Is Angina a Serious Illness?

What is Angina Pectoris?

Angina pectoris is the medical term given to chest pain caused by a blockage in the coronary arteries. Our coronary arteries are responsible for delivering oxygenated blood to the heart’s muscles, providing it with key nutrients. Over time, lifestyle factors such as a poor diet and inactivity can contribute to plaque buildup, leading to the development of a condition known as coronary artery disease. Because of the plaque build-up, our arteries become narrower, restricting the amount of blood that can flow through them. Consequently, the heart's muscles receive a lower supply of oxygenated blood, causing them to become weaker and us to experience chest pain (angina).  

Types of Angina

Angina pectoris is the general term used for chest pain caused by insufficient blood supply to the heart's cardiac muscle. However, there are different classifications of angina based on their triggers and causes.

Stable angina

Stable angina has been identified as the most common type of angina. Stable angina does not pose any immediate threat to life, however, does act as a warning sign that without medical attention and lifestyle changes more severe cardiovascular conditions may develop. Stable angina pain is most commonly triggered by physical exertion and normally subsides with rest.

Unstable angina 

Whilst less common, unstable angina is considered a more severe condition that requires immediate medical attention. Unstable angina is harder to manage than stable angina and can require surgical procedures in severe cases. Unstable angina does not have any obvious triggers, meaning those who suffer the condition may suffer angina attacks even whilst resting.

Variant angina

You may also see variant angina referred to as coronary artery spasm, vasospastic angina and prinzmetal angina. Variant angina occurs when our coronary arteries go into spasm, causing them to become temporarily narrowed, thus reducing oxygenated blood flow to the cardiac muscles, and causing angina pain.

Microvascular angina

A rare type of angina that is not caused by coronary artery plaque build-up. Microvascular angina can be caused by numerous blood vessel-related issues including spasms, damage to vessel lining as well as increased heart sensitivity. In the first two instances, blood flow to the heart can be restricted, therefore causing chest pain.

Signs and Symptoms

The most commonly experienced symptom of angina is the feeling of pressure, squeezing or tightness in the chest area. The pain that is experienced alongside these symptoms can vary; some may feel higher levels of pain whereas others complain of a dull ache. Below are some of the less common symptoms those with the condition may suffer alongside their angina pain.

  • Chest pain spreads to the neck, jaw, arms or back
  • Ingestion-like pains in the stomach
  • Regularly feeling sick
  • Feeling more tired than usual
  • Sweating
  • Short of breath

Causes and Risk Factors

As previously mentioned, the main cause of angina patients’ chest pains, with the exception of those with microvascular angina, is the buildup of plaque in the coronary arteries. The buildup of plaque can be influenced by a variety of factors, with certain risk factors significantly increasing an individual’s risk of developing coronary artery disease and angina. Below are some of the key factors that can increase an individual’s risk of suffering from angina.  

  • Sedentary (inactive) lifestyle
  • Poor diet
  • Age (45+ at highest risk2)
  • Smoking
  • Stress
  • Diabetes
  • Obesity
  • Hypertension (high blood pressure)
  • High blood cholesterol levels

Is it different for people AFAB than people AMAB?

In short, no. Both people assigned female at birth (AFAB) and male at birth (AMAB) will experience similar chest pains and potentially some of the less common symptoms as a result of their condition. However, research has identified that people AFAB are more likely to suffer from some of the less common symptoms, such as sickness and shortness of breath.

How Serious is Angina?

The severity of an individual’s condition is highly dependent on the type of angina they have, and how well managed it is. Whilst stable angina that is well managed would not be considered serious, unstable angina is classified as a medical emergency3. The following section will go over in greater detail the severity of angina and some of the complications that can arise as a result of the condition.

Complications of Angina

Myocardial infarction - Over a prolonged period of time, the heart muscles become weaker and damaged as a result of the reduced oxygenated blood flow associated with angina and coronary artery disease. As a result of this damage, the British Heart Foundation5 report that those with angina are at an increased risk of myocardial infarction (heart attack).

Heart Failure - As the cardiac muscles become weaker, the heart begins to fail. Consequently, it is unable to pump an adequate amount of blood around the body. Unfortunately, statistics6 emphasize the severity angina can pose, finding that heart failure is present in 11% of angina patients.

Stroke - Due to the increased arterial plaque build-up found within angina patients, strokes occur in 5.4%6 of angina patients within four years of their diagnosis. If plaque build-up occurs in the carotid artery, the artery responsible for transporting oxygen to the brain, the brain may be starved of oxygen, causing a stroke.

Emotional Stress - Due to the fear and anxiety that some experience as a result of their condition, emotional stress disorders such as chronic anxiety and depression are present in 8.8%7 of angina patients. Being diagnosed with a cardiovascular condition can be extremely overwhelming, ensure to regularly seek reassurance and advice from your healthcare provider if you begin to become stressed about your condition.

Can You Die from Angina?

As angina is technically classified as a symptom, it is not normally considered an immediate threat to life. However, as in most cases, angina is a symptom of coronary artery disease, the American Heart Association4 report those who suffer from the condition are at an increased risk of a variety of life-threatening cardiovascular diseases, such as stroke, and myocardial infarction, and heart failure.

Life expectancy with Angina

Recent statistics indicate that the average expectancy in the UK is between 79 and 82.9 years. Previously published research9 states that those with angina may live between 1.5-2 years less than the average life expectancy. This however does not mean that you will definitely lead a shorter life if you are diagnosed with angina. Both the NHS10 and the American Heart Association11 report that those diagnosed with the condition can go on to live long and normal lives provided their condition is well managed.  

Management and Treatment

The treatment and angina management options available to an individual diagnosed with the condition greatly depend on the type and severity of their angina. Below are some of the most commonly utilized methods.

