It is the pain or discomfort you experience when your heart cannot get enough blood. The discomfort does not damage your heart but is a warning symptom that there is a problem with the blood supply to your heart.
Although you may think that having angina is the same for everyone, there are certain differences that are important to know.
For some individuals, they only get angina if they do a lot of strenuous activities. In such individuals, it is likely that the narrowing in their arteries is not very severe or that the narrowing is in a place that supplies only a small amount of heart muscle.
In other individuals, angina may come on when they do very little activity. Such people may have a severe narrowing in one or more of their coronary arteries or the narrowing is in an area that supplies a very large amount of heart muscle.
The discomfort often starts in the chest and spreads to the arms and even up to the neck and jaw and around the back. It may feel like a heavy weight has been placed on your chest or like indigestion. The pain or discomfort is usually continuous.
Women can experience different symptoms.
Women can experience angina differently than men with symptoms such as nausea, shortness of breath, abdominal pain or extreme fatigue, with or without chest pain.
When and how long does it usually happen?
Angina usually happens when people are walking or doing something that takes some effort. It lasts longer than a few seconds and eases off when exertion stops. It can get worse if you continue to exercise. It may also occur if you become very stressed and eases off as you become more relaxed.
Sharp, stabbing pains are usually not angina. Chest pain that allows one to run around and do physical activity is unlikely to be angina. The pain does not usually vary with breathing or with changing your posture which occurs with lung and chest wall problems.
If you experience new or different symptoms, tell your doctor immediately.
New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. Unstable angina is when the anginal symptoms occur at rest or with very little exertion.
If you have had anginal symptoms before and now find that they are occurring more often and with less activity then unstable angina is present.
If your angina symptoms change or happen more often, you should tell your doctor immediately. You may need to go to hospital for more treatment and further tests. This is a serious condition and requires prompt medical attention.
These arteries can normally adapt when the heart needs more blood during exercise. However, if the arteries are narrowed due to plaques, then the artery may not be able to provide enough blood for the heart during exercise. Therefore the portion of the heart muscle supplied by the narrowed artery would not have enough oxygen.
To protect itself from further lack of oxygen, the heart produces angina to stop you from doing more exercise. Except for a few rare exceptions, the condition that narrows our coronary arteries is called atherosclerosis.
Some conditions make angina occur more often such as high blood pressure, low levels of red blood cells (anaemia), cold weather, heavy meals, smoking, being overweight and carrying heavy loads. The reason for this is that these conditions cause the heart to need more blood or that the supply of blood is reduced.
An anginal attack is often brought on when you ask your heart to do a lot of work but at the same time you do not give it enough fuel to do the work. The fuel (oxygen and energy source) is brought into your heart muscle via the coronary arteries.
If these arteries are narrowed or if the amount of fuel in the blood is not enough (due to lack of oxygen or the red cells that carry it around), your heart muscle would not have enough energy to do its work. It would then complain by giving you angina. These episodes usually settle after a few minutes.
These include avoiding exercise after meals for 2 hours, reducing your weight, quitting smoking, covering your face with a scarf in cold weather and managing high blood pressure. Many patients need to take medicines called “anti-anginal drugs” to help prevent angina episodes.
However, your doctor will take a history of your symptoms and may be able to tell if you have angina from your description.
There are some tests which may help your doctor: you will have an electrocardiogram (ECG) done while you are resting. You may have one done while you are exercising to see how your heart reacts to exercise. These simple tests are often all that is needed. Sometimes more complicated tests are required. The most usual of these is a coronary angiogram or a heart scan.
There are many drugs used in the treatment of angina. The main drugs used are called: beta-blockers, calcium channel blockers, nitrates, ACE inhibitors or Angiotensin Receptor Blockers (ARBs) as well as drugs that prevent clots forming, such as aspirin or clopidogrel.
Your doctor will advise you on the need for angioplasty or stent placement. The usual indication for such a procedure is when your angina is not controlled with medicines alone.
However, in some situations your doctor may feel that the disease in your arteries is best managed by angioplasty and stenting or bypass surgery. The usual indication for such procedures is when your angina is not controlled with medicines alone.
It is often very easy to think that your health is outside of your own control and that only your doctor and some magic drugs are going to keep you well. This is certainly not true. There are many things that you can do to reduce the amount of anginal attacks you may get. There are also important things to do to improve the state of your arteries.
Remember the reason we get angina is because our heart is not getting enough oxygen for its needs. There is a balance between supply and demand which has been upset. To reduce the demands of our heart you might think you should get into a cocoon and not move. However, there are simple things you can do to reduce the demands of your heart.
Things you can do to reduce angina:
If you do require heart surgery, learn more about it in our booklet here.
The Irish Heart Foundation offers a range of free support services to those affected by heart disease or stroke that can greatly improve their quality of life. These include support groups, physical exercise classes, therapy sessions and more.
For more information on these supports, see our Patient Supports page.
If you have any questions about heart disease or stroke, you can also call the Irish Heart Foundation’s Nurse Support on (01) 668 5001 to speak to a nurse specialist who will answer your questions, and give you guidance and reassurance.
Our Step by Step Through Angina booklet further explains the causes, types of angina, how to treat it and improve your heart health, as well as reduce the number of attacks.
To reduce your risk factors, read our articles on Your Heart Health Information that include healthy eating, getting active, high blood pressure, cholesterol, managing your weight, and stopping smoking.
View our page on Angioplasty for helpful advice and information.
View our Step by Step Through Heart Medicines booklet that guides you through the things you should know such as avoiding grape fruit juice.
Have a read of our Step by Step Through Heart Attack booklet to be aware of the signs and ways to reduce your risks.