What is an angina attack?

Angina is a chest pain or discomfort that occurs when the heart doesn’t receive enough oxygen-rich blood. While an angina attack isn’t normally life-threatening, it could be a potential risk factor for other heart-related conditions, such as heart attack or stroke. 

In this article, we will take a detailed look at what angina is, what causes an attack, and what can be done to prevent its onset. We’ll also teach you how to recognise the first signs and symptoms and where to seek help should you need it.

Angina causes and risk factors

One of the main causes of angina is coronary artery disease. This occurs when a fatty substance called plaque builds up in your arteries — the blood vessels that carry oxygen-rich blood around your body. 

When your arteries become narrowed or blocked by plaque, the amount of blood received by the heart muscle is reduced. This is known as atherosclerosis. 

When your heart needs to put in extra work to pump more blood around the body, such as during exercise or when you’re feeling stressed, it receives insufficient oxygen from the narrowed blood vessels. This then causes the typical symptoms associated with angina, as discussed in more detail below. 

Several risk factors can also increase the risk of an angina attack. These include:

• Diet – unhealthy foods high in saturated fat, sugar or salt can increase the risk of angina onset.
• Smoking – smoking, chewing or being exposed to tobacco over a long period can damage the lining of the arteries and cause them to become clogged
• Age – angina is most common in adults aged over 60 years old
• High blood pressure – having high blood pressure can cause the arteries to become damaged and harden over time
• Exercise – having an inactive lifestyle can increase the risk of high cholesterol, type 2 diabetes and obesity, all of which can damage your arteries.
• Diabetes – over time, high blood sugar levels could damage the blood vessels and arteries to your heart
• Family history of heart disease
• Stress

Recognising the symptoms of an angina attack

When experiencing an angina attack, you will typically feel a tight, squeezing sensation in the middle of your chest. This can range from being quite painful to more of a dull ache. 

You may also feel the same sensation spread to other areas of your body, including your shoulders, jaw, back, neck, stomach or, most commonly, left arm. 

Other symptoms of angina can include breathlessness, nausea, a pain similar to indigestion, tiredness and dizziness. However, these should only last for a few minutes and eventually stop after resting for a few minutes. 

Diagnosis and medical assessment

If you experience any of the symptoms mentioned above, but they go away after resting, your first step should be to arrange a consultation with a cardiologist. They will have the training and expertise required to help diagnose whether you have angina or not. 

At London Medical, we are able to offer flexible and rapid appointment bookings with our team of renowned cardiologists. Simply call us today on +44 (0)800 0483 330 and we will be able to book you an appointment. If you let our team know that you are experiencing chest pain, we will make sure you have an early appointment.  

During your initial consultation, your consultant will likely ask you questions about the exact symptoms you experienced, what caused them to start, what your lifestyle is like, and what your medical history is. 

Alternatively, you should always call 999 if you feel chest pain and meet any of the following criteria: 

• You haven’t previously been diagnosed with angina
• The chest pain is happening at rest
• The chest pain is worse than during previous attacks
• The chest pain does not go away within 20 minutes
• This is your first angina attack
• You do not have your angina medication with you

Tests for angina

Following your consultation, your cardiologist may run a few quick tests to analyse your likelihood of experiencing a heart problem. These could include: 

• Measuring your blood pressure 
• Taking weight and height measurements (to calculate your body mass index)
• Taking a waist circumference measurement
• Running blood tests (to check your cholesterol and blood sugar)

If your cardiologist thinks you may be at risk of angina or another heart-related condition, you will undergo further medical assessments to determine your angina risk, using tests like: 

• An electrocardiogram (ECG) – to record the rhythm, rate and electrical activity of your heart
• An exercise tolerance test – the same as an ECG, but performed while you exercise
• A computer tomography – to see any suspected narrowing of your arteries
• A coronary angiogram – to see your heart’s blood vessels and identify any problems through X-ray imaging
• Further blood tests (such as complete lipid status, longterm sugar and C-reactive protein, among others)

Types of angina

There are two main types of angina that you will typically be diagnosed with:

• Stable angina – also known as angina pectoris, stable angina is the most common type of angina and causes chest pain because of a specific trigger, like exercising. Its symptoms tend to improve within five minutes of resting and you will likely be prescribed certain medicines to treat attacks as and when they occur.

• Unstable angina – the more serious type of angina, unstable angina is characterised by unpredictable attacks that can continue despite taking short periods of rest. Further medical tests may be required to determine the best course of treatment.

Variant angina and microvascular angina are two other types of angina you could be diagnosed with. However, these are much rarer.  

If you experience angina symptoms for more than 20 minutes at rest, you should visit your local A&E department or call 999 as a matter of urgency. 

Angina treatment and prevention

If you are diagnosed with angina, you will likely need to take several different medicines throughout your life. These will help treat any attacks as and when they happen, prevent further attacks from taking place, and reduce your risk of developing any other heart-related conditions, such as coronary heart disease. 

Depending on the extent of your angina or the type of angina you have, some medications may not help. In these cases, you might require surgery to re-open your arteries and ensure your heart muscle receives enough oxygen-rich blood. 

Making some simple lifestyle changes can also make a big difference to your likelihood of experiencing angina and other heart-related conditions. Here are some ideas to help achieve this:

• Maintain a balanced diet by avoiding high-fat and high-sugar foods
• Quit smoking
• Exercise regularly to keep a healthy weight (BMI of 25kg/m² or less)
• Reduce your alcohol intake
• Manage your stress 
• Lower your blood pressure (<140/90mmHg) and cholesterol levels (LDL-C <1.8mmol/l)
• Control your blood sugar

Angina attacks: a summary

An angina attack may feel like a scary experience but, don’t worry — it is only a warning rather than an actual heart attack. 

With the right care, medication and lifestyle adjustments, you can still lead an active, fulfilling life while keeping angina under control. 

By embracing positive lifestyle changes, such as quitting smoking, eating well and exercising regularly, you can greatly improve your heart health and reduce any angina-related symptoms. 

Get in touch

If you are currently living with angina, are worried you might be experiencing symptoms or would like to find out more information about the condition, our cardiology team can provide you with an early appointment to access all the expert advice you might need. 

Simply contact our friendly team today to book an appointment. 

Sources:

• https://www.nhs.uk/conditions/angina
• https://www.nhs.uk/conditions/angina/diagnosis/ 
• https://www.bhf.org.uk/informationsupport/conditions/angina 
• https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes 
• https://www.nhlbi.nih.gov/health/angina/causes 
• https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html