Angina

Angina is chest pain caused by reduced blood flow to your heart. It can come on with activity, and can have different symptoms in women and men. Our heart health specialists are experienced in diagnosing angina and delivering effective, personalised treatment.

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What is angina?

Angina is a feeling of pain or tightness, usually in your chest. It’s caused by a lack of blood flow to your heart. It can come on with activity such as climbing stairs or exercise, stress, or cold temperatures.

People who have it often describe it as squeezing, pressure, heaviness, tightness, or pain in the chest. It can either be a new pain that needs diagnosing by a cardiologist, or it could be a returning pain that your consultant treated previously.

Angina can be a sign of cardiovascular disease that’s narrowing your blood vessels due to fatty deposits. It's important to see a health professional as soon as possible if you think you may have it. Diagnosing and treating angina effectively may help cut the risk of a heart attack. Angina pain can also happen when the blood vessels in your heart tighten.

At Welbeck, our cardiology consultants diagnose and treat patients with chest pain in our state-of-the-art Heart Health centre.

Different kinds of angina and who gets them

There are different types of angina, including:

  • stable angina – this usually happens when your heart needs to work harder, such as walking up stairs or hills, or exercising. It’s the most common form of angina – it’s called stable because it’s often predictable. You can usually know when you’ll get it, it lasts under 10 minutes, and goes away when you rest or take your medicines. Even the type of pain is predictable, as it will usually feel the same each time it comes on.

  • unstable angina – this type isn’t as predictable. It can be unexpected, and happen even when you’re resting, so you don’t always know when it’s likely to hit. It often feels more severe, lasts longer (up to 30 minutes) and doesn’t always improve if you rest or take your medicines. If the pain doesn’t improve after 2 doses of your medicine 5 minutes apart, call 999.

  • microvascular angina – this type is more common in women than men, and can occur more often around the time of menopause. It usually happens during exercise or times of stress or anxiety. Microvascular angina is caused by problems with the tiny arteries within your heart muscle that go into spasm and restrict blood flow. In the past, microvascular angina was called cardiac syndrome X

  • vasospastic angina – this is a rare kind that happens when a coronary artery goes into spasm and narrows or tightens, reducing the supply of blood and oxygen to your heart. It can happen when you’re resting. This type of angina is more common in women than men. Some healthcare professionals might call it coronary artery spasm or Prinzmetal’s angina

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The main symptom of angina is a sudden pain or dull ache in your chest, neck, shoulders, jaw, or arms. It can feel like pressure, tightness, or squeezing in your chest. You might also feel it in your shoulders, arms, neck, jaw, back, or stomach.  

Other symptoms of angina can include:

  • feeling very tired (fatigue)

  • dizziness

  • sweating

  • feeling sick

  • shortness of breath

Angina in women and non-white ethnicities

The symptoms for women and people from non-white ethnicities include classic angina symptoms, but are also more likely to include:

  • nausea

  • breathlessness

  • sweating

  • dizziness

  • abdominal pain

  • neck, jaw, or back pain

  • stabbing chest pain rather than pressure in the chest

Angina happens when the heart does not get enough blood.

This is usually due to coronary heart disease, where the blood vessels supplying blood to the heart become narrowed or blocked by fatty deposits.

But it can also be caused by the blood vessels in your heart tightening when they should not (vasospastic angina or microvascular angina).

You're more likely to get coronary artery disease and angina if you have one or more of these risk factors:

  • smoking

  • drinking more than 14 units of alcohol a week

  • diabetes

  • arthritis

  • kidney disease

  • high blood pressure

  • high blood cholesterol

  • older age – men over 45 and women over 55 are at greater risk

  • lack of exercise

  • obesity

  • stress

  • family history of heart disease

  • previous heart problems, like a heart attack or heart rhythm problem (arrhythmia)

  • menopause, a heart condition called cardiomyopathy, and some autoimmune diseases can increase the risk of microvascular angina

  • Raynaud’s disease, migraine, cold weather and use of cocaine and marijuana can be linked to an increased risk of vasospastic angina

Diagnosing your angina usually involves an initial consultation where our heart health specialist will:  

  1. Take a history to get a full understanding of your family history and health status

  2. Ask about your pain and how it affects you – for example, how severe it is, where it is, what makes it worse or better, and how it affects daily life.

