Angina: symptoms, causes, treatment and when to call 999

The NHS says the main symptom of angina is sudden pain in the chest, neck, shoulders, jaw or arms. The pain may feel like tightness, squeezing or pressure, or like a dull ache, and may make you feel sick, breathless, dizzy or sweaty. These symptoms may be called an angina attack, episode or pain.

The BHF adds that angina can also be felt in the stomach or back, and that other symptoms can include fatigue. It says that both men and women can have the same symptoms, but women are more likely than men to have less common symptoms such as feeling sick, sweaty, dizzy and breathless.

Attacks are often brought on by exercise, stress, emotion or cold temperatures, although sometimes there is no obvious trigger. The BHF says eating a big meal can trigger angina, and that people sometimes confuse angina with indigestion. It also says panic attacks or anxiety can cause chest pain which is not angina.

The BHF describes angina, sometimes called angina pectoris, as a pain or an uncomfortable feeling when blood flow to the heart is reduced. It says angina is a symptom rather than a disease, that it is not dangerous in itself, but can be a sign of a heart problem such as coronary heart disease.

The NHS explains that angina happens when the heart does not get enough blood. This is usually due to coronary heart disease, where the blood vessels supplying blood to the heart become narrowed or blocked by fatty deposits. It can also be caused by the blood vessels in your heart tightening when they should not (vasospastic or microvascular angina).

The BHF describes several types of angina. It is important to know the difference, because unstable angina needs urgent help.

The NHS says that if you have been diagnosed with angina and get chest pain you should stop what you are doing and rest, use any medicine you have been prescribed (usually glyceryl trinitrate, GTN), take another dose after 5 minutes if the first dose does not help, and call 999 for an ambulance if you still have symptoms 5 minutes after the second dose.

The NHS says to call 999 now if you have been diagnosed with angina and have chest pain that does not stop after resting for a few minutes or after taking your angina medicine; you get sudden pain or discomfort in your chest that does not go away (squeezing, pressure, burning or indigestion); you get pain that spreads to your left or right arm, neck, jaw, shoulder, stomach or back; or you have chest pain and feel sweaty, sick, light-headed or short of breath. You could be having a heart attack. Do not drive yourself to A&E.

The NHS says to get help from NHS 111 if you have chest pain or other symptoms of angina that come and go, or if you have been diagnosed with angina and it feels worse than before, is happening more often, lasts longer or happens when you are resting.

The NHS says that if you have angina you may be given medicine to treat an attack if you have one (glyceryl trinitrate), to lower your chances of having an attack, such as beta blockers, and to reduce your risk of having a stroke or heart attack, such as low-dose aspirin or statins. Sometimes you may be recommended surgery to increase blood flow to the heart: coronary angioplasty or a coronary artery bypass.

The BHF says medicines such as nitrate sprays, patches and pills may help control symptoms. In a coronary angioplasty a special kind of balloon is gently inflated to open a narrowed artery, and many people also have a stent, a type of mesh, inserted to keep the artery open. Heart bypass surgery may also be an option. NICE guideline CG126 covers managing stable angina in people aged 18 and over, including the roles of medical therapy and revascularisation.

The NHS says that with treatment the symptoms should improve over time and may eventually stop. Having angina means you are at higher risk of having a heart attack or stroke, so it is important to treat it and make healthy lifestyle changes.

The NHS says there are things you can do to help symptoms or reduce the chance of attacks, and that if symptoms are well controlled angina will not usually have a big impact on your life. You will usually be able to continue with most things, including exercise and sex.

• Avoid things that trigger your angina as much as possible, like stress, cold temperatures or eating large meals.

• Always have your angina medicine with you and use it as you have been told.

• Try to quit smoking if you smoke.

• Try to keep to a healthy weight and eat a balanced diet.

• Have the most active lifestyle your symptoms will allow.

• Try to cut down on alcohol if you drink more than 14 units a week.

• Speak to your doctor before you take up a new activity or if you are worried about exercising.

• Ask your doctor whether you need to inform the DVLA, especially if you drive buses, coaches or lorries.

The most common cause is coronary heart disease, according to the BHF and NHS. The BHF says the arteries that supply the heart muscle with blood and oxygen are narrowed by a fatty substance called plaque.

The NHS says you are more likely to get angina if you are a man aged 45 or over or a woman aged 55 or over; smoke; drink more than 14 units of alcohol a week; are living with obesity or overweight; have high blood pressure or high cholesterol; have had heart problems before such as a heart attack or arrhythmia; have close relatives with heart problems; or have another condition such as diabetes, arthritis or kidney disease. The BHF says angina is not an inherited condition but a strong family history can increase your chance of developing a heart condition.

The BHF says your doctor may be able to tell whether you have angina from your symptoms, or may want to do a health check or send you for tests such as an ECG, a coronary angiogram or a heart scan.

The NHS says that if a GP thinks you may have angina you will be referred to a heart specialist (cardiologist). You may have blood tests, an electrocardiogram (ECG) to check the electrical activity of the heart, a check of the level of oxygen in your blood, and scans such as an angiogram, MRI scan or CT scan.

On the NHS, new chest pain is assessed by a GP or by 111 and, if it could be angina, by a cardiologist, who arranges tests and treatment. The NHS says to see a GP as soon as possible if you think you may have angina.

Private cardiology consultations and heart scans are also available, for example for a quicker ECG or CT coronary angiogram. Whichever route you use, chest pain that does not settle after rest is an emergency and needs 999, not an appointment.