Angina

Angina is chest discomfort caused by reduced blood flow to the heart muscle, usually due to narrowing of the coronary arteries (coronary heart disease). It is often triggered by exertion, stress or cold weather and typically improves with rest and/or medication.

Angina is a sign that the heart isn’t getting enough oxygen at certain times. Some presentations need urgent assessment, particularly if symptoms occur at rest, are more severe than usual, or do not settle as expected.

At the Royal Buckinghamshire Hospital, we offer consultant-led assessment, investigation and management planning for patients with angina symptoms.

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Types of Angina

• Stable angina
  Symptoms are usually predictable and triggered by exertion, emotional stress, or cold temperatures. Episodes typically last a few minutes and improve with rest and/or GTN medication. (NHS inform)
• Unstable angina
  Symptoms can be more unpredictable and may happen at rest. Episodes can feel more severe, last longer, or not improve as expected. Unstable angina needs urgent medical assessment as it may indicate a higher risk of a heart attack. (NHS inform)
• Vasospastic (Prinzmetal) angina
  Caused by spasm (temporary tightening) of a coronary artery, often occurring at rest.

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Common Causes of Angina

Angina happens when the heart muscle’s oxygen demand temporarily exceeds the oxygen supply. Common underlying causes include:

• Coronary artery disease (narrowing of the heart’s arteries)
• Coronary artery spasm (in vasospastic angina)
• Factors that increase the heart’s workload, such as physical exertion or emotional stress

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Symptoms of Angina

Angina is commonly felt as discomfort rather than a sharp pain. Symptoms may include:

• Chest tightness, pressure, heaviness or squeezing
• Pain or discomfort that can spread to the arm(s), neck, jaw, shoulder or back
• Breathlessness
• Feeling sick, sweaty, dizzy or lightheaded (nhs.uk)

Symptoms may come on with activity and settle with rest. If symptoms are new, worsening, happening at rest, or lasting longer than usual, urgent assessment is recommended.

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Diagnosis at Royal Buckinghamshire Hospital

A consultant-led assessment helps confirm whether symptoms are due to angina and guides the safest treatment plan. Investigations may include:

• Clinical history (triggers, duration, frequency, relief with rest/medication) and risk factor review
• Examination and baseline observations (blood pressure, pulse)
• ECG (heart rhythm tracing)
• Blood tests where appropriate
• Further tests to assess coronary heart disease risk and heart function, depending on your presentation and symptoms

Your consultant will explain findings clearly and advise on next steps, including whether urgent same-day escalation is needed.

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Treatment & Management

Treatment aims to reduce symptoms, improve quality of life, and lower the risk of future cardiac events.

Immediate symptom relief

Many patients with stable angina are prescribed a short-acting nitrate (for example GTN spray/tablet) to relieve an episode and, in some cases, to prevent symptoms before exertion.

Preventing episodes and improving control

For stable angina, first-line long-term symptom control commonly includes a beta blocker or a calcium channel blocker, adjusted based on your medical history and tolerance.

If symptoms remain uncontrolled or certain medicines are not suitable, alternative anti-anginal options may be considered by your clinician.

Reducing cardiovascular risk

Your consultant may also discuss “secondary prevention” measures, which can include:

• Optimising blood pressure, cholesterol and diabetes control where relevant
• Lifestyle measures (activity guidance, weight management, smoking cessation support)
• Medication to reduce future cardiac risk where appropriate

Procedures (selected cases)

If angina is persistent, worsening, or linked to significant coronary narrowing, your consultant may recommend referral for further cardiac assessment and discussion of interventions such as coronary angiography and, where indicated, stenting or bypass surgery (managed by specialist cardiology teams).

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When to seek urgent help

Call 999 urgently if:

• Chest pain/discomfort is new, severe, or comes on suddenly
• Symptoms happen at rest
• Pain does not improve after a few minutes of rest, or does not settle after using GTN as advised
• Symptoms are accompanied by collapse, severe breathlessness, or you feel very unwell (British Heart Foundation)

If you have previously diagnosed angina but symptoms are becoming more frequent, lasting longer, happening with less activity, or occurring at rest, seek urgent medical advice the same day, as this may indicate unstable angina.

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If you are experiencing chest discomfort, breathlessness on exertion, or symptoms suggestive of angina, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.