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- Angina — chest pain due to a lack of oxygen to the heart muscle when the coronary arteries narrow.
- Discomfort occurs when walking, climbing stairs, under stress or in the cold, and eases at rest.
- The pain may radiate to the left arm, shoulder, neck, lower jaw or back.
- For pain at rest, a prolonged attack, cold sweat and shortness of breath, call an ambulance.
- Examination includes electrocardiography, echocardiography, coronary angiography and blood tests for cholesterol and glucose.
What is angina
Angina is pain or discomfort in the chest that occurs when the heart muscle does not get enough oxygen due to narrowing of the coronary arteries. It is a manifestation of coronary heart disease, and the pain usually subsides at rest or after taking certain medicines prescribed by a doctor.
What happens in the body
The heart muscle constantly needs oxygen, which is delivered through the coronary arteries. When the lumen of these vessels narrows, less blood arrives than the working heart requires. At the moment of exertion, the myocardium's need for oxygen rises sharply, while delivery remains the same. A shortage of supply arises, which the heart feels as pain or pressure behind the breastbone. A person notices discomfort when walking, climbing stairs or in the cold. At rest, the need decreases, and the unpleasant sensations usually subside. If chest pain recurs on exertion, this is a reason to discuss the condition with a doctor.
What causes it to develop
- Atherosclerosis of the coronary arteries: plaques form on the vessel walls, which narrow the lumen and reduce blood flow to the heart muscle.
- Spasm of the coronary arteries: the vessel narrows sharply due to contraction of its wall, and the blood supply to a section of the myocardium temporarily drops.
- High blood pressure: the heart has to work under greater load, and the need for oxygen increases noticeably.
- Diabetes mellitus: elevated glucose levels damage the vessels and accelerate the development of changes in their walls.
- High cholesterol levels: excess fatty substances are deposited in the walls of the arteries and contribute to the formation of plaques.
- Smoking and excess weight: these factors increase the load on the heart and worsen the condition of the vessels, accelerating the narrowing of the lumen.
Who faces this more often
Angina is more common in older people, but its appearance depends not only on the number of years lived. In men, the condition is detected earlier than in women, which is linked to the characteristics of hormonal background and lifestyle. After the onset of menopause, the risk in women increases noticeably and becomes comparable to that in men. Heredity also plays a role: if close relatives had heart problems, attention to one's condition should be higher. High blood pressure, diabetes mellitus and high cholesterol increase the likelihood of chest pain. Smoking and excess weight further worsen the blood supply to the heart muscle. If discomfort in the chest occurs on exertion, it is worth discussing this with a doctor rather than putting it down to fatigue.
What symptoms can occur?
Angina is recognised by discomfort behind the breastbone that appears on exertion and eases at rest. It is important to distinguish the usual sensations from those that require calling an ambulance.
How it is noticed at the very beginning
At the beginning, angina manifests as a pressing, squeezing or burning pain behind the breastbone, which a person often puts down to tiredness or overwork. The unpleasant sensations occur during brisk walking, climbing stairs, emotional stress or in the cold. The pain may radiate to the left arm, shoulder, neck, lower jaw or back, and this is often mistaken for problems with the joints or teeth. Sometimes, instead of pain, a person feels heaviness or discomfort in the chest, which also makes recognition difficult. Usually such an attack does not last long and passes if you stop and rest. Because of their brevity and connection with exertion, the first episodes are often ignored and not linked to the heart. If such sensations recur on exertion, it is worth booking an appointment with a cardiologist for an examination.
Signs that occur most often
- Pressing or burning pain behind the breastbone: the main sign of angina, which is important not to confuse with heartburn or muscle pain.
- Pain radiates to the arm, neck, jaw or back: referred pain is often confusing because it is felt away from the heart.
- Occurs on exertion or stress: the connection with physical effort or emotional strain helps distinguish the attack from other conditions.
- Eases at rest or after the prescribed remedy: the rapid easing of pain at rest indicates a connection with the work of the heart.
- May be accompanied by breathlessness: a lack of air together with pain suggests that the heart is not getting enough oxygen.
- Sometimes felt as heaviness or discomfort rather than pain: the muted form is more common in the elderly and people with diabetes.
When to seek help urgently
Examinations and tests
Examination for angina begins with a conversation and a physical examination, and then the doctor selects instrumental and laboratory methods. Each test answers its own question: how the heart works, whether there is narrowing of the arteries, how blood parameters change.
How the examination begins
Examination for angina begins with a history-taking, during which the doctor clarifies the nature of the pain and its connection with exertion. He asks about risk factors, past conditions and how long ago the complaints appeared. Then the doctor examines the patient, measures blood pressure and listens to the heart to assess the general condition. After the examination, he prescribes tests that help confirm or rule out angina. Resting electrocardiography shows the work of the heart at the moment of recording, and stress electrocardiography shows the response to physical activity. Echocardiography gives an idea of the structure of the heart and its contractile ability. Blood tests for cholesterol and glucose identify risk factors affecting the condition of the arteries. If the picture needs to be clarified, the doctor may refer for 24-hour electrocardiogram monitoring or coronary angiography. Keep all results and records of previous visits: they help the doctor see changes over time.
What is prescribed and what it shows
What is worth preparing for an appointment
- Discharge summaries: bring previous doctors' conclusions and test results to show the dynamics of the condition.
- Pain diary: write down when and with what exertion the discomfort occurs, this helps clarify the connection with activity.
