Angina

What Causes Angina?

Angina normally happens because your arteries are narrowed, this is called atherosclerosis. The narrowing means that there is less blood and oxygen getting to your heart muscle. Your heart tries to improve the blood supply by beating harder and faster. This causes you discomfort and is a sign that your heart needs to rest.

Signs and Symptoms

You may have some of the following:

• Tightness, squeezing, pressure or ache in the chest
• Chest pain similar to indigestion
• Sudden breathing difficulty (sometimes)
• Chest pain that radiates to the jaw, teeth or earlobes
• Heaviness, numbness, tingling or ache in the chest, arm, shoulder, elbow or hand usually on the left side
• Pain between the shoulder blades.

If you are experiencing any of these signs and symptoms please discuss them with your doctor or nurse.

Are you experiencing chest pain now?

Check out the Angina Action Plan (PDF 529kb) for information on what you should do.

How is Angina Diagnosed?

Your doctor may know if you have angina simply by listening to the description of your symptoms.

An ECG may confirm your diagnosis of angina. However, you may have a normal ECG but still have angina. An 'exercise' ECG is another way to diagnose the condition. If you are not able to walk well enough to do this test you may be given a stress echo. An angiography (or cardiac catheter) may also help confirm that you have angina.

How is Angina Treated?

Treatments for angina include lifestyle changes, medication and medical procedures.
The main goals of treatment are to:

• Reduce pain and discomfort and how often it occurs
• Prevent or lower the risk of heart attack and death by treating what’s causing your angina.

Lifestyle changes and medicines may be the only treatments required if your symptoms are mild and aren't getting worse. When lifestyle changes and medicines don't control angina, you may need medical procedures and cardiac rehabilitation.
Unstable angina (pain when resting) is an emergency condition that requires treatment in the hospital.

Medical Procedures

When medicines and other treatments don't control angina, you may need a medical procedure to treat the heart condition causing your angina. Angioplasty and coronary artery bypass grafting surgery (CABG) are both commonly used to treat angina.

Your doctor will help decide which treatment is right for you.

Medicine to treat Angina

Nitrates are the most commonly used medicines to treat angina. They relax and widen blood vessels.  This allows more blood to flow to the heart while reducing its workload.

• GTN is the most commonly used nitrate for angina. GTN (tablet and spray form) dissolves under your tongue or between your cheeks and gum and is used to relieve an angina episode.
• Nitroglycerin (pills and skin patches) is used to prevent attacks of angina.

These forms of nitroglycerin act too slowly to relieve pain during an angina attack.

You also may need other medicines to treat angina.  These may include beta blockers, calcium channel blockers and anticoagulants and can help to:

• Lower blood pressure and cholesterol levels
• Slow the heart rate
• Relax blood vessels
• Reduce strain on the heart
• Prevent blood clots from forming.

What Can I Do To Control My Angina?

Making lifestyle changes can help prevent episodes of angina.
You can:

• Slow down or take rest breaks if angina comes on with exertion
• Avoid large meals and rich foods that leave you feeling very full especially if angina comes on after a heavy meal
• Try to avoid situations that make you upset or stressed if angina comes on with stress
• Learn ways to handle stress that can't be avoided
• You also can make lifestyle changes that help lower your risk of heart disease. An important lifestyle change is adopting a healthy diet
• Making lifestyle changes will also will help prevent or reduce high blood pressure and high cholesterol.

More information on lifestyle changes.

Are You Having An Angina Attack?

Plan of action

This sequence of events is advised by the Heart Foundation:

If you think you are having angina or a heart attack:

1. Stop what you are doing and sit down and rest

 If your doctor has prescribed you an angina (nitrate) spray or tablets, then,

• If the pain or symptoms persist after resting for 1-2 minutes, take 1 puff of your nitrate spray or half to 1 tablet
• Wait 5 minutes
• If the pain or symptoms are relieved by rest, or by your nitrate spray or tablet, you may resume activity gently
• If the pain or symptoms persists, repeat the dose and wait for 5 minutes.

If the pain or symptoms are not relieved after 2 doses or with resting for 10 minutes, call an ambulance.

Dial 111 immediately requesting an ambulance. Tell them you are having a possible heart attack.