  3. Do a physical examination.

  4. Check your blood oxygen levels, BMI, and blood pressure.

  5. Review any relevant scans and other previous investigations.

  6. Talk through their initial findings and what will happen next.

They may also recommend :

  • blood tests

  • an electrocardiogram (ECG) to check your heart’s electrical activity

  • an exercise tolerance test (ETT) – to show how your heart works during exercise

  • myocardial perfusion scan (MPS) – measures how well blood is reaching your heart

  • coronary angiography – shows any blockages in your coronary arteries and how severe they are. 

  • an MRI scan

  • stress echocardiography

  • acetylcholine provocation

Your consultant will work to rule out other causes of chest pain, too. These include:

  • acid reflux

  • pleurisy

  • pericarditis

  • muscular pains

You can help to manage angina or reduce your risk with certain lifestyle changes:

  • quit smoking if you smoke, because it clogs and narrows your arteries

  • control any underlying health conditions such as high blood pressure, diabetes, high cholesterol or kidney disease

  • eat a healthy balanced diet low in saturated animal fats that increase cholesterol

  • get active – it helps reduce cholesterol levels, and encourages healthy blood sugar and blood pressure levels

  • stick to the recommended alcohol limit of 14 units a week

  • stay at a healthy weight

  • talk to your consultant about hormonal health during peri/menopause, as some research suggests HRT can help reduce the risk of cardiovascular disease in women

Angina is a symptom of an underlying issue with your blood vessels narrowing due to cardiovascular disease. Angina can therefore put you at increased risk of:

  • heart attack – it can also be a symptom of a heart attack

  • stroke – another cardiovascular disease

Microvascular angina can cause myocardial ischemia, when your heart muscle begins to die because it doesn’t get enough blood.

1 in 5 people with microvascular angina may find episodes get worse, happen more often, last longer and may need hospital treatment.

Untreated vasospastic angina can increase your risk of heart rhythm disorders (arrhythmias), which in turn increase the risk of stroke.

Once your angina has been diagnosed, and your consultant is clear about the possible cause or causes, they’ll recommend the most appropriate next steps and will arrange treatment to ensure you make the best possible recovery. Treatment options include:

  • medicine to ease the pain and stop an angina attack if you have one (glyceryl trinitrate)

  • medicines to help reduce the number of angina attacks, such as beta blockers

  • medicines to help keep your blood vessels and blood pressure healthy - to cut your risk of having a stroke or heart attack - such as low-dose aspirin or statins

  • surgery to increase the blood flow to your heart (coronary angioplasty or a coronary artery bypass)

  • cognitive behavioural therapy to help manage the pain

  • lifestyle approaches to help manage underlying cardiovascular health risks

Our consultants have access to multidisciplinary teams who can be brought in to support your personalised angina and heart health management plan.

At Welbeck, our heart health specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.

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London

1 Welbeck Street
Marylebone
London
W1G 0AR

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Frequently asked questions

Angina can be an early warning sign of a serious cardiovascular condition. So it’s always important to seek medical help if you:

  • start getting chest pains or other angina symptoms that come and go

  • have been diagnosed with angina, and it gets worse, happens more often, lasts longer or happens when you're resting

If you've been diagnosed with angina and your chest pain comes on, do as your consultant instructed to manage your attack. This will most often be :

  1. Stop what you're doing and rest.

  2. Use any prescribed angina medicine you've got – this is usually glyceryl trinitrate (GTN).

  3. Take another dose after 5 minutes if the first dose does not help.

If you still have symptoms 5 minutes after taking the 2nd dose, call 999 for an ambulance. Don’t drive yourself to A&E.

If you have angina, you’ll probably notice what triggers an attack.

Keep a diary so you can talk to your consultant about your triggers, and work out a way to avoid or manage them. You can’t always avoid them, and some triggers – such as activity – are actually good for your heart health and your angina in the end.

Triggers may include:

  • cold temperatures

  • eating large meals

  • stress

  • activity such as sex, hill walking or climbing stairs

For people with vasospastic angina, substances that affect blood vessels may be triggers, such as the herb ephedra, or ephedrine (the active ingredient from the herb), which may make your vessels spasm. It’s found in some decongestants, cold medicines, weight-loss supplements, and energy drinks.

If your symptoms are well controlled, you can usually get on with your daily life. You may need to make a few adjustments after discussion with your consultant.

Angina pain may affect your work if it involves a lot of physical activity and your attacks are not under control. If you drive, you may need to talk to the DVLA about your condition – your consultant can advise you

Speak to your doctor before you take up a new activity or if you're worried about exercising, and always carry your angina medicine with you.

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