Angina

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.

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.

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.

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.

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.

Read more about the complications of angina and preventing angina.

Who's affected by angina

Angina is a common condition among older adults.

In England, it's estimated that 1 in every 12 men and 1 in every 30 women between 55 and 64 years of age have angina. This figure rises to 1 in every 7 men and 1 in every 12 women who are over 65 years of age.

Angina is more common in men than women.