Angina
Angina: Pt's Guidance
Angina is a common symptom of underlying coronary artery disease (CAD), one of the leading causes of morbidity and mortality worldwide. It refers to chest discomfort or pain that occurs when the heart muscle does not receive enough oxygen-rich blood. This imbalance usually results from narrowing or blockage of the coronary arteries due to atherosclerosis (build-up of fatty deposits called plaques).
While angina itself is not a heart attack, it is an important warning sign of cardiovascular disease and significantly increases the risk of developing myocardial infarction (heart attack). Angina affects millions of people globally and becomes more common with age, smoking, diabetes, high cholesterol, high blood pressure, and family history of heart disease.
This comprehensive guide explains angina in detail, covering symptoms, diagnosis, treatment, lifestyle advice, prognosis, and key questions patients should ask their cardiologist.
Angina typically presents as chest discomfort rather than sharp pain. Symptoms of angina may vary between individuals and can be more subtle in women, older adults, and people with diabetes.
Common features of angina include:
Chest pain or discomfort – usually felt behind the breastbone (sternum).
Character – often described as pressure, squeezing, heaviness, tightness, or burning.
Radiation – may spread to the neck, jaw, shoulders, arms (especially the left), or back.
Duration – usually lasts a few minutes (not seconds, and typically not hours).
Triggers – exertion, stress, heavy meals, or exposure to cold weather.
Relief – symptoms improve with rest or nitroglycerin.
Other associated symptoms may include:
Shortness of breath
Sweating (cold, clammy skin)
Nausea or indigestion-like discomfort
Fatigue or dizziness
Types of angina:
Stable angina – predictable chest discomfort triggered by exertion or stress, relieved by rest/medication.
Unstable angina – occurs suddenly, at rest, or with minimal exertion; more severe and prolonged; medical emergency.
Variant (Prinzmetal’s) angina – caused by coronary artery spasm, often at rest, sometimes at night.
Microvascular angina – chest pain due to dysfunction of small coronary vessels, more common in women.
Angina happens when the heart muscle needs more oxygen than the coronary arteries can deliver. In most people the underlying cause is coronary artery disease, but other mechanisms and conditions can also cause or worsen angina.
Atherosclerosis (coronary artery disease)
This is the most common cause. Fatty deposits called plaques build up in the walls of the coronary arteries and narrow them. During exertion or stress the heart needs more blood, the narrowed artery cannot supply it, and angina results. If a plaque ruptures and a clot forms, it can cause unstable angina or a heart attack.
Coronary artery spasm and small-vessel disease
Variant (Prinzmetal) angina: temporary spasm of a coronary artery, often at rest or at night.
Microvascular angina: dysfunction of the very small coronary vessels, which can cause angina even when the large arteries look normal on an angiogram. It is more common in women.
Risk factors for coronary artery disease
Smoking.
High blood pressure.
High cholesterol, particularly raised LDL cholesterol.
Diabetes and pre-diabetes.
Being overweight and physical inactivity.
Chronic kidney disease.
Increasing age, and being male or a woman after the menopause.
A family history of early heart disease (a father or brother under 55, or a mother or sister under 65).
Conditions that can bring on or worsen angina
Anything that increases the heart workload or reduces oxygen delivery can trigger angina in someone with coronary narrowing:
Anaemia.
A fast heart rate, including atrial fibrillation and an overactive thyroid.
Aortic stenosis and hypertrophic cardiomyopathy, which can cause angina even with normal coronary arteries.
Uncontrolled high blood pressure.
Common triggers
Physical exertion, particularly uphill or into the wind.
Emotional stress or anger.
Cold weather.
Heavy meals.
Smoking and stimulant drugs, including cocaine.
You should seek urgent medical attention if you experience:
Chest pain lasting more than 10–15 minutes, not relieved by rest or nitroglycerin.
New-onset chest pain or worsening pattern of angina.
Chest pain at rest or during minimal activity.
Chest pain associated with fainting, severe breathlessness, or palpitations.
Call 999 (UK emergency services) immediately if you suspect a heart attack (severe chest pain with sweating, nausea, breathlessness, or collapse).
Even if symptoms are mild, it is important to see a GP or cardiologist for evaluation, as angina indicates significant cardiovascular risk.
Diagnosis is based on a combination of history, examination, and investigations.
Initial assessments:
Detailed history of symptoms and risk factors.
Physical examination (heart sounds, blood pressure, vascular health).
Blood tests (cholesterol, glucose, kidney function, troponins if suspected acute coronary syndrome).
ECG (electrocardiogram) – may show changes during an episode.
Further investigations may include:
Exercise stress test:Â ECG monitoring during treadmill or bike exercise.
Stress echocardiography:Â ultrasound imaging of the heart during stress.
Myocardial perfusion scan:Â nuclear medicine scan assessing blood flow to the heart.
Stress Cardiac MRI: Assessing blood flow to the heart muscle by MRI
Coronary CT angiography:Â detailed imaging of coronary arteries.
Coronary angiography (cardiac catheterisation) – gold standard test, directly visualises blockages and allows intervention (stenting).
We offer an exercise ECG (treadmill test), a CT coronary angiogram and a stress echocardiogram.
Tests and services that may help
We can arrange the investigations used to diagnose and assess angina:
ECG reporting, UK-wide, and cardiac monitoring
Consultation by telephone, video or face to face
If your chest pain is severe, sudden or getting worse, call 999 rather than waiting for an appointment.
The goals of angina treatment are to relieve symptoms, improve quality of life, and reduce risk of heart attack and death.
1. Lifestyle Modifications for Angina
Quit smoking
Eat a heart-healthy diet (low in saturated fats, high in fruits, vegetables, whole grains, oily fish)
Regular exercise (as advised by doctor)
Weight management
Stress reduction and adequate sleep
Control of blood pressure, diabetes, and cholesterol
2. Medications
Nitrates (e.g., GTN spray/tablets) – relieve chest pain.
Beta-blockers – reduce heart workload and oxygen demand.
Calcium channel blockers – relax blood vessels, reduce angina.
Antiplatelet agents (aspirin, clopidogrel) – reduce clot formation.
Statins – lower cholesterol and stabilise plaques.
ACE inhibitors / ARBs – improve heart and vascular health.
Ranolazine, ivabradine, nicorandil – may be used if symptoms persist.
3. Interventional / Surgical Options
Percutaneous coronary intervention (PCI) – balloon angioplasty with stent placement.
Coronary artery bypass grafting (CABG) – surgical revascularisation using grafts from veins/arteries.
With proper management, many patients live full and active lives.
Living with angina
Carry GTN spray/tablets at all times.
Recognise early warning signs of angina.
Adhere to medications as prescribed.
Regular follow-up with a cardiologist.
Participate in cardiac rehabilitation after heart procedures.
Maintain a healthy lifestyle and avoid smoking.
Monitor blood pressure, cholesterol, and diabetes closely.
Lifestyle Modifications for Angin
Quit smoking
Eat a heart-healthy diet (low in saturated fats, high in fruits, vegetables, whole grains, oily fish)
Regular exercise (as advised by doctor)
Weight management
Stress reduction and adequate sleep
Control of blood pressure, diabetes, and cholesterol
Driving, work and travel
Based on DVLA guidance last updated 7 November 2025:
Car and motorcycle (Group 1): do not drive if angina occurs at rest, with emotion or at the wheel. You may drive again once symptoms are satisfactorily controlled, and you need not tell the DVLA.
After a heart attack: do not drive. Driving may resume after 1 week if you had successful angioplasty (PCI), no further urgent procedure is planned and your pumping function was at least 40% before discharge. Otherwise the wait is 4 weeks.
After a stent: no driving for at least 1 week. After bypass surgery: at least 4 weeks.
Bus, coach and lorry (Group 2): angina must be reported to the DVLA, and relicensing usually requires an exercise or other functional test and a pumping function (ejection fraction) of at least 40%.
Work and travel: most people with stable angina can work and fly. Carry your GTN in your hand luggage, keep it within reach, and plan rest stops. Avoid strenuous exertion in extreme heat or cold. Rules change, so always check GOV.UK, and see our DVLA cardiac assessment page if you drive for work.
The outlook depends on the severity of coronary artery disease, overall heart function, and risk factor control.
Stable angina – with treatment and lifestyle changes, risk of heart attack and death can be significantly reduced.
Unstable angina – higher risk; needs urgent treatment.
Patients who undergo successful PCI or CABG often experience significant symptom relief and improved quality of life.
Long-term prognosis improves greatly with adherence to treatment and risk factor modification.
- Angina is a symptom of heart disease, not a disease itself.
- It is caused by reduced blood flow to the heart muscle.
- Stable angina is predictable and occurs with exertion; unstable angina is unpredictable and dangerous.
- Chest pain can radiate to the jaw, arms, or back.
- Risk factors include smoking, diabetes, high cholesterol, hypertension, and family history.
- Women and diabetics may have atypical symptoms such as breathlessness or fatigue.
- Angina increases the risk of heart attack.
- Diagnosis often requires stress tests and coronary angiography.
- Treatment includes lifestyle changes, medication, stents, or bypass surgery.
- With good management, many people live long, active lives despite angina.
Guidelines and sources
This page follows current UK and European guidance:
NICE CG95: Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis.
Vrints C et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal 2024;45:3415-3537.
Maron DJ et al. Initial invasive or conservative strategy for stable coronary disease (ISCHEMIA). New England Journal of Medicine 2020;382:1395-1407.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about angina.
What does angina feel like?
Most people describe a pressure, tightness, heaviness or squeezing in the centre of the chest, sometimes spreading to the arms, neck, jaw or back. It may also feel like breathlessness or indigestion. It usually comes on with exertion or stress and settles within a few minutes of rest.
How do I tell angina from a heart attack?
