Heart conditions - angina

Angina is a temporary chest pain or discomfort that happens when your heart doesn’t get enough blood and oxygen. It is a symptom of an underlying heart condition, usually coronary heart disease.

Coronary heart disease occurs when there’s narrowing of the coronary arteries supplying blood to the heart muscles, due to a build-up of a fatty substance in the arteries (plaque).

Angina is not the same as a heart attack. Unlike a heart attack, angina does not cause permanent damage to the heart muscle.

Symptoms of angina

Different people experience angina in different ways, and symptoms can vary from mild to severe. Pain or discomfort from angina may feel like heaviness, pressure, tightness or squeezing in your chest. You may also feel it in your shoulders, back, neck, jaw or arms. Some people with angina feel chest discomfort but have no pain at all.

Other symptoms of angina include:

• dizziness
• fatigue
• shortness of breath.

Talk to your doctor if your angina:

• becomes more severe
• happens more often
• lasts longer
• doesn’t respond as well to medicine
• happens with less exertion
• happens at night or when you are resting.

Angina action plan

There are several steps you should take as soon as you feel angina symptoms.

• Step 1. Stop and rest immediately.
• Step 2. If rest doesn’t relieve your symptoms, take one dose of your angina medicine (available in a spray or dissolvable tablet form). Sit or lie down before taking your medicine, because it can make you feel dizzy. Take the smallest dose that works for you (e.g. a full, a half or even a quarter of a tablet).
  • Spray: once under the tongue
  • Tablet: place under your tongue but do not swallow it. When your symptoms stop, spit out what is left of the tablet.
• Step 3. Wait five minutes. If the angina continues, take another dose of medicine.
• Step 4. Wait another five minutes.
• Step 5. Tell someone how you’re feeling, or call a relative or friend.
• Step 6. Call Triple Zero (000) if the angina:
  • is not completely relieved within the 10 minutes you have waited or
  • is severe or
  • gets worse quickly.

Ask for an ambulance and don’t hang up – then wait for advice from the operator.

Common triggers of angina

Angina can stop and start, and episodes of angina can last anywhere from seconds to minutes. It often happens when your heart is working harder than usual and needs more oxygen-rich blood than the narrowed arteries can deliver.

Common triggers of angina include:

• physical exertion
• emotional stress
• cold temperatures
• eating a large meal.

Types of angina

There are different types of angina including:

• stable angina
• unstable angina
• vasospastic angina
• microvascular angina.

Stable angina

Stable angina is usually triggered by physical exertion or emotional stress. The symptoms often go away after a few minutes of rest. It can also be relieved by angina medicine.

Unstable angina

Unstable angina can occur anytime, and often happens while resting. The symptoms may not improve with rest or medicine and can last longer than stable angina.

Vasospastic angina

Vasospastic angina is also known as Prinzmetal angina or variant angina. This type of angina is rare and often severe but can be relieved with medicines. It can happen while resting when spasms in the coronary arteries supplying blood to the heart cause them to narrow or tighten.

Microvascular angina

Microvascular angina, also known as cardiac syndrome X, may be a symptom of coronary microvascular disease (MVD). Coronary MVD is a heart disease that affects the smallest blood vessels of the heart. The pain or discomfort can be more severe and can last longer than stable angina.

Risk factors for angina

There are several risk factors that can increase your risk of coronary heart disease and angina, including:

• unhealthy eating patterns
• excessive alcohol drinking
• being physically inactive
• tobacco smoking
• stress
• overweight or obesity
• high cholesterol
• high blood pressure
• diabetes
• having a mental health condition such as anxiety and depression
• increasing age
• being male
• being a post-menopausal woman
• having a family history of coronary heart disease
• ethnicity – people of certain ethnic backgrounds, including Aboriginal and/or Torres Strait Islander Peoples have increased risk of coronary heart disease.

Diagnosing angina

To diagnose angina, your doctor will review your symptoms, ask about your family history of heart disease and conduct a physical examination. Your doctor may also perform one or more of the following tests:

• blood tests - to measure your cholesterol levels and other heart disease markers
• electrocardiogram (ECG) – to measure the electrical activity of your heart
• exercise stress test – the heart is monitored using an ECG while you ride a stationary bike or walk on a treadmill. The test will stop if you experience angina (chest pain).
• coronary angiogram – This is where a long, thin tube (catheter) is inserted into an artery in your wrist (or sometimes the groin). The catheter is threaded through the artery until it reaches your heart. A special dye is then injected into the catheter and an X-ray is taken. The X-ray shows where the coronary arteries are narrowed or blocked from a build-up of plaque.

Treatment for angina

Angina treatment reduces the frequency and severity of symptoms. It also lowers your risk of a heart attack by treating other underlying conditions.

Angina can be treated and managed with medicines, lifestyle changes and surgery.

Medicines

Nitrate medicines (for example, glyceryl trinitrate or GTN) are commonly prescribed to widen your blood vessels and increase blood flow to your heart. These are available in many forms including a spray or patches. Some nitrate medicines are used to relieve angina, whilst others are taken every day as a preventative measure.

If you have coronary heart disease, you may also need to take other medicines to reduce your risk of a heart attack. These can include:

• antiplatelets – to reduce the risk of blood clots forming
• beta blockers – to lower blood pressure and regulate your heart rate and rhythm
• calcium channel blockers – to widen your blood vessels, increase blood flow to the heart and lower blood pressure
• cholesterol-modifying medicines - to reduce your cholesterol levels.

Always take your medicines as prescribed by your doctor to help prevent, treat and manage angina and lower your risk of further heart problems.

Lifestyle changes

Making lifestyle changes can help to prevent angina and reduce your risk of a heart attack. They include:

• quitting smoking and limiting exposure to second-hand tobacco smoke
• being physically active most days of the week
• following a heart-healthy eating pattern
• drinking less alcohol
• looking after your mental health
• maintaining a healthy body weight
• managing your blood pressure and cholesterol levels
• managing your blood sugar levels, for people with diabetes.

Surgery

Some people with angina may need to have surgery if medicines or lifestyle changes are not helping to relieve their angina symptoms.

The two main types of surgery for angina are:

• coronary angioplasty and stent insertion – a procedure to open up a narrowed or blocked coronary artery using a balloon. Once the artery is open, a special expandable wire mesh tube (stent) is left in place to keep it open, and the balloon is withdrawn. This improves blood flow to your heart.
• coronary artery bypass graft (CABG) surgery – an operation where a healthy blood vessel (can be a vein or artery from your arm, leg or chest) is attached to either side of the blocked artery in your heart and is used to allow blood flow to your heart again.

Living with angina

Taking medicines as prescribed and making changes to your lifestyle can lower your risk of worsening angina and from developing further complications, including a heart attack.

Living with a heart condition like angina can cause feelings of anxiety and stress in some people. If you are worried about your thoughts or how you are feeling, talk to your doctor and seek support from your loved ones.

Where to get help

• In an emergency, always call triple zero (000)
• Your GP (doctor)
• Cardiologist
• Emergency department of your nearest hospital 
• Heart Foundation
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice 24 hours a day, 7 days a week