Angina

Angina is chest pain that occurs when the blood supply to the muscles of your heart are restricted. This can be due to narrowing of the arteries supplying the heart.

Key points

  1. Angina is usually described as a discomfort or unpleasant feeling, like indigestion, tightness, pressure or weight on the chest, and sometimes a feeling of breathlessness.
  2. It usually only lasts a few minutes and can be relieved by rest and/or medication.
  3. Lifestyle changes are needed to reduce risk factors for heart disease.
  4. In some cases surgery or angioplasty, a procedure to widen a narrowed or blocked artery, may also be appropriate.
  5. If your angina is not relieved after rest or three doses of your medication in 10 to 15 minutes, call an ambulance: dial 111 immediately.

Angina action plan

  • Check your angina action plan Heart Foundation of NZ
  • If you feel angina coming on, stop what you are doing and rest now.
  • Tell someone how you are feeling. 
  • If you have been given GTN (glyceryl trinitrate) tablets or spray, take 1 puff of your GTN spray or put 1 tablet under your tongue.
  • After 5 minutes if your symptoms have not been relieved, take 1 more puff of your GTN spray or 1 tablet under your tongue.
  • After another 5 minutes if you still have symptoms, treat as a heart attack and dial 111 and ask for an ambulance. Chew an aspirin unless advised not to. 
  • If your symptoms are relieved, you can resume your activities gently.
  • 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.
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Causes

In most cases angina is caused by coronary artery disease, a conditions that occurs when fatty deposits build up under the lining of the blood vessels supplying blood to the heart muscle. As a result, these arteries become narrowed and blood flow to the heart muscle is reduced. Angina occurs when the blood flow to the heart muscle is insufficient for the extra demands made on it, eg, with exercise. There is no damage to the heart muscle from an episode of angina

Symptoms

Angina can affect people in different ways, and the symptoms may differ at various times. Angina is usually felt across the centre of the chest, but may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in the hands. Some people experience it in only one of these areas and not in the chest at all.

Angina is usually brought on by exertion, emotion, a heavy meal, or cold weather. Angina can occur at rest or even during the night. It can often be experienced at particular times of the day, eg, first thing in the morning or late afternoon.

Angina symptoms, regular pattern
If you get angina at predictable times (eg, cold temperatures, walking up hills, mowing lawns, while showering, during sexual activity, while at work), use your spray or tablets a few minutes before attempting that activity. If you are experiencing angina symptoms every day, consult your doctor so that further treatment can be planned.

Change in angina symptoms
If the pattern of your angina symptoms changes significantly in one or more of the following ways: frequency, severity, more prolonged, occurs when you're doing very little or are resting, see your doctor within 24 hours (continue to use your medication in the meantime). If the angina is not relieved after three doses in 10 to 15 minutes, call an ambulance – dial 111 immediately.

Angina or heart attack?

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Angina

  • symptoms are associated with a temporary reduction in blood flow to part of the heart muscle
  • leaves no damage to the heart muscle
  • pain is relieved by rest and glyceryl trinitrate (GTN) tablets or spray within a few minutes
  • angina that lasts more than 15 minutes will need more treatment.

Heart attack

  • results from a blockage in blood flow to part of the heart muscle
  • causes permanent damage to the heart muscle
  • pain associated with a heart attack usually lasts more than 15 minutes and is not relieved by glyceryl trinitrate (GTN) tablets or spray.

Treatment

The most common medications for managing angina are beta-blockers and nitrates, which relax the blood vessels, opening them wider so blood can flow more freely.

There are two types of nitrate:

  • short-acting nitrates include glyceryl trinitrate (GTN) spray, eg, nitrolingual, and GTN tablets, eg, Lycinate.
  • longer acting nitrates,eg, Isosorbide mononitrate.

To confirm a diagnosis of angina, your doctor may arrange further tests, eg, heart monitoring while you exercise.

Glyceryl trinitrate (GTN) spray

Glyceryl trinitrate spray, eg, Nitrolingual, delivers a measured dose of nitrate into your mouth. The spray droplets are absorbed quickly, giving an almost immediate effect. Do not shake the canister, hold it upright and spray one or two puffs on or under your tongue, then close your mouth. If angina is not relieved after three doses within 15 to 20 minutes, call an ambulance. If you have not used your spray recently, be sure it still sprays.

