Angina

Chest pain from a heart not getting enough blood. A warning that arrives before the heart attack, if it is heeded.

What it is

Angina is chest pain or tightness caused by narrowed coronary arteries. The heart muscle gets enough blood at rest and not enough under exertion, so pain arrives with effort and settles with rest.

Around 2 million people in the UK live with it. It is not a heart attack: the muscle is starved, not dying. But it is the same disease process, and it is the clearest warning anybody gets.

Stable angina is predictable: the same amount of exertion produces the same symptom. Unstable angina is not, and that change is what should send somebody to hospital.

Women, people with diabetes and older people frequently present atypically: breathlessness, fatigue, jaw or back pain, or nausea rather than classic chest tightness. That is a major reason heart disease is under-diagnosed in women.

Signs you might notice

Tightness, heaviness or pressure in the chest, brought on by exertion, cold, heavy meals or emotion, and relieved by rest.

Pain spreading to the arm, neck, jaw, back or stomach.

Breathlessness with the pain.

Relief within a few minutes of GTN spray.

Unstable angina: pain at rest, pain lasting longer, pain coming on with less exertion than before, or pain not relieved by GTN. That is a 999 call.

How it can affect day-to-day life

Fear of provoking pain leads people to reduce activity, which worsens fitness, which lowers the threshold for pain. Cardiac rehabilitation exists to break that cycle and is under-attended.

GTN spray technique and expectations matter: many people do not know they can use it before exertion, preventively.

Secondary prevention medication is often incompletely taken because it treats a risk rather than a symptom.

Supporting someone well

Learn the GTN rule and write it down: sit down, one spray, wait five minutes, repeat, wait five minutes, then call 999 if the pain persists.

Use GTN before exertion known to trigger it.

Attend cardiac rehabilitation. It reduces mortality and it is free.

Take secondary prevention medicines every day: statin, antiplatelet, blood pressure treatment.

Know the escalation: any change in the pattern is unstable angina until proved otherwise.

Do not dismiss atypical symptoms in women and older people.

Where to get help

A GP can refer to a rapid access chest pain clinic for new symptoms.

Call 999 for pain at rest, pain lasting more than 15 minutes, or pain not relieved by GTN.

British Heart Foundation helpline: 0808 802 1234.