Angina symptoms, emergency signs, diagnosis and treatment guidance.

Overview

What is angina?

• Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle
• Angina may feel like pressure, heaviness, squeezing, tightness or burning in the chest
• Some people may also feel pain in the arm, neck, jaw, shoulder or back

What causes angina?

The most common cause of angina is coronary heart disease (CHD). In CHD, fatty deposits called plaque build-up inside the blood vessels supplying the heart. When these blood vessels become narrowed, by about 75% or more, blood flow and oxygen supply to the heart muscle reduce, causing chest pain or discomfort.

Other causes of angina include:

• Coronary microvascular disease: Damage to the small blood vessels of the heart
• Coronary artery spasm: Sudden tightening of the blood vessels supplying the heart, which temporarily reduces blood flow to the heart

How common is angina in the Indian scenario?

• Heart disease is one of the leading causes of death in India
• Indian studies show that angina and coronary artery disease are increasing in both urban and rural populations
• A large Indian study reported angina symptoms in around 4.7% of men and 7% of women aged 45 years and older

Why is it important?

Angina can be an early warning sign of a heart attack.

Who is at risk of angina?

Risk of angina is higher in people with:

• High blood pressure
• Diabetes
• High cholesterol
• Smoking or tobacco use
• Obesity
• Stress
• Lack of exercise
• Family history of heart disease
• Older age
• Severe anaemia
• Existing heart conditions

Signs and symptoms

Angina usually feels like pressure, tightness, heaviness or squeezing in the chest. The discomfort may also spread to the:

• Jaw
• Neck
• Shoulders
• Arms
• Back
• Stomach

Some people may also feel:

• Breathless
• Tired
• Dizzy
• Sweaty
• Sick or nauseous

How will you know if the pain is angina?

Angina pain often happens when the heart is working harder, such as during:

• Physical activity or exercise
• Emotional stress
• Cold weather
• After a heavy meal

The pain usually improves with rest or medicines.

Chest pain can also happen due to other causes such as:

• Acidity or indigestion
• Muscle or chest injury
• Anxiety or panic attacks
• Swelling around the ribs

What are the types of angina?

The two main types of angina are:

• Stable angina
• Chest pain or discomfort that usually happens during physical activity, stress or exercise, when the heart works harder
• Symptoms usually last for 5 minutes or less
• Pain often improves with rest or medicines
• Stable angina is usually managed with medicines, lifestyle changes and planned procedures if needed
• Unstable angina
• Chest pain or discomfort that can happen even while resting
• Symptoms may occur suddenly and are not always triggered by activity
• Pain may last longer for ~15 minutes or more, feel more severe and may not improve with rest or medicines
• Some people with stable angina may progress to unstable angina
• Unstable angina needs urgent medical attention and may require hospital treatment or emergency procedures to restore blood flow to the heart.

Tests to diagnose angina

Doctor may check:

• Blood pressure
• Weight and waist size
• Cholesterol and blood sugar levels through blood tests

Other tests include:

• Electrocardiogram (ECG): Checks the heart's electrical activity
• Echocardiogram: Ultrasound scan to look at the heart
• Stress test: Checks how the heart works during exercise or stress
• Coronary angiogram: Looks for narrowing or blockage in the heart blood vessels
• Blood tests: Help rule out heart attack or other conditions

Treatment of angina

Treatment helps relieve chest pain, improve blood flow to the heart and reduce the risk of heart attack or stroke.

Medicines

Most people with angina need daily medicines. These may help to:

• Relieve chest pain
• Prevent angina symptoms
• Protect the heart

What is GTN?

GTN (glyceryl trinitrate) is a medicine used for quick relief from angina pain. It works by widening the blood vessels, helping more blood reach the heart.

GTN may be given as:

• A mouth spray
• Tablets placed under the tongue
• A skin patch

Other medicines

The doctor may prescribe medicines such as:

• Beta blockers: Help the heart beat slower and reduce strain on the heart
• Calcium channel blockers: Relax blood vessels and improve blood flow to the heart
• Other medicines may also be used if symptoms continue

Procedures or surgery

Some people may need:

• Coronary angioplasty and stenting: Opens blocked heart blood vessels
• Coronary artery bypass surgery (CABG): Creates a new path for blood flow around blocked blood vessels

What happens during angioplasty and stenting?

• A small balloon is passed through a blood vessel to open the narrowed heart blood vessel.
• A small tube called a stent is placed to keep the blood vessel open and improve blood flow to the heart.

What happens during bypass surgery?

• A healthy blood vessel from another part of the body is used to create a new path for blood flow around the blocked heart blood vessel.
• This helps improve blood and oxygen supply to the heart muscle.

Lifestyle changes to manage angina

Lifestyle changes that help manage angina include:

• Maintaining a healthy weight
• Controlling blood pressure, cholesterol and blood sugar levels
• Eating a healthy, balanced diet
• Stopping smoking and avoid tobacco products
• Limiting alcohol intake
• Staying physically active as advised by the doctor and based on the type of angina

Myths and facts

FAQs