Angina

Angina is chest pain or discomfort and is a common symptom of heart disease. Knowing what it feels like, what triggers it, how it’s treated and how it’s different from a heart attack can help you manage your symptoms and protect your heart.

What is angina?

Angina is a type of chest pain or discomfort that happens when your heart isn’t getting enough oxygen-rich blood. This usually happens when the coronary arteries, which are blood vessels that carry blood to your heart, become narrowed (smaller inside) or partly blocked.

Angina is a sign of heart disease.

Angina stages

Types of angina

Stable angina

Stable angina is the most common type. It’s often triggered by things like physical activity, stress, cold weather or a large meal. It usually lasts less than five minutes and improves with rest and/or medication.

Stable angina can become unstable angina if your symptoms change or worsen.

Unstable angina

Unstable angina is when your angina happens suddenly at rest or with little activity. It can feel different to your normal symptoms.

See your doctor within 24 hours if your angina goes away with medication but you've noticed it:

• happens more often
• is worse
• lasts longer
• happens at rest or when doing very little.

If your angina doesn't go away after following the angina action plan, call 111 immediately.

Unstable angina can also affect people who've never had angina before. If you haven't had angina before and have chest pain or discomfort, call 111 immediately.

Microvascular angina

Microvascular angina is also known as cardiac syndrome X. This type of angina is caused by problems in the small blood vessels that supply the heart. It's more common in women and can happen at rest or with activity.

Vasospastic angina

Vasospastic angina is a rare type of angina caused by a spasm (sudden tightening) in the coronary arteries. It is also called:

• variant angina
• Prinzmetal angina
• vasospasm.

What causes angina?

The most common cause of angina is coronary artery disease (atherosclerosis). This happens when plaque (fatty material) builds up in your arteries, causing them to narrow and stiffen. This makes it harder for blood to reach your heart.

What are the symptoms of angina?

Angina can feel different for everyone.

It can feel like:

• pressure, tightness, discomfort or pain in your chest
• pain or discomfort that spreads to your arms, back, shoulders, neck or jaw
• pain in your neck, jaw or arms, without chest pain.

The pain can range from a dull ache to very strong.

You may also feel short of breath, tired, sweaty or nauseous (sick).

Important: If you haven’t been diagnosed with angina and you have any of these symptoms, you could be having a heart attack. Stop what you’re doing and call 111 now.

What should I do during an angina attack?

If you’ve been diagnosed with angina, follow the steps in your angina action plan:

Chest pain, discomfort or tightness can be a symptom of angina or a heart attack. If it's angina, it should ease within a few minutes of resting or using your GTN spray.

Important: If your angina happens more often, is worse, lasts longer or happens at rest or when doing very little, see your doctor within 24 hours.

Download an angina action plan here.

What triggers angina?

You may not be able to stop angina attacks completely, but knowing your triggers and how to manage them can help.

Angina symptoms often start when your heart needs more oxygen, such as when you're:

• physically active
• stressed, upset or angry
• in cold weather
• smoking
• eating a large meal.

Sometimes angina happens without a clear trigger.

Knowing your triggers

Knowing what brings on your angina can help you manage it. For example:

• take rest breaks or slow down if activity causes chest pain
• plan activities to avoid triggers
• eat smaller meals if large meals are a trigger
• find ways to manage stress, and ask for support if it's hard to avoid.

You may not be able to avoid all triggers, but spotting patterns can help you find ways to reduce how often you get angina.

The most important way of staying symptom-free is taking your prescribed medicines and following your doctor's advice.

Make sure you keep your GTN spray with you at all times.

How is angina diagnosed?

The most common test for angina is an exercise tolerance test. It checks how your heart responds to physical activity.

Other forms of tests may also be done, including a stress echo and nuclear stress test.

You may also have pictures taken of your heart's coronary arteries either by a CT coronary angiogram (CTCA) or conventional coronary angiography.

How is angina treated?

Angina is initially treated with medication.

There are a range of medications that help reduce symptoms and lower your risk of heart attack or stroke.

• Glyceryl trinitrate (GTN) spray: A fast-acting spray that goes under your tongue. It reduces chest pain by relaxing and opening blood vessels.
• Beta blockers: Slow your heart rate, reduce how hard the heart has to work and lower your blood pressure.
• Calcium channel blockers: Lower your blood pressure, relax blood vessels and reduce chest pain.
• Long-acting nitrates: Help prevent chest pain by dilating your blood vessels and improving blood flow.

Read more about medications for angina

Other treatments

If medicines aren’t enough to control your angina, you may need a procedure to improve blood flow to your heart.

• Angioplasty and stenting
  A small balloon is used to open up a narrowed artery. Then a stent (tiny metal mesh tube) is placed in the artery to keep it open.
• Coronary artery bypass graft (CABG) surgery
  A blood vessel from another part of your body, like your leg, is used to make a new path around a blocked artery, improving blood flow to the heart.

What is the difference between angina and a heart attack?

Angina and heart attacks can feel similar. Both can cause chest pain, tightness or discomfort. The key difference is:

• Angina happens when a coronary artery is narrowed. Blood flow to the heart is reduced, particularly when the heart is working harder.
• A heart attack happens when a coronary artery is fully blocked. Blood flow stops, and part of the heart muscle is permanently damaged.

Angina usually gets better with rest or medication. Heart attack pain doesn't.

Some people have angina before a heart attack, others don't. Some people continue to have angina after a heart attack. Everyone's experience is different.

When should I get medical advice?

If your chest pain doesn't go away when you take your GTN spray, call 111 immediately.

See your doctor within 24 hours if your angina pain goes away with your GTN spray, but you've noticed it:

• happens more often
• is worse
• lasts longer
• happens at rest or when doing very little.

Can you prevent angina?

You may not be able to prevent angina completely, but there are lots of things you can do to control your symptoms.

Taking medication, managing other health conditions and making healthy changes can slow or stop artery damage and help your heart.

This includes:

• working with your doctor or nurse to manage your blood pressure and cholesterol
• taking medication as prescribed
• stopping smoking
• getting enough physical activity
• choosing healthy foods and drinks
• aiming for a healthy weight
• finding ways to manage stress
• managing diabetes if you have it.

Living well with angina

You can live a full life with angina. If your symptoms are well controlled, you'll still be able to do most things that matter to you.

It is helpful to know your triggers and plan ways to manage or avoid them.

Keep your GTN spray with you at all times.

It's also important to keep spare GTN sprays handy, such as in your:

• car
• office
• work bag or sports bag.

Check the expiry date on your GTN spray regularly. Medication that is past its expiry date may not work properly.

Hear from people living with angina

Read about other heart conditions