Understanding angina

What usually causes angina attack

Angina occurs when the blood flow that supplies your heart muscle becomes limited. This is usually due to coronary heart disease (CHD), in which the coronary arteries feeding your heart with blood are narrowed, due to the formation of fatty plaque deposits. These fatty substances are formed in response to blood vessel injury due to strain, commonly caused by high blood pressure. 

Reduced blood flow causes stress to the muscular walls responsible for heart pumping. This is because blood carries oxygen and nutrients, both vital in granting muscles enough energy to contract. This deficit will manifest into angina’s main symptom, chest pain.¹ 

Angina does not permanently damage your heart muscle because episodes will last for only short amounts of time before recovery. However, the same arterial narrowing that causes angina will cause heart attacks too. A heart attack happens when these arteries become completely blocked, causing the sudden inhibition of blood flow to the heart, leading to cardiac arrest. Angina can be thought of as a risk factor with each attack being a warning for a future major cardiovascular event.

Symptoms of angina

Symptoms of angina can vary from patient to patient.² However, they often include:

• Heavy chest pain or discomfort (often a burning sensation likened to indigestion)
• Pain that spreads to your arms, neck, jaw, abdomen or back
• Nausea
• Breathless
• Dizziness
• Sweating

What will you do during angina attack

Upon experiencing symptoms of an angina attack, stop what you are doing, sit down, and rest until the pain passes. Try and stay as calm as you can. Angina is often brought on by physical exertion or stress, so it is important to relax your body. This also diminishes the chances of falls due to the dizziness that an episode can bring. 

If you have not been previously diagnosed with angina and your chest pain passes in after a few minutes, still arrange an urgent GP appointment for help and a diagnosis. If the pain does not pass after five minutes, an ambulance should be called as this is a sign of a heart attack. Upon experiencing this ongoing pain, after calling 999, stay resting, and if you are not allergic, chew one aspirin tablet to ease and reduce the effects of a heart attack.

When to call an ambulance during angina

Warning signs

The symptoms of angina and a heart attack can overlap, with both events causing gripping chest pain. Due to one of these events being relatively harmless and the other very dangerous, it is important to know the small distinctions between the two and when to act fast.

Angina chest pain is normally short-term, therefore if the pain goes on for over five minutes, contact an ambulance immediately, as you may be having a heart attack. If you have already been diagnosed with angina or CHD, and these pains aren’t as surprising, you should be able to manage your angina with prescribed nitrate medicines (GTN, glyceryl trinitrate) to ease an attack. If this does not ease the discomfort, or you notice worsening symptoms, contact 999.³

Prevention and treatments

You can treat angina with nitrate-containing medicines (GTN spray, ointment, patches, tablets) to prevent an angina attack from occurring, or you can take them during an attack to reduce symptom severity. 

Nitrate medicines are fast-acting vasodilators meaning they widen your blood vessels. If your blood vessels are widened, they can transport blood efficiently to the heart where it is needed to compensate for a narrowed angina-causing vessel region. You can also surgically treat CHD-narrowed arteries to increase blood flow to the heart by widening them with a stent or balloon during coronary angioplasty. Alternatively, you can treat angina by undergoing heart bypass surgery. In this procedure, the narrowed blood vessels are compensated for by rerouting the blood flow around the blocked artery, so the heart still gets a constant supply of blood.⁴ 

A good way to prevent angina or to improve your symptoms and take your diagnosis into your own hands is to change your lifestyle. CHD is the major cause of angina, which is a multifactorial phenomenon of which environmental triggers include:

• Smoking
• Dehydration
• High cholesterol
• Unhealthy diet
• Diabetes
• Immobility 
• Stress
• Drinking excess alcohol
• Getting little sleep

These risk factors contribute to the formation of arterial fatty plaques and the narrowing of arteries. Despite the multitude of risk factors for CHD, we can change these facets of our lifestyle ourselves to strive for a healthier routine without medication or interruption to our day-to-day lives.

Summary

With proper awareness, medicines to treat attacks and healthy lifestyle changes, angina is not a dangerous condition and one can live a normal life with the disease. It must be emphasised that increased knowledge on the distinction between angina and a serious cardiac event is the only way a patient can be vigilant towards their cardiac health and can know when to act quickly when they or a loved one is experiencing such an event. This article aimed to help towards this.

Furthermore, angina is often a warning sign for cardiac emergencies as the arterial narrowing that causes them has the potential to worsen and become full arterial blockages. This key fact should prompt angina patients to contact their doctors for preventative treatments and help with achieving a healthy diet and lifestyle. To prevent angina and heart problems in general, we can limit the probability of arteries narrowing by cutting down on environmental risk factors.