Symptoms and Causes of Angina

What does angina feel like?

Angina is typically felt as discomfort in the middle of the chest that can be brought on by effort, exercise, strong feelings or even a cold wind and goes away with rest.

It may start off as a dull pain or ache.  It has been described as heaviness, burning, tightness, constriction or squeezing sensation, a heavy weight or pressure.  Angina can also cause breathlessness, more than you would expect with exercise or even when resting.  In some people angina can feel very similar to indigestion or heartburn.

 

Picture of Angina Spread

Angina pain may spread to the throat or neck, to the jaw, to the shoulders, to the left or right arm or both (going down the inside of the arms) and sometimes to the back or stomach.  Occasionally, angina pain occurs in one of these places without chest pain, for example, pain in the arm, which is relieved by resting.

 

What is angina?

Angina is a symptom - it is the heart complaining that it is not getting sufficient oxygen and does not result in permanent damage to your heart.  It usually passes when you stop the activity that brought it on or after taking medication to relieve the pain of angina. This is called stable angina.

 

What is unstable angina?

Unstable angina is when angina attacks occur more frequently.  Attacks may even occur at rest or wake you from sleep.  This may be an indication of a worsening condition and you should see your doctor urgently.

Main coronary arteries of the heart

What causes angina?

Like any other muscle, the heart requires it's own blood supply to provide the oxygen and nutrients it needs.  It gets this supply through three main coronary arteries.

In some people, a fatty deposit builds up in the lining of the arteries throughout the body, over a number of years.  This deposit narrows the artery and eventually reduces the amount of blood that can get through.  This deposit is called ‘atheroma’.

Picture of atheroma

When this build up of atheroma affects the coronary arteries it is called ‘coronary artery disease’ or ‘coronary heart disease’ (CHD for short).

When we make demands on the heart by increasing the heart rate during activity for example, the narrowed arteries cannot supply the heart muscle with oxygen quickly enough and pain develops. This is the heart’s way of telling us that we need to take a rest.


What causes coronary heart disease?

You are more likely to develop coronary heart disease if you:

  • smoke cigarettes (or cigars regularly)
  • have high blood cholesterol level
  • have high blood pressure
  • do not get enough exercise
  • are diabetic
  • unhealthy diet
  • are overweight
  • drink too much alcohol
  • have a family history

These are risk factors which increase the risk of developing CHD or make it worse. The risks don’t just add, they multiply.


What is the difference between angina and a heart attack?

Angina occurs when the heart cannot get enough oxygen because of a narrowed coronary artery.  A heart attack happens when the artery becomes completely blocked by a blood clot.  The chest pain that occurs with a heart attack will not go away with GTN tablets/spray or with rest within 15 minutes.  There may be other symptoms such as feeling sick and sweating.  A heart attack is a medical emergency and you should phone 999 if this happens to you. 


The information on this page has been adapted from the CHSS leaflet "Living with Angina"