In most cases angina is caused by coronary artery disease, a conditions that occurs when fatty deposits build up under the lining of the blood vessels supplying blood to the heart muscle. As a result, these arteries become narrowed and blood flow to the heart muscle is reduced. Angina occurs when the blood flow to the heart muscle is insufficient for the extra demands made on it, eg, with exercise. There is no damage to the heart muscle from an episode of angina
Angina can affect people in different ways, and the symptoms may differ at various times. Angina is usually felt across the centre of the chest, but may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in the hands. Some people experience it in only one of these areas and not in the chest at all.
Angina is usually brought on by exertion, emotion, a heavy meal, or cold weather. Angina can 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.
Angina symptoms, regular patternIf you get angina at predictable times (eg, cold temperatures, walking up hills, mowing lawns, while showering, during sexual activity, while at work), use your spray or tablets a few minutes before attempting that activity. If you are experiencing angina symptoms every day, consult your doctor so that further treatment can be planned.
Change in angina symptomsIf the pattern of your angina symptoms changes significantly in one or more of the following ways: frequency, severity, more prolonged, occurs when you're doing very little or are resting, see your doctor within 24 hours (continue to use your medication in the meantime). If the angina is not relieved after three doses in 10 to 15 minutes, call an ambulance – dial 111 immediately.
The most common medications for managing angina are beta-blockers and nitrates, which relax the blood vessels, opening them wider so blood can flow more freely.
There are two types of nitrate:
To confirm a diagnosis of angina, your doctor may arrange further tests, eg, heart monitoring while you exercise.
Glyceryl trinitrate spray, eg, Nitrolingual, delivers a measured dose of nitrate into your mouth. The spray droplets are absorbed quickly, giving an almost immediate effect. Do not shake the canister, hold it upright and spray one or two puffs on or under your tongue, then close your mouth. If angina is not relieved after three doses within 15 to 20 minutes, call an ambulance. If you have not used your spray recently, be sure it still sprays.
Glyceryl trinitrate given in tablet form, eg, Lycinate, is absorbed into the bloodstream from the lining of the mouth. The tablet does not work if it is swallowed whole. A quarter or half a tablet may be enough to relieve your angina. Place the tablet under your tongue, letting it dissolve (for a more rapid effect chew the tablet and let the pieces dissolve in your mouth). If angina is not relieved after three doses within 15 to 20 minutes, call an ambulance.
Nitrate skin patches are the longest acting forms of nitrates and are absorbed through the skin. Put the patch on smooth, unblemished skin on the body trunk, or upper arms or legs, avoiding skin folds and using a different area of skin each time. Apply a patch at the same time each day or as prescribed by your doctor.
After a shower or bath, wait until your skin is completely dry before attaching the patch. If the patch gets wet while swimming or bathing, that is okay (water will not stop it working). Store spare patches at room temperature and change as prescribed.
There is a variety of long-acting tablets that your doctor may prescribe. These medications are absorbed through the stomach instead of the mouth and have a longer-acting effect.
Beta-blocker medication reduces the frequency of angina attacks. They slow your heart rate, letting the heart pump more efficiently which results in improved physical activity levels.
Calcium antagonists are further medication options for preventing angina symptoms. Calcium antagonists help to relax the arteries, allowing more blood to flow through so that the heart beats more efficiently. All of these medications are prescribed by your doctor.
GTN spray and tablets can sometimes cause flushing, headaches, a feeling of fullness in the head, dizziness or palpitations. They may also cause a burning or tingling feeling in your mouth. If you are using GTN tablets it may help to take a quarter to half a tablet or to spit it out once symptoms are relieved.
These medications temporarily lower your blood pressure, so you may feel a bit faint when using them for the first time, if you take too large a dose or if you use them when you are hot (eg, after a shower). It is best, therefore, to be seated when taking them for the first time. If taking longer-acting medications and experiencing these side effects, discuss them with your doctor.
Despite some side effects, these drugs are safe and are not habit-forming. You can drink alcohol while taking them, but it may increase the chances of side effects (faintness and dizziness). Discuss any concerns about side effects with your doctor.
It is important that you always have sufficient medication with you and that it is not old or damaged. Follow instructions for use and storage carefully.
Coronary artery bypass surgery or angioplasty (opening up the arteries with a special balloon) can also help control angina. An x-ray of the coronary arteries (coronary angiography) is used to decide whether surgery or angioplasty is appropriate.
Everyone who has angina should benefit from developing healthy heart habits. Dealing with angina is not just a matter of dealing with the symptoms. Risk factors for coronary heart disease include raised blood pressure, smoking, raised blood cholesterol, diabetes, excess weight and lack of physical activity.
To improve your heart health:
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.
Angina NHS ChoicesAngina section Medline PlusAngina – explained Watch, Learn, Live: Interactive Cardiovascular Library – American Heart Association