In the Western world, heart attacks remain one of the most common causes of sudden and premature death. Although some heart attacks come out of the blue, and are the first sign that there is a problem with the heart, many of those affected will have had the warning sign known as angina.
Angina is a pain or feeling of discomfort in the chest caused by the heart muscle not getting enough oxygen.
The pain of angina is usually felt in the centre of the chest, but may spread to the neck or arms (especially the left arm) and is sometimes felt in the shoulders or back. It usually comes on during physical exertion or emotional distress and stops when the exertion or distress ceases. It is often described as a feeling of 'tightness' or 'pressure' and can range in severity from a mild ache to severe pain. In women, angina can be slightly different: the pain can sometimes feel stabbing, pulsating or sharp, and other symptoms, such as nausea, shortness of breath and abdominal pain, are more likely than in men.
Angina occurs because the heart's workload increases dramatically during exercise or stress, requiring the heart muscle to work much harder. To do this the muscle needs oxygen, which is carried in the blood flowing through the coronary arteries. When the blood flow through these arteries is reduced, the heart muscle does not receive enough oxygen, and angina occurs. The most common reason for this reduced blood flow is coronary artery disease (also known as coronary heart disease), when the arteries are narrowed by fatty deposits in their walls (atherosclerosis).
Factors that increase your risk of coronary artery disease and angina include smoking, having diabetes, high blood pressure or high blood cholesterol, taking little exercise, and being overweight. Other risk factors include having a family history of heart disease and getting older (over 45 for men and over 55 for women).
Most people with angina need to have special investigations to see if their coronary arteries are badly narrowed. If this is the case surgery may be needed to bypass the blocked arteries (known as a coronary artery bypass graft). Other procedures, such as insertion of a 'stent', are also available to unblock affected arteries.
Not everyone needs surgery and there are other ways to treat angina. These include tablets taken on a daily basis; patches stuck to the skin; and medicines, known as nitrates, that are used to relieve a sudden attack. Nitrates are sometimes given in the form of a tablet placed under the tongue when angina is felt. They also come in an aerosol spray, which is squirted under the tongue.
Nitrates are very useful in relieving the pain of angina, but can cause temporary side effects. These include headache, flushing and dizziness or a light-headed feeling. If you are using these medicines it is important to sit or even lie down.
If angina is not relieved by your medicines rapidly (within 10 minutes), you should dial 000 to call an ambulance and get to hospital as quickly as possible, in case you are having a heart attack.
Last Reviewed: 16 June 2010