Medication

In the majority of cases, angina patients will be prescribed a variety of medications to help treat their condition. Below are some of the most commonly prescribed medications.

Glyceryl Trinitrate (GTN)

A spray/tablet that can help reduce the amount of pain suffered during an angina attack.

Nitrates

Cause the blood vessels to relax and widen, increasing coronary blood flow to the heart's cardiac muscles

Beta-Blockers

Causes the heart to beat slower and with less force, by suppressing the effects hormones, such as adrenaline, have on it.

Aspirin

Slows the rate of blood clots, reducing the risk of arteries from becoming narrowed further as a result of blood clotting.

Lifestyle Changes

Alongside medication, research12 has shown that leading a healthier lifestyle post-diagnosis helped reduce the severity and frequency of patients’ angina attacks, particularly those with stable angina. Below details some of the most effective lifestyle changes angina patients can make:

  • Lead a more active lifestyle
  • Consume a healthy and balanced diet
  • Limit saturated fat, sugar and alcohol consumption
  • Practice stress management and relaxation techniques
  • Avoid smoking and drug usage

Surgery

In severe cases, angina patients may need surgery to prevent more severe health implications such as heart attacks and strokes. Below are details of the two main types of surgery performed on those with angina: 

  • Coronary Angioplasty and Stent Insertion - A small tube called a stent is placed within the narrowed section of an artery, helping widen it and increase blood flow.
  • Coronary Artery Bypass Graft - Blood flow is redirected around the blocked or narrowed part of an artery using a blood vessel taken from another part of the body.

Prevention

For those who do not have angina or symptoms of coronary artery disease, leading a healthy lifestyle can significantly reduce the risk of developing angina as well as a wide variety of other chronic health conditions. Below details some of the angina prevention methods that have been proven to be most effective.

  • 150 minutes of weekly aerobic exercise (walking, cycling, jogging, swimming)
  • Consume a diet low in saturated fats and sugars
  • Regularly consume your 5 a day
  • Practice stress management and relaxation techniques
  • Quit smoking

When to See a doctor

Knowing when to see a doctor and when to call for an ambulance is vital information that could potentially save your or a loved one’s life. If you suffer from any of the following conditions, contact your medical provider for an appointment as soon as possible.

  • Chest pain that subsides with rest
  • Chest tightness or sensation of tightness and squeezing
  • Feeling lightheaded or nauseous after physical activity

If you or someone around you suffers from any of the following symptoms, they could be suffering from a heart attack or stroke. In the event of the following, ring 999/991 immediately.

  • Chest pain that lasts longer than 5 minutes
  • Extreme chest discomfort
  • Chest pain that spreads to arms, neck, back and jaw
  • Vomiting or nausea
  • Feeling very lightheaded, dizzy or loss of consciousness

Summary

To summarize, whilst angina alone is not a serious condition that poses an immediate threat to life, it should be taken as a serious warning that without medical attention and healthy lifestyle changes, a more severe cardiovascular condition could be imminent. If you suffer regularly from some of the angina symptoms discussed above, ensure to contact your healthcare provider for an appointment as soon as possible.

References

  1. Patel, Harshida, et al. ‘Symptoms in Acute Coronary Syndromes: Does Sex Make a Difference?’ American Heart Journal, vol. 148, no. 1, July 2004, pp. 27–33. PubMed, https://doi.org/10.1016/j.ahj.2004.03.005
  2. Rodgers, Jennifer L., et al. ‘Cardiovascular Risks Associated with Gender and Aging’. Journal of Cardiovascular Development and Disease, vol. 6, no. 2, Apr. 2019, p. 19. PubMed Central, https://doi.org/10.3390/jcdd6020019
  3. Angina. https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/angina
  4. ‘Coronary Artery Disease - Coronary Heart Disease’. Www.Heart.Org, https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/coronary-artery-disease
  5. Angina - Causes, Symptoms & Treatments. https://www.bhf.org.uk/informationsupport/conditions/angina
  6. Eisen, Alon, et al. ‘Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry’. Journal of the American Heart Association, vol. 5, no. 10, p. e004080. ahajournals.org (Atypon), https://doi.org/10.1161/JAHA.116.004080
  7. Tsai, Ching-Ching, et al. ‘The Association between Psychological Distress and Angina Pectoris: A Population-Based Study’. PLoS ONE, vol. 14, no. 11, Nov. 2019, p. e0224451. PubMed Central, https://doi.org/10.1371/journal.pone.0224451
  8. National Life Tables – Life Expectancy in the UK - Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020
  9. Clarke, Robert, et al. ‘Survival in Relation to Angina Symptoms and Diagnosis among Men Aged 70-90 Years: The Whitehall Study’. European Journal of Cardiovascular Prevention and Rehabilitation: Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, vol. 14, no. 2, Apr. 2007, pp. 280–86. PubMed, https://doi.org/10.1097/01.hjr.0000214602.68619.05
  10. ‘Angina - Living With’. Nhs.Uk, 23 Mar. 2018, https://www.nhs.uk/conditions/angina/living/
  11. What Is Angina | Heart Foundation. https://heartfoundation-prod.azurewebsites.net/conditions/angina
  12. Winchester, David E., and Carl J. Pepine. ‘Angina Treatments and Prevention of Cardiac Events: An Appraisal of the Evidence’. European Heart Journal Supplements : Journal of the European Society of Cardiology, vol. 17, no. Suppl G, Dec. 2015, pp. G10–18. PubMed Central, https://doi.org/10.1093/eurheartj/suv054
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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George Evans

MSc, Sport Science, University of Lincoln

George is a freelance writer with three years of writing experience and first class honours in Sport Science (BSc).

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