Stable angina: symptoms, GTN, tests and treatment

The British Heart Foundation (BHF) describes angina as a symptom: a pain or uncomfortable feeling when blood flow to the heart is reduced. It is not a disease in its own right, 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, usually because the coronary arteries are narrowed or blocked by fatty deposits, though the blood vessels can also tighten when they should not (vasospastic or microvascular angina).

Stable angina is the most common type. It tends to occur when the heart works harder, for example walking uphill, and settles when you rest. You usually know when it is likely to happen and the discomfort resembles what you have had before. Unstable angina is different: it can happen at rest, feels more severe, lasts longer and may not improve with rest or medicine, which is why it is treated as an emergency.

The NHS says the main symptom is sudden pain in the chest, neck, shoulders, jaw or arms that may feel like tightness, squeezing or pressure, or a dull ache, and may make you feel sick, breathless, dizzy or sweaty. The BHF adds that it can be felt in the back or stomach, that it may bring fatigue, and that both men and women can have the classic pain, although women are more likely to have less common symptoms such as feeling sick, sweaty, dizzy and breathless, and microvascular angina.

Common triggers are exercise, stress, emotion and cold temperatures, though sometimes there is no clear trigger. A big meal can also trigger angina, and the BHF notes people sometimes confuse angina with indigestion. It also points out that panic attacks and anxiety can cause chest pain that is not angina, because anxiety is not caused by a problem with blood flow. If you are not sure, treat chest pain as potentially cardiac and seek advice.

• Tightness, pressure or squeezing in the chest.

• Spread to arms, neck, jaw, shoulders, back or stomach.

• Breathlessness, sweating, nausea or dizziness.

• Brought on by exertion, stress, cold or large meals.

• Eases within minutes of resting or using GTN.

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

The NHS says to call 999 now if your chest pain does not stop after resting for a few minutes or after your angina medicine, or if you get sudden pain or discomfort in your chest that does not go away, pain spreading to the arm, neck, jaw, shoulder, stomach or back, or chest pain with sweating, sickness, light-headedness or breathlessness, because you could be having a heart attack. Do not drive yourself to A&E. Get help from NHS 111 if you have chest pain or angina symptoms that come and go, or if your angina feels worse than before, is happening more often, lasts longer or occurs at rest.

The BHF says a doctor may be able to tell from your symptoms, or may arrange tests such as an ECG, a coronary angiogram or a heart scan. According to the NHS, if a GP thinks you may have angina you will be referred to a cardiologist, and tests may include blood tests, an electrocardiogram (ECG), checking the level of oxygen in your blood, and scans such as an angiogram, MRI or CT scan.

Risk factors listed by the NHS include being a man aged 45 or over or a woman aged 55 or over, smoking, drinking more than 14 units of alcohol a week, living with obesity or overweight, high blood pressure or high cholesterol, previous heart problems, close relatives with heart problems, and conditions such as diabetes, arthritis or kidney disease. The BHF clarifies that angina itself is not inherited but a strong family history raises the chance of heart conditions.

The NHS says medicines can treat an attack (GTN), lower the chance of attacks (for example beta blockers) and reduce the risk of heart attack or stroke (low-dose aspirin or statins). Surgery or procedures to increase blood flow, coronary angioplasty or a coronary artery bypass, may be recommended for some people. The BHF adds that angioplasty uses a balloon to open a narrowed artery and often a stent to keep it open, and that nitrate sprays, patches and pills may help control symptoms.

The NHS suggests avoiding triggers such as stress, cold and large meals, always carrying your angina medicine, trying to stop smoking, keeping to a healthy weight, eating a balanced diet, being as active as your symptoms allow and cutting alcohol if you drink more than 14 units a week. Eating smaller portions more often may help if meals trigger angina, according to the BHF.

The NHS says having angina puts you at higher risk of a heart attack or stroke, so treatment and lifestyle change matter. With treatment, symptoms should improve over time and may eventually stop, and if they are well controlled angina will not usually have a big impact on life: you can usually continue most things including exercise and sex. It may affect work if the job is physically demanding or involves driving buses, coaches or lorries, and your doctor will say whether you need to inform the DVLA. Speak to your doctor before taking up a new activity.

Practical points include always carrying medicine, keeping a spare supply and checking that GTN is in date. Cardiac rehabilitation programmes may be offered to some people, and the NHS and BHF both provide support.

The NHS route is GP assessment, referral to a rapid access chest pain clinic or cardiologist, tests, and a treatment plan involving medicines first and procedures if symptoms persist or tests show higher-risk disease. Waiting times vary by area.

Private cardiology can offer quicker access to ECG, exercise testing, CT coronary angiography or invasive angiography. The clinical decisions are the same, and anyone with new, worsening or resting chest pain should use the emergency routes rather than waiting for a private appointment. Ask what each test will add and how results will be shared with your GP.