Angina

Angina is chest pain that occurs when the blood supply to the muscles of your heart is restricted.

Could it be a heart attack?
If your angina is not relieved after rest and 2 doses of your medication 5 minutes apart, after another 5 minutes call 111 and ask for an ambulance immediately.

On this page, you can find the following information:

Key points about angina

  1. Angina is usually described as chest pain or discomfort, like indigestion. This may be felt as an unpleasant feeling, tightness, pressure or weight on your chest and sometimes a feeling of breathlessness.
  2. While it's not usually life-threatening, it is a warning sign that you could be at risk of a heart attack or stroke.
  3. It usually only lasts a few minutes and can be relieved by rest and/or medicine (see angina action plan).
  4. If your angina is not relieved after rest and 2 doses of your medication 5 minutes apart, after another 5 minutes call 111 and ask for an ambulance immediately.
  5. With medicines and a heart-healthy lifestyle, it’s usually possible to reduce the risk of more serious problems.
  6. In some cases, surgery or angioplasty, a procedure to widen narrowed or blocked arteries, may also be recommended.
Action plan for if you have an angina attack
  1. Stop what you are doing and rest, tell someone how you are feeling and use your glyceryl trinitrate (GTN) medicine – take 1 puff of your GTN spray or put 1 tablet under your tongue.
  2. If you still have symptoms after 5 minutes, take 1 more puff of your GTN spray.
  3. If you still have symptoms 5 minutes after taking the second dose, call 111 and ask for an ambulance. Chew an aspirin while you wait if advised to by a paramedic. 
  • 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.
  • Unsure what to do? Call Healthline 0800 611 116 for free health advice anytime.

Create your own angina action plan Heart Foundation, NZ


Image credit: Heart Foundation NZ


(British Heart Foundation, UK, 2019)

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, your 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 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. Continue to use your medicine in the meantime. 

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.
If your angina is not relieved after rest or 2 doses of your medication in 10–15 minutes call 111 and ask for an ambulance immediately.

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
  • whether heart problems run in your family/whānau.

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 will be given medicines to treat attacks when they occur and reduce the risk of further attacks. If you have unstable angina, you will 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 to 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, UK
Angina section Medline Plus, US
Angina – explained American Heart Association

Reference

  1. Angina Heart Foundation NZ

Resources for healthcare providers

NZ primary care handbook Ministry of Health, NZ, 2012 
Cardiovascular disease risk assessment and management for primary care Ministry of Health, NZ, 2018
Medical management of stable angina BPAC, NZ, 2011
Management of stable angina and acute coronary syndromes NZ Formulary 
Stable angina NICE Pathway, UK
Exercise tolerance testing Patient Info Professional, UK, 2015

Reviewed by

Andy McLachlan is a cardiology nurse practitioner with clinical experience in long-term condition support and management, acute cardiology and adult cardiac intensive care nursing. He leads a team of nurses at Middlemore Hospital managing a range of cardiac nursing interventions and runs clinics to help support people back to health following cardiac events, interventions or surgery. 
Credits: Health Navigator Editorial Team. Reviewed By: Andrew McLachlan, Nurse Practitioner Cardiology, Counties Manukau DHB Last reviewed: 25 Jun 2019