Angina

Did you know?

• 5-14 people in every 100 will die after being diagnosed with unstable angina
• In the UK, angina affects between 1.5 and 2 million people
• 52,000 new cases of angina in men are reported each year in the UK
• For women the figure is 43,000 new cases each year
• The direct costs of treating angina to the NHS is around £700 million per year
• Men with angina are twice as likely to suffer a heart attack as women with the condition

Causes of angina

Angina occurs when the heart requires more blood than the coronary arteries can supply. If the coronary arteries become too narrow, they are unable to supply enough blood and the resulting symptoms are referred to as angina. There are a number of different types of angina.
The most common cause of narrowing of the coronary arteries is coronary heart disease. This is caused by atherosclerosis whereby the inside of the coronary arteries have a build up of fatty substances known as atheroma. These form over a period of years and grow to a size that narrows the arteries and reduces blood flow.

Narrowing of the coronary arteries can lead to 'stable angina' while 'unstable angina' is due to the major narrowing of one of the arteries from the artheroma breaking open and causing a blood clot to form. The clot can disappear only to form again and each time this occurs (and narrows the artery) chest pain is felt while sleeping or at rest.

Sudden contraction or spasm of the coronary artery causing it to narrow is called 'variant angina'. This type of angina can be experienced even when there is no atherosclerosis.

Other causes of angina include:

• Inflammation or infection of the arteries
• Anaemia
• Abnormal heart rhythm or fast heart rhythm
• Coronary artery compression

Factors which increase the risks of angina include:

• Being male
• Being middle-aged or older
• Smoking
• High cholesterol
• High blood pressure
• Obesity (or being overweight)
• Lack of exercise of activity
• Hereditary (family history)
• Diabetic

Symptoms of angina

Someone with angina can experience some of the following symptoms:

•    Chest pain or discomfort (tightness in the middle of the chest or a feeling of heavy weight on the chest)
•    Neck pain, arm pain, pain in the jaw or pain between the shoulder blades
•    A feeling of choking
•    Feeling out of breath
•    Sweating
•    Nausea
•    Exhaustion

These symptoms usually occur when the heart is having to work harder and requiring more blood, typically during physical activity or exertion. However, angina can be triggered by other factors such as: stress, excitement, anger, cold weather or after eating a large meal.

Symptoms of the three main types of angina (stable angina, unstable angina and variant angina) can be triggered by different factors.

Stable Angina

This is the most common type of angina whereby pain is triggered by exertion when the heart is having to work harder. Stable angina has a regular pattern (hence its name) and the level of activity that triggers pain is predictable.

Pain can last anywhere from 3 to 10 minutes and is relieved by medication however it will often occur again if activity is resumed. Should the pattern of the angina alter then you should visit your doctor so treatment can be adjusted.

Unstable Angina

Unlike stable angina, unstable angina has no pattern and any pain can be triggered by little physical effort such as walking or when resting. Symptoms of pain are more frequent, more severe and can last much longer than stable angina. Medication typically has little effect on the symptoms. Unstable angina can follow stable angina but it may be the first type that is experienced.

Variant Angina

This is the least common type of angina and typically affects women. Sometimes called 'Prinzmetals angina', the condition triggers pain without warning and usually while resting or sleeping.

Anybody experiencing the following symptoms should seek medical help:

• Awoken in the night by angina symptoms
• Severe symptoms of angina (more than normal)
• Frequently suffering symptoms (more than is normal)
• Symptoms lasting longer than normal

Diagnosis of angina

You should first visit your GP if you've been experiencing symptoms which you believe are similar to angina. The GP will take a medical history and carry out a physical examination including blood pressure, pulse rate, checking for swollen ankles and listening to the heart's rhythm.

The GP may also send you for diagnostic tests including:

• An exercise ECG (electrocardiograph) test to determine if the ECG is abnormal when exercising on a treadmill or exercise bike.
• Blood tests to determine any underlying causes such as diabetes, anaemia, high cholesterol or thyroid problems.

Other tests may be carried out if the above tests prove inconclusive. These tests can include:

• Chest X-Ray - to show if lung disease or heart failure is the cause.
• Echocardiogram – sound waves to check if the heart is pumping correctly.
• Coronary Angiogram – a dye injected into the coronary arteries to highlight any blockages under X-ray.

Related terms

Heart problems
Chest pain
Heart attack
Angina pectoris
Ludwig's angina
Cardiac
Angiography
Blood clot
Cholesterol
Aneurysm