Angina

Angina is chest discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood, almost always because the coronary arteries are narrowed by fatty plaque. It is a symptom of coronary artery disease, not a disease in itself.

Stable angina comes on predictably with effort or stress and settles within minutes of rest or a nitrate spray. Unstable angina is new, worsening or occurs at rest, and it is treated as an emergency because it can precede a heart attack.

Symptoms

• Tightness, pressure, heaviness or a band-like feeling across the chest
• Discomfort spreading to the left arm, both arms, neck, jaw, back or upper stomach
• Brought on by walking uphill, cold wind, heavy meals or emotional stress
• Relief within about 5 to 10 minutes of stopping or using glyceryl trinitrate
• Breathlessness, sweating or nausea with exertion
• In women, older people and people with diabetes: breathlessness, fatigue or indigestion-like symptoms without classic chest pain

Causes and risk factors

The usual cause is atherosclerosis narrowing one or more coronary arteries, so that blood flow cannot rise to meet demand during exertion. Risk factors are smoking, high LDL cholesterol, high blood pressure, diabetes, obesity, inactivity, kidney disease and a family history of early heart disease. Less common causes are coronary artery spasm (vasospastic angina), disease of the tiny heart vessels (microvascular angina, more frequent in women), severe aortic stenosis, hypertrophic cardiomyopathy and severe anaemia.

How it is diagnosed

• Clinical assessment and resting ECG: The pattern of symptoms is the most important clue. The ECG is often normal between episodes.
• Blood tests: Lipids, glucose, kidney function, blood count and thyroid; troponin if the pain is recent or prolonged.
• CT coronary angiography: First-line test in many guidelines for new stable chest pain; shows plaque and narrowing non-invasively.
• Functional stress testing: Stress echo, perfusion scan or stress MRI to show whether the heart muscle becomes short of blood.
• Invasive coronary angiography: When symptoms are severe, tests show high-risk features, or revascularisation is planned.
• Echocardiography: Checks pumping function and valve disease.

Treatment options

• Lifestyle change: Stopping smoking, regular walking, a Mediterranean-style diet and weight control slow the disease and reduce attacks.
• Event-preventing medicines: Low-dose aspirin or another antiplatelet, a high-intensity statin, and blood pressure and diabetes control.
• Symptom-relieving medicines: GTN spray for attacks; beta blockers or calcium channel blockers as first-line prevention; long-acting nitrates, ranolazine, ivabradine, nicorandil or trimetazidine as add-ons.
• Coronary angioplasty and stent: For angina not controlled by medicines, with suitable anatomy.
• Coronary bypass surgery: For left main or multi-vessel disease, particularly with diabetes or reduced heart function.
• Cardiac rehabilitation: Supervised exercise and education that improve stamina and confidence.

When it is urgent

Call your local emergency number if chest pain lasts more than 10 to 15 minutes, is not relieved by rest or two doses of GTN five minutes apart, comes on at rest, or is accompanied by sweating, nausea, breathlessness or faintness. Angina that is new or is suddenly more frequent needs same-day medical assessment where you are. Do not board a flight with these symptoms.

Travelling to Türkiye for treatment

Stable, well-defined angina is suitable for a planned visit: a second opinion, CT or invasive angiography, and if appropriate a stent procedure within about a week, or bypass surgery with a stay of about 3 weeks. Unstable symptoms must be treated locally. Day-to-day medical management and risk factor control continue with your own doctor.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

الأسئلة المتكررة