Angina is a fancy term for a symptom of chest discomfort (rather than necessarily pain) which comes from the heart. This means that if a patient has no symptoms then they don’t have angina. In its severest form angina can lead to a heart attack.
Angina is caused because the supply of blood does not quite meet the requirements of the heart muscle and therefore the heart muscle does not get as much oxygen as it needs. This can be because of a variety of reasons, but most often due to the furring up and narrowing of blood vessels which supply the heart muscle. These are called coronary arteries. We all have 3 coronary arteries. They are called the left anterior descending artery (LAD), left circumflex (LCx) and right coronary artery (RCA). Flow limiting disease in any one or more of these arteries will cause angina.
When the heart is doing a lot more work, it needs more blood i.e. on exercise. Due to the narrowing in the coronary arteries, the blood cannot get through quickly enough. The heart starts aching which is manifested as a discomfort across the chest.
Angina in its early stage occurs during exertion/exercise and gets better with rest. This is termed stable angina. The heart aches more when it needs more blood. Angina may often be associated with breathlessness. The typical scenario is that a patient who can normally walk unrestricted may start noticing a heaviness or pressure or constriction around the chest which may radiate to the neck, arms or back after walking a certain distance especially in cold weather or up inclines. When the patient slows down or stops for a few minutes, the symptoms resolve. When the patient then restarts the exercise, they may experience the same symptoms after a few minutes. Eventually, the symptoms gradually get worse if ignored. The person’s exercise capacity becomes less and less to the point that the patient may start getting the discomfort even at rest. Rest pain, also termed unstable angina, suggests that the obstruction is extremely severe and immediate medical attention is necessary.
Risk factors for coronary disease which then causes angina include high blood pressure, a history of heavy smoking, high cholesterol, excessive weight (especially truncal obesity), diabetes, advanced age (>50 years) and a strong family history.
Angina can be a blessing as it is essentially a warning that alerts the patient that there may be a problem which can then allow the patient to seek help and get matters addressed. The more dangerous heart attacks occur out of the blue with no warning.
If you think you are suffering from stable angina (occurs only on exertion and improves with rest), stop doing any physical activity, see your GP immediately and ask to be referred to a cardiologist urgently. The GP should start you on some medications whilst you are waiting to see a cardiologist. Treatment for angina includes Aspirin to thin the blood, so that it passes through the heart easier. Aspirin reduces the coaguability of blood platelets which could form clot around the narrowed areas and make the situation worse. The GP should also provide you with a glyceryl trinitrate spray. The GTN spray transiently opens the vessels relieving any chest discomfort. This is to be used whenever discomfort is experienced and can be life-saving in certain situations. The GTN spray can open up the blood vessels in the head and therefore cause a headache and many patients avoid using the spray. I always recommend that the spray should be used if the discomfort does not go away with rest.
Other medications which help with angina are beta-blockers if there are no contraindications (such as asthma). Beta blockers reduce the heart rate and therefore reduce the requirements for blood by making the heart muscle work less hard.
Finally the doctor should prescribe a cholesterol lowering agent (Statin) even if your cholesterol levels are normal. Long term studies have shown that statins reduce progression of coronary artery narrowings and prolong life.
If you think you are suffering from unstable angina (angina at rest), use the GTN spray, call an ambulance and go to your local emergency department immediately. Do not wait to go and see your GP the next day. Many people choose to wait till the next day to avoid causing bother. This is a mistake. Chest pain means that the heart is suffocating without oxygen rich blood. The longer it is left unfixed, the more likelihood of permanent damage to the heart and possibly a heart attack and even death.
I'm Dr Sanjay Gupta, a Consultant Cardiologist with specialist interest in Cardiac Imaging at York Teaching Hospital in York, UK. I believe that high quality reliable jargon-free information about health should be available at no cost to everyone in the world.