Angina or angina pectoris refers to a pain in the centre of the chest that comes from the heart.

You experience a pain in the centre of the chest, which may also travel into the neck, jaw, and arms (especially the left). Angina is usually described as a crushing, heavy, or gripping pain. It mostly follows exercise, but may also be triggered by emotion, digesting a heavy meal, or going out in a cold wind. Sometimes you may also feel breathless.

Angina is rather similar to cramp in a muscle during vigorous exercise. It is caused by the muscles of the heart not receiving enough oxygen (via the blood) for the work they are performing. This is because the blood vessels that supply the heart muscles with oxygen have become narrowed. The main cause of narrowing of the blood vessels is age, but this is accelerated by cigarette smoking. To a lesser extent people with a high cholesterol level, people who are obese (overweight), and diabetics are also more at risk.

Diagnosis of angina is largely from what you describe to the doctor. That is, there has been pain, usually brought on by exertion, which is situated as indicated above, usually goes off within a few minutes when you stop what you are doing, and is relieved by sucking a GTN (glyceryl trinitrate) tablet under the tongue.

Your doctor may also want you to undertake an electrocardiogram (ECG - a tracing which shows the electrical activity of the heart) and an exercise ECG (this involves walking on a treadmill while attached to an ECG). He is also likely to check your weight, blood pressure, various blood tests including blood sugar, cholesterol, and C Reactive Protein (CRP), and to discuss your smoking and drinking habits. All of these may be normal even though you are suffering from angina.

If you think you have angina you should consult your doctor. He may well prescribe some tablets to suck under your tongue, or the same medication as a spray (this has a longer shelf life than the tablets which only last two months after opening). They work by opening the blood vessels, and as a result may give a side effect of throbbing headache. If this happens you can spit out the tablet as it will already be working on the blood vessels. Should you suffer from this side effect, persevere as it usually wears off after the first two or three tablets.

If you have angina your doctor will want to prescribe the following to reduce your risk of having a heart attack (myocardial infarction):

• antiplatelet therapy, most likely one aspirin tablet of 75mg daily, as long as you are able to take this
• a cholesterol lowering drug (statin) very often simvastatin 40mg at night

If you have high blood pressure (hypertension) your doctor will also want to treat this to reduce any strain on the heart.

Angina usually lasts no longer than ten minutes, and if you get it you should stop what you are doing and take one of the tablets or a puff of the spray under your tongue. If an activity always seems to bring it on then it is wise to take the treatment before you start. If you are suffering frequently you should consult your doctor as he will probably also wish to consider preventative treatment which will involve regular tablets.

If your symptoms are not controlled by drugs and also if the tests suggest it, your doctor may refer you to a heart specialist (cardiologist) for consideration of further treatment. It is likely that at this stage you would have a test to show up the blood vessels that supply oxygen to the heart muscle (coronary angiography).

Further treatment is not necessary except in quite advanced cases and involves either using a tube (catheter) to enlarge the blood vessels where they are narrowed (angioplasty), usually inserting a stent (a steel mesh tube), which is left behind, holding open the narrowed part of the coronary artery, or bypassing the blood vessels with alternative vessels (coronary artery bypass grafts - CABG).

• Do not smoke
• Lose weight if you are over weight
• Eat a low fat diet with a good fibre intake
• Take regular exercise and if possible build this up slowly. If necessary your doctor may arrange some help with this.
• Avoid unnecessary stress and learn relaxation techniques
• Do not drink excessive amounts of alcohol
• Do not add salt to your food

• Heart Care Foundation of India
• British Heart Foundation
• American Heart Association

Books

Heart health at your fingertips, by Dr Graham Jackson

Dr Graham Jackson, a London heart specialist, goes into detail on how to protect your heart, and how to improve your health if you already have heart disease. He offers useful and practical advice.