Glyceryl trinitrate tablets

Glyceryl trinitrate given in tablet form, eg, Lycinate, is absorbed into the bloodstream from the lining of the mouth. The tablet does not work if it is swallowed whole. A quarter or half a tablet may be enough to relieve your angina. Place the tablet under your tongue, letting it dissolve (for a more rapid effect chew the tablet and let the pieces dissolve in your mouth). If angina is not relieved after three doses within 15 to 20 minutes, call an ambulance.

Nitrate skin patches: long-acting medication

Nitrate skin patches are the longest acting forms of nitrates and are absorbed through the skin. Put the patch on smooth, unblemished skin on the body trunk, or upper arms or legs, avoiding skin folds and using a different area of skin each time. Apply a patch at the same time each day or as prescribed by your doctor.

After a shower or bath, wait until your skin is completely dry before attaching the patch. If the patch gets wet while swimming or bathing, that is okay (water will not stop it working). Store spare patches at room temperature and change as prescribed.

Nitrate tablets or capsules: long-acting

There is a variety of long-acting tablets that your doctor may prescribe. These medications are absorbed through the stomach instead of the mouth and have a longer-acting effect.

Beta-blockers

Beta-blocker medication reduces the frequency of angina attacks. They slow your heart rate, letting the heart pump more efficiently which results in improved physical activity levels.

Calcium antagonists

Calcium antagonists are further medication options for preventing angina symptoms. Calcium antagonists help to relax the arteries, allowing more blood to flow through so that the heart beats more efficiently. All of these medications are prescribed by your doctor.

Side effects of medications

GTN spray and tablets can sometimes cause flushing, headaches, a feeling of fullness in the head, dizziness or palpitations. They may also cause a burning or tingling feeling in your mouth. If you are using GTN tablets it may help to take a quarter to half a tablet or to spit it out once symptoms are relieved.

These medications temporarily lower your blood pressure, so you may feel a bit faint when using them for the first time, if you take too large a dose or if you use them when you are hot (eg, after a shower). It is best, therefore, to be seated when taking them for the first time. If taking longer-acting medications and experiencing these side effects, discuss them with your doctor.

Despite some side effects, these drugs are safe and are not habit-forming. You can drink alcohol while taking them, but it may increase the chances of side effects (faintness and dizziness). Discuss any concerns about side effects with your doctor.

Storing your medication

It is important that you always have sufficient medication with you and that it is not old or damaged. Follow instructions for use and storage carefully.

Surgery & other procedures

Coronary artery bypass surgery or angioplasty (opening up the arteries with a special balloon) can also help control angina. An x-ray of the coronary arteries (coronary angiography) is used to decide whether surgery or angioplasty is appropriate.

Self care

Everyone who has angina should benefit from developing healthy heart habits. Dealing with angina is not just a matter of dealing with the symptoms. Risk factors for coronary heart disease include raised blood pressure, smoking, raised blood cholesteroldiabetes, excess weight and lack of physical activity.

To improve your heart health:

  • cut down on saturated (animal) fats and salt
  • eat more fruit, vegetables and wholegrain cereals
  • do not smoke
  • have your blood pressure checked regularly
  • enjoy regular physical activity
  • maintain a healthy bodyweight
  • develop ways to cope with stress.

Support

Sometimes it can be helpful to talk with someone who knows what it’s like to live with heart disease and angina. The Heart Foundation has an online directory of community-run support groups around the country. To find a support group near you, visit the Heart Foundation’s HeartHelp Directory.

Learn more

Angina NHS Choices
Angina section Medline Plus
Angina – explained Watch, Learn, Live: Interactive Cardiovascular Library – American Heart Association

Credits: Original material provided by the Heart Foundation of New Zealand. Updated by Health Navigator. Reviewed By: Andrew McLachlan, Nurse Practitioner Cardiology February 2016 Last reviewed: 19 Feb 2016