- List of complaints: describe in advance how long ago the symptoms appeared and how often they recur.
- Blood pressure measurements: bring records of home measurements, they show the picture outside the appointment.
- Questions for the doctor: formulate in advance what you want to clarify so as not to forget at the appointment.
Which doctor should I see?
This section explains which doctor to consult for angina, what happens at the first appointment and what areas of care the treatment consists of. Below are guidelines for choosing a specialist and understanding how follow-up is organised.
Which specialist manages this condition
Angina is managed by a cardiologist, and it is to them that patients are referred for chest pain related to exertion. If there is no specialist nearby, start with a general practitioner at your place of residence: they will assess your complaints and refer you further. At the first appointment, the cardiologist asks under what circumstances the discomfort occurs, how long it lasts and what relieves it. Then they measure blood pressure, listen to the heart and review existing records and reports. The doctor clarifies what conditions and interventions have occurred before and how the person tolerates everyday exertion. Based on the conversation and examination, they determine whether further investigation is needed and to what extent. The cardiologist then explains how to change lifestyle and, if necessary, refers for procedures or surgery.
What the treatment consists of
- Selection of drug therapy by the doctor: the cardiologist individually determines which medicines are right for you and how to combine them.
- Changes to lifestyle and diet: adjusting eating habits and activity affects how you feel every day and supports the other areas of care.
- Monitoring of blood pressure and cholesterol: regular measurements and checks show the doctor whether the chosen approach is working and allow timely adjustment.
- Angioplasty or stenting when indicated: these procedures restore blood flow in narrowed vessels when conservative measures prove insufficient.
- Coronary artery bypass grafting when indicated: surgery creates a bypass route for blood if the changes affect several vessels at once.
- Regular follow-up with a cardiologist: scheduled visits help detect changes before they become noticeable and adjust the approach in time.
What depends on the patient themselves
Regular follow-up with a cardiologist is the part of the result that rests on the person themselves, not only on the doctor. When visits take place according to the scheduled plan, the specialist sees the dynamics and notices changes before they become pronounced. Measuring blood pressure and checking cholesterol at home give the doctor information that cannot be obtained in a single appointment. If a person postpones the visit until things become really bad, care begins later and requires more effort. Notes about when the discomfort occurred and what preceded it make the conversation at the appointment specific. Following recommendations on diet and activity affects how you feel not immediately, but over months. It is worth preparing questions for the visit in advance and bringing all available reports.
What helps prevent an exacerbation?
Preventing the worsening of angina is helped by everyday lifestyle and attention to your own condition. Below are habits, indicators to monitor and how often to see a doctor.
What to change in your habits
Giving up smoking is one of the main changes that reduces the strain on the heart and blood vessels. Regular physical activity as recommended by a doctor supports the work of the heart muscle and helps you cope with everyday exertion. A healthy diet with limited fats and salt reduces the risk associated with high blood pressure and cholesterol levels. Maintaining a normal weight reduces the constant strain on the heart and makes blood pressure easier to control. Timely treatment of accompanying conditions stops them from making the angina worse. Many changes are not noticeable straight away, so it is important to assess them by how you feel and by your doctor's observations, rather than by the first sensation. It is worth discussing with your doctor which changes are manageable right now, and to move gradually, without sudden overexertion.
What to keep under control
- Blood pressure: it is measured regularly, because a persistent rise increases the strain on the heart and blood vessels.
- Cholesterol level: it is checked as prescribed by a doctor, since changes over time go unnoticed in how you feel.
- Body weight: it is monitored, because extra kilograms increase the strain on the heart during ordinary activity.
- Physical activity: its amount is agreed with a doctor, so that the exertion is manageable and does not cause unpleasant sensations.
- Accompanying conditions: they are treated in good time, otherwise they make the angina worse and interfere with control.
- How you feel: changes in sensations should be written down and shown to a doctor, this helps to adjust the monitoring in good time.
How often to see a doctor
Regular visits to a doctor are needed even when you feel well and nothing is troubling you. Angina can go on for a long time without noticeable changes, while blood pressure, cholesterol and weight change gradually and imperceptibly. At an appointment the doctor assesses these indicators together with your complaints and, if necessary, changes the lifestyle recommendations. If new sensations have appeared or your usual exertion has become harder to tolerate, the visit should not be put off. If you have cardiovascular diseases, monitoring should be constant, and not only when things get worse. Notes about how you feel and your measurements help the doctor to see the whole picture, rather than a single day. So it is worth agreeing on a clear schedule of visits in advance and sticking to it, without waiting for the angina to worsen.
What is worth remembering
Angina is a reason to understand your sensations and not to postpone a visit to a specialist. Below are the main thoughts that help you make the right decision.
Main conclusions
Angina requires a careful attitude towards yourself, because its manifestations are easily attributed to fatigue or age. Pain or pressure behind the breastbone, occurring on exertion and passing at rest, is a signal that cannot be ignored. If such episodes recur, become more frequent or occur without an obvious cause, you should not delay consulting a doctor. Self-diagnosis is dangerous here: similar sensations occur in other conditions, and only a specialist can sort it out after an examination. Postponing the visit leads to help being provided later, when there are fewer options. It is important to remember that angina is not a sentence, but a condition you can live with if you keep the situation under control. Regular monitoring and attention to your well-being help you notice changes in time and adjust your lifestyle.