Stable angina is brought on by effort and eases within about 5 to 10 minutes with rest or GTN. Chest pain that comes on at rest, lasts longer than 15 minutes, does not ease with GTN, or comes with sweating, nausea, breathlessness or collapse may be a heart attack. If in doubt, call 999.
How should I use my GTN spray or tablets?
Stop what you are doing and sit down. Take one dose under the tongue. If the pain has not gone after five minutes, take a second dose. If it is still present five minutes after the second dose, call 999. GTN can cause a headache, flushing and light-headedness, which is why you should sit down. Never take GTN with sildenafil, tadalafil or similar medicines, because the combination can cause a dangerous drop in blood pressure. Check the expiry date and how to store it, as tablets lose strength once opened.
Can angina be cured?
The underlying coronary artery disease cannot be removed, but angina can usually be controlled very well. Medicines, lifestyle changes and, where needed, a stent or bypass surgery can relieve symptoms and reduce the risk of future heart problems.
What tests will I need?
Usually an ECG, blood tests and a heart scan. NICE recommends CT coronary angiography (CTCA) as the first-line test for most people with typical or atypical angina. If CTCA is not suitable, functional tests such as stress echocardiography, myocardial perfusion scanning or stress cardiac MRI can show whether the narrowing limits blood flow. Invasive angiography is reserved for those who need treatment. See our CTCA page and stress echo page.
Which medicines are used for angina?
Two groups of medicines are used. Anti-anginal medicines relieve symptoms: a beta-blocker or a calcium channel blocker first, with others such as long-acting nitrates, ranolazine, ivabradine or nicorandil added if needed. Preventive medicines reduce the risk of heart attack: aspirin or another antiplatelet, a statin, and an ACE inhibitor in some people. Treatment is individualised.
Will I need a stent or bypass operation?
Not always. In the large ISCHEMIA trial of people with stable coronary disease, starting with an invasive strategy did not reduce death or heart attack compared with optimal medical treatment alone, although it can improve symptoms. A stent or bypass is most often advised when symptoms are not controlled by medicines, or when scans show high-risk disease such as left main coronary narrowing or reduced pumping function.
Can I exercise with angina?
Yes, and regular activity improves symptoms and heart health. Build up gradually, warm up first, avoid exercising straight after a heavy meal or in very cold weather, and keep your GTN to hand. If your doctor has advised it, a dose of GTN before exertion can prevent angina. Cardiac rehabilitation is recommended after a stent, bypass or heart attack.
Is it safe to have sex if I have angina?
If your angina is stable and well controlled, and you can manage a brisk walk or two flights of stairs without symptoms, sex is usually safe. Do not use sildenafil, tadalafil or similar medicines if you take any nitrate, including GTN. Ask your doctor if you are unsure.
Is angina different in women?
Yes, it can be. Women are more likely to feel breathlessness, fatigue, nausea or pain in the back or jaw rather than classic chest pressure, and are more likely to have microvascular angina. These symptoms are sometimes missed, so they deserve the same careful assessment.
What should I do if my angina is getting worse?
Angina that is new, more frequent, more severe, comes on with less effort or occurs at rest is called unstable angina and can be an early warning of a heart attack. Seek urgent medical help the same day, and call 999 if the pain is severe, persistent or comes with sweating or breathlessness.
Does angina shorten life expectancy?
With good treatment, many people with stable angina live a normal or near-normal lifespan. The outlook depends on the extent of coronary disease, the strength of the heart muscle, and how well risk factors such as smoking, blood pressure, cholesterol and diabetes are controlled.
When should I see a cardiologist?
You should have specialist assessment for any new chest pain, if angina is not controlled on two anti-anginal medicines, if your symptoms are changing, if you are considering a stent or bypass, or if you have angina-type pain but your arteries looked normal on a previous angiogram. You can arrange a telephone, video or face-to-face consultation.
- What type of angina do I have – stable, unstable, or variant?
- How severe is my coronary artery disease?
- What tests are necessary to confirm the diagnosis?
- What lifestyle changes will make the biggest difference for me?
- Which medications will I need, and what are their side effects?
- Do I need a stent or bypass surgery?
- How can I tell if chest pain is angina or a heart attack?
- What is my long-term outlook with angina?
- How often should I have follow-up appointments and repeat tests?
- Can I safely exercise, travel, and lead a normal life with angina?
What happens inside the artery?
Angina occurs when a narrowed coronary artery cannot deliver enough oxygen-rich blood to the heart muscle when it works harder. A complete blockage by a clot causes a heart attack, which is an emergency.
Angina or heart attack?
Stable angina is predictable and settles with rest or GTN. Pain that is new, worsening, occurs at rest or lasts longer needs urgent assessment, and pain that does not settle should always be treated as an emergency.
If you have chest pain at rest, pain that is not relieved by two doses of GTN taken five minutes apart, or chest pain with sweating, breathlessness or collapse, call 999 immediately.
If you have symptoms of angina, you may benefit from a telephone consultation or video consultation to discuss your symptoms in detail, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as ECG reporting, CT coronary angiography (CTCA), exercise stress echo and cardiac monitoring may be recommended to further evaluate your condition.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.