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.
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.
Shortness of breath
Sweating (cold, clammy skin)
Nausea or indigestion-like discomfort
Fatigue or dizziness
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.
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.
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.
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.
Exercise stress test: ECG monitoring during treadmill or bike exercise.
Stress echocardiography: ultrasound imaging of the heart during stress.
Myocardial perfusion scan: nuclear medicine scan assessing blood flow to the heart.
Stress Cardiac MRI: Assessing blood flow to the heart muscle by MRI
Coronary CT angiography: detailed imaging of coronary arteries.
Coronary angiography (cardiac catheterisation) – gold standard test, directly visualises blockages and allows intervention (stenting).
The goals of treatment are to relieve symptoms, improve quality of life, and reduce risk of heart attack and death.
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
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.
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.
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.
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
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.
Share with others: