Is it angina or a heart attack? Angina symptoms like chest tightness or discomfort are very similar to warning signs of a heart attack. Find out why the symptoms are so similar and learn what to do when you experience angina.
Angina happens when your heart isn't getting enough blood, usually because of narrowed coronary arteries. Your heart may try to improve its blood supply by beating harder and faster. This causes symptoms of angina and is a sign that your heart needs to rest.
The key difference between angina and a heart attack is that angina is the result of narrowed (rather than blocked) coronary arteries. This is why, unlike a heart attack, angina does not cause permanent heart damage.
Some people experience episodes of angina before having a heart attack and may continue to experience it afterwards. Other people never experience angina before or after a heart attack.
Symptoms of angina
Angina symptoms differ from person to person, but can include:
- Discomfort, heaviness or tightness of the chest which may spread to the back, shoulders, neck or jaw. Other people describe it as a dull ache
- Discomfort in the arm, neck or jaw with no chest discomfort
- The discomfort can range from mild or dull to severe.
If you haven't been diagnosed with angina but you're experiencing any of the above symptoms, you may be having a heart attack. Stop what you are doing and call 111 now.
If you have been diagnosed with angina, when you experience angina or heart attack symptoms you should follow your angina action plan.
Angina action plan
Chest pain, discomfort or tightness can be a symptom of both angina and a heart attack.
If it is angina, it should ease after a few minutes of resting or taking medication prescribed by your doctor such as GTN (glyceryl trinitrate). If you are experiencing a heart attack, the symptoms are unlikely to ease after a few minutes of resting or taking medication.
If you have angina use our action plan to find out what to do when you have symptoms of angina and when to call 111. Download a copy of the angina action plan.
Step 1: Angina symptoms start
- If you’re having angina symptoms, stop what you’re doing and rest now.
- Tell someone how you’re feeling.
- Take one puff of your GTN spray, or one tablet under your tongue.
Step 2: Wait five minutes
- If you still have symptoms after five minutes, take one more puff of your GTN spray, or one more tablet under your tongue.
Step 3: Wait another five minutes
- If you still have symptoms after another five minutes, treat it as a heart attack. Dial 111 and ask for an ambulance.
- Chew an aspirin if advised by a paramedic.
If your symptoms go away, you can carry on with your activities gently.
Important: If your angina becomes more frequent, severe, lasts longer or happens when you’re doing very little or resting, see your doctor in the next 24 hours.
What causes angina?
Angina is usually caused by coronary artery disease (also called atherosclerosis), which is the build-up of plaque in the walls of your arteries. This build-up can narrow one or more of the coronary arteries that feed blood to your heart and makes it harder for your heart to pump blood around your body.
One of the most important things you can do is learn what triggers your angina and plan how to cope with your triggers. For example:
- 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, and learn ways to handle stress that can't be avoided
Tests to identify angina
An exercise tolerance test is the most common test used to check if you have angina.
You may also be asked to have coronary angiography, which produces x-ray pictures of your arteries.
After being diagnosed with angina, you will be given an action plan to follow for when you experience symptoms.
How to treat angina
There are treatments that can be used to help control angina long-term. These include:
- Opening up your arteries with a special balloon and stent (angioplasty)
- Making a new way for blood to flow around a blocked artery (heart bypass surgery)
- Medications to help prevent further angina episodes.
Living with angina is not just about managing the symptoms. You have an important role to play in your health, and can make choices today to improve your heart health.
Managing episodes of angina
You may notice patterns in your angina episodes. Commonly, symptoms start when you are active, cold, worried or angry. When you know what your triggers are, you can take steps to prevent episodes. For example, if you find that you are more likely to experience angina when you are cold, you can put an extra layer of clothing on before heading outside in Winter. Or if physical exertion is a trigger for you, you can make sure you take your GTN spray with you when you are planning to do some exercise.
Stable and unstable angina
Stable angina is when you get angina symptoms during moderate physical activity or when you are pushing yourself physically. These symptoms go away with rest and/or medication.
Unstable angina is when you get angina symptoms while doing very little or resting. This can happen to people who have never experienced angina before.
Stable angina can become unstable.
If your angina becomes more frequent, severe, lasts longer or happens when you are doing very little or resting, see your doctor in the next 24 hours. You may need further tests or treatment.
The coronary arteries supply blood to your heart muscle by routing it through a network of smaller blood vessels. When a blood flow problem occurs in one or more of the smaller blood vessels supplying blood to your heart, it is called microvascular angina, cardiac syndrome X, or coronary microvascular dysfunction.
Because of the reduced size of the blood vessels, it's likely you will be advised to start a combination of medication and lifestyle changes rather than offered a stent or heart bypass surgery.
Women seem to be more likely than men to experience microvascular angina. The reasons for this have not yet been confirmed
Angina is a symptom of coronary artery disease or atherosclerosis. This is a process that is accelerated by a number of factors including unhealthy lifestyle choices such as smoking, poor diet, being overweight, physical inactivity and poor mental health and wellbeing.
Making changes to your risk factors can slow or stop the damage to your arteries and lower your risk of having another heart attack.
- If you smoke, quit smoking
- Take your medications as prescribed
- Make heart healthy eating and drinking choices
- Move more
- If you are overweight, lose weight