Angina

Angina is chest pain that occurs when the blood supply to the muscles of your heart is restricted. While it's not usually life-threatening, it is a warning sign that you could be at risk of a heart attack or stroke.

Key points

  1. Angina is usually described as a discomfort or unpleasant feeling, like indigestion, tightness, pressure or weight on your chest, and sometimes a feeling of breathlessness.
  2. It usually only lasts a few minutes and can be relieved by rest and/or medication (see angina action plan).
  3. If your angina is not relieved after rest or 3 doses of your medication in 10 to 15 minutes, call an ambulance: dial 111 immediately.
  4. With medicines and a heart-healthy lifestyle, it’s usually possible to reduce the risk of more serious problems.
  5. In some cases surgery or angioplasty, a procedure to widen narrowed or blocked arteries, may also be recommended.
Angina action plan
If you have an angina attack:
  • stop what you are doing and rest – tell someone how you are feeling
  • use your glyceryl trinitrate (GTN) medicine – take 1 puff of your GTN spray or put 1 tablet under your tongue
  • take another dose after 5 minutes if the first one doesn't help
  • dial 111 and ask for an ambulance if you still have symptoms 5 minutes after taking the second dose
  • while you wait, chew an aspirin unless advised not to
  • if your symptoms are relieved, you can resume your activities gently
  • if your angina becomes more frequent or severe, lasts longer or happens when you are doing very little or resting, see your doctor in the next 24 hours.

Create your own angina action plan Heart Foundation, NZ

What causes angina?

In most cases, angina is caused by coronary artery disease. This is a condition that occurs when fatty deposits build up in blood vessels supplying blood to your heart muscle. This is called atherosclerosis.

Things that can increase your risk of atherosclerosis include:

  • getting older
  • an unhealthy diet
  • a lack of exercise
  • being overweight
  • regularly drinking excessive amounts of alcohol
  • smoking
  • other conditions, including high blood pressurehigh cholesterol and diabetes
  • a family history of atherosclerosis or heart problems.

What are the symptoms of angina?

The main symptom of angina is chest pain.

  • The pain may feel tight, dull or heavy and is usually felt across the centre of your chest. It may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in your hands. Some people experience it in only one of these areas and not in the chest at all.
  • Angina is usually brought on by physical exertion or stress.
  • Angina usually stops within a few minutes of resting or taking angina medicines.

Angina can also cause breathlessness, feeling sick (nausea), pain in your lower chest or belly that is similar to indigestion and fatigue. Women and older people are more likely to present with these symptoms. Some people have these symptoms without obvious chest pain.

Angina may also 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.

Regular pattern of angina symptoms

If you get angina at predictable times (eg, in cold temperatures, walking up hills, while mowing lawns or showering, during sexual activity or at work), use your GTN spray or tablets a few minutes before doing that activity.

If you are experiencing angina symptoms every day, see your doctor so that further treatment can be planned.

Change in angina symptoms

See your doctor within 24 hours (continue to use your medication in the meantime) if the pattern of your angina symptoms changes significantly in one or more of the following ways: frequency, severity, more prolonged, when you're doing very little or are resting. If the angina is not relieved after 3 doses of GTN in 10 to 15 minutes, call an ambulance – dial 111 immediately.

What is the difference between angina and a heart attack?

Angina

Heart attack

  • Caused by temporary reduction in blood flow to part of the heart muscle.
  • Is caused by a blockage in blood flow to part of the heart muscle. 
  • Does not damage the heart muscle.
  • Causes permanent damage to the heart muscle. 
  • Pain is relieved by rest and GTN tablets or spray within a few minutes.
  • If it lasts more than 15 minutes it will need more treatment.
  • Pain associated with a heart attack usually lasts more than 15 minutes and is not relieved by GTN tablets or spray.

How is angina diagnosed?

See your GP if you have had an episode of chest pain or are concerned about angina. They may ask about:

  • your symptoms – what you experienced and when it happened
  • your lifestyle – eg, what your diet is like and whether you smoke
  • family medical history – whether heart problems run in your family.

They may also measure your:

  • blood pressure
  • weight
  • blood levels of glucose and cholesterol.

If they think you might have angina, they may refer you to hospital for testing.

Tests in hospital

To check if you have angina and assess your risk of more serious problems like heart attacks or stroke you may have:

  • an electrocardiogram (ECG) – to check your heart's rhythm and electrical activity
  • an exercise ECG – recorded while you are exercising on a treadmill or stationary bike to assess your heart's response to stress or exercise
  • a coronary angiography – a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart
  • blood tests. 

What happens if I am diagnosed with angina?

Your treatment depends on the type of angina you're diagnosed with.

There are 2 main types of angina:

  • stable angina (the most common type) – attacks have a trigger (such as exercise) and improve with medicines and rest
  • unstable angina (the more serious type) – attacks are more unpredictable and can continue despite resting.

If you have stable angina, you'll be given medicines to treat attacks when they occur and reduce the risk of further attacks.

If you have unstable angina, you'll need medicines to prevent blood clots and reduce your risk of having a heart attack or stroke. 

What is the treatment for angina?

A combination of medicines and healthy lifestyle can help stop angina attacks and reduce the risk of further problems like heart attacks.

  • You may need to take several medicines to control your angina.
  • Adopting a heart-healthy lifestyle will help prevent further damage.
  • Surgery may be recommended if medicines and lifestyle changes don't help.

Medicines for angina

You may need to take several medicines to control your angina. These may include:

  • medicines to ease chest pain – glyceryl trinitrate (GTN)
  • medicines to prevent angina, such as:
    • beta-blockers – to help make your heart beat slower and with less force
    • calcium channel blockers – to relax the blood vessels, opening them wider so blood can flow more freely
    • isosorbide mononitrate – to relax the blood vessels, opening them wider so blood can flow more freely
  • medicines to reduce further heart problems such as aspirin and statins.

Read more about medicines for angina

A healthy lifestyle will help prevent further heart damage

Angina is a sign that your heart is not healthy. Medicines and surgery can help with symptoms but are not a cure for heart disease. The best way to help prevent further damage is to make healthy lifestyle changes.

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. 
Even a small change can have a positive impact on your risk of heart attack and stroke. The more you change, the better for your health. 

Learn more about: 

Surgery for angina 

If medicines and lifestyle changes aren't helping control your angina, or if you have unstable angina, surgery may be recommended.

The 2 main types of surgery for angina are:

  • coronary artery bypass surgery (CABG) – a section of blood vessel from another part of your body is used to re-route blood around a narrowed or blocked artery
  • percutaneous coronary intervention (PCI) – widening of a narrowed section of artery by use of a stent (a tiny piece of tube). 

An x-ray of the coronary arteries (coronary angiography) is used to decide whether CABG or PCI is appropriate.

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, UK
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, June 2019 Last reviewed: 25 Jun 2019