaspoonful. For more information, see tips for a lower-salt diet.

      Stopping smoking

      Smoking can significantly increase your risk of both heart attacks and strokes, as it causes your arteries to narrow and raises your blood pressure.

      If you decide to stop smoking, your GP can refer you to the NHS Smokefree service, which provides you with dedicated help and advice about the best ways to give up smoking.

      You can also call the Smokefree National Helpline on 0300 123 1044. The specially trained helpline staff will offer you free expert advice and encouragement.

      If you're committed to giving up smoking but don't want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up.

      Read more about stopping smoking and stop smoking treatments.

      Reducing your alcohol consumption

      Regularly drinking alcohol above the maximum recommended limits can raise your blood pressure.

      Alcohol is also high in calories, so you'll gain weight if you drink regularly, which can further increase your blood pressure.

      Staying within the recommended levels is the best way to reduce your risk of developing high blood pressure:

      • men and women are advised not to regularly drink more than 14 units a week
      • spread your drinking over three days or more if you drink as much as 14 units a week

      Read more about alcohol units and tips on cutting down on alcohol.

      Maintaining a healthy weight

      Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure. Find out if you need to lose weight with the BMI healthy weight calculator.

      If you do need to lose weight, it's worth remembering that just losing a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely.

      Exercising

      Being active and taking regular exercise helps keep your heart and blood vessels in good condition. Regular exercise can also help you lose weight and lower your blood pressure.

      Starting an exercise programme when you have angina can be challenging as physical activity may trigger the symptoms of an angina attack. But the more you exercise, the less likely it is you'll have an angina attack.

      Low-impact activities, such as walking, swimming and cycling, are recommended, whereas more strenuous activities, such as playing football and squash, should be avoided.

      Find out about walking for health, swimming for fitness, and the benefits of cycling.


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