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What is angina?
Angina is an uncomfortable feeling or pain in the chest. It usually feels like a heaviness or tightness in the centre of the chest which may spread to the arms, neck, jaw, back or stomach. In some people, the pain or tightness may affect only the arm, neck, stomach or jaw. Some people describe angina as a dull, persistent ache. Symptoms usually fade within about 10 to 15 minutes. For some people the tightness is severe; for others it is not much more than mild discomfort.

What brings on an angina attack?
Angina can be brought on by physical activity or emotional upset. It often comes on when you are walking. If you are walking after a meal, the angina may be triggered more easily. You may sometimes get an attack of angina while you are resting, or it may even wake you when you are asleep.

Stable angina and unstable angina
Many people have angina that comes on with a particular amount of exercise, and is well controlled with drugs. This is known as stable angina.

Unstable angina
Unstable angina is angina which has just developed for the first time, or angina which was previously stable but has recently got worse or changed in pattern. For example, your angina pain may come on after doing much less exercise or after less stress than usual, or it may even come on while you are resting. If the pattern of your angina changes in this way, tell your doctor about it immediately, as you may need to go to hospital for some tests and treatment.

What to do if you get an angina attack
If you get an attack of angina, you should stop what you are doing and rest until the discomfort has passed. You may also need to take medication to relieve the discomfort. Most people are prescribed a nitrate tablet or a spray for under the tongue to relieve angina.

What causes angina?
The muscle of the heart needs its own supply of oxygen and nutrients so that it can pump blood around your body. The coronary arteries deliver oxygen-rich blood to the heart’s muscle. Two main coronary arteries (the left and the right) divide many times so that the blood reaches all the parts of the heart’s muscular wall.

The coronary arteries can become narrowed by a gradual build-up of fatty material within their walls. (This process is called atherosclerosis and the fatty material is called atheroma.) In time, the artery may become so narrow that it cannot deliver enough oxygen-containing blood to the heart muscle when its demands are high – such as when you are doing exercise. The pain or discomfort that happens as a result is called angina. You are particularly likely to develop atherosclerosis if:

• you smoke any form of tobacco
• you have high blood pressure
• you have a high blood cholesterol level
• you take little physical activity, or
• you have diabetes.

Other risk factors are being overweight or obese, and having a family history of relatives having a heart attack or angina before the age of 55 for a man or 65 for a woman. (A ‘risk factor’ is something that increases your risk of developing atherosclerosis).

How will I know if it’s angina?
The most common cause of chest pain is narrowed coronary arteries, but many chest pains or discomfort have nothing to do with the heart. Short, sharp stabbing pains are often muscular pains. Some people get a dull, persistent ache under the left breast when they are tense or anxious. Indigestion can also cause pain in the centre of the chest, but this is usually related to food rather than exercise. Severe anaemia can also cause chest pain. If you have a chest pain that you are worried about, it is important to talk to your doctor about it.

What’s the difference between angina and a heart attack?
A heart attack happens when a narrowed coronary artery becomes blocked by a blood clot. The chest pain that comes with a heart attack is sometimes more severe than angina. Also, it usually lasts longer and it doesn’t usually go away with rest. You may sweat and feel sick. A nitrate tablet or spray, which are usually very effective in relieving angina, may not help. Unusual indigestion symptoms which do not get better after taking medication may be a heart attack.

How can doctors diagnose angina?
Your GP may be able to tell if you have angina from the symptoms you describe. However, it is harder to diagnose angina in women than in men. The GP will listen to your heart to check its rate and rhythm, and will assess your general condition. He or she will also carry out tests to assess your risk factors, such as a test for diabetes and a blood cholesterol test. (A blood cholesterol test measures the level of cholesterol and other fats in your blood.) Your doctor may also send you for one or more specific tests on the heart.

These include:
• an electrocardiogram (ECG) or an exercise ECG
• a stress echocardiogram
• a radioisotope scan
• a coronary angiogram (cardiac catheterisation).

Some people may have an MRI scan or a CT scan. All these tests are usually carried out in hospital as a day case (which means that you don’t have to stay overnight).

How is angina treated?
Most people who are diagnosed with angina will have drug treatment at first, but some people will need coronary angioplasty or coronary bypass surgery. The treatment you are offered will depend on how severe your angina is, whether the angina is stable or unstable, and your overall condition.

      Doctor Tips
Angina is an uncomfortable feeling or pain in the chest.
It usually feels like a heaviness or tightness.
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