Suffering from chest pain? Here's what you should know about angina

Angina is not pleasant and, if you’re suffering, it can also cause anxiety. Find out about causes, treatment and prognosis.

angina chest pain
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Experiencing chest pain can be alarming. Any chest pain should be investigated by a medical professional – if you feel it’s non-urgent, make an appointment with your GP.

One possible cause of your chest pain could be angina. We spoke with Dr James Spratt, Consultant Interventional Cardiologist at London Bridge Hospital (part of HCA Healthcare UK), to find out more about what causes angina, plus how it’s treated.

What is angina?

Angina describes the sensation of chest pain or equivalent (it can also be experienced as breathlessness) felt when there is an imbalance between the energy required by the heart and the energy that’s actually supplied. This is why it’s usually felt during exercise, as the amount the heart beats increases with exercise and stress.

Angina causes

The most common cause of angina is coronary artery disease, which leads to a build-up of plaque in coronary arteries, which in turn impedes flow.

Angina can also be caused by problems in the function of smaller arteries (arterioles), leading to similar symptoms but different treatments (primarily medication).

Angina risk factors

Coronary artery disease (the most common cause of angina) is a chronic inflammatory condition. Contributing factors include:

    Many of these causes are inter-related. For example, a high-sugar diet can lead to obesity, diabetes and chronic inflammation.



    Angina symptoms

    The most specific symptom of angina is limitation in exercise tolerance, usually due to crushing chest pain (also described as chest tightness).

    Angina is also frequently associated with breathlessness (which can occur in isolation, without the chest pain).

    Angina diagnosis

    Angina is described as a ‘clinical syndrome’. This means it requires a history consistent with angina, as well as confirmatory tests.

    These tests may include an exercise tolerance test – a treadmill walk while wired to an ECG (heart leads), or an equivalent ‘functional test’. A functional test can determine whether the heart is short of blood under conditions of stress and can be performed by echocardiography (ultrasound scan), MRI or CT scanner.

    Sometimes, an anatomical test is also required. This can either be non-invasive, such as a CT scan, or invasive, such as a coronary angiogram.

    Which test is most suitable for you will depend on your individual characteristics and should be discussed with your cardiologist.



    Angina treatment

    If you are diagnosed with angina, there are a number of treatment options:

    Lifestyle changes

    Your doctor will likely advise you to reduce your risk factors. This will include:

    • following a sensible weight-loss program
    • increasing your intake of vegetables and fruit
    • reducing your intake of sugar and trans fats
    • stopping smoking
    • exercising more regularly

      Medication and revascularisation

      Angina can be treated exclusively with medication, or by a combination of medication and revascularisation, which improves blood flow to the heart muscle. Revascularisation can either be via coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).

      PCI is much less invasive, with patients recovering much more quickly. It is now the preferred revascularisation method for most patients.

      Which mode of revascularisation is right for you can be discussed with your cardiologist and, if necessary, a surgeon.

      It is important to appreciate that not all cardiologists will be able to treat all types of coronary artery disease and that specialist input may be required.

      angina chest pain
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      What else could it be?

      Angina can be mistaken for any condition that limits exercise tolerance due to chest pain and breathlessness. This includes conditions such as:

        The symptoms of angina can also be made worse by co-existent conditions, such as anaemia, hyperthyroidism or infection.

        Does angina mean you are more susceptible to heart attack or stroke in the future?

        Unfortunately yes – if the cause of your angina is coronary artery disease, then there is an increased risk of a heart attack or other vascular disease, such as a stroke.

        The good news is that medication is highly effective at reducing this risk and that, when combined with revascularisation and lifestyle changes, prognosis can be very good.




        Last medically reviewed: 19-06-2020

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