Angina

Angina — chest pain from heart ischaemia

Angina pectoris — chest discomfort from myocardial ischaemia — oxygen demand exceeds coronary supply — usually coronary artery disease (CAD).

~2 million UK — stable majority — unstable — emergency.

Stable angina

Typical features:

• substernal pressure/tightness
• triggered — exertion, cold, emotion, heavy meal
• radiates — jaw, arms, back
• duration <10 min
• relieved by rest AND/OR GTN within ~5 min

Canadian Cardiovascular Society grading — I–IV functional limitation

Unstable angina — ACS emergency

Any of:

• pain at rest >20 min
• crescendo pattern — more frequent, lower threshold
• new onset severe

= Acute coronary syndrome — may evolve to MI

Phone 999 — do not drive self

GTN (glyceryl trinitrate)

Sublingual spray:

• 1–2 sprays under tongue
• sit down — hypotension risk
• repeat 5 min if needed — max 2 doses before 999
• headache common

GTN tolerance with patches — different use

Store — replace 8 weeks open, avoid heat

Assessment

GP urgent referral:

• exercise ECG, CT coronary calcium/CTCA, stress imaging
• angiography if high risk features

Blood: lipids, HbA1c, FBC

Risk scores — QRISK3

Long-term treatment

Secondary prevention (all):

• aspirin (or alternative if intolerant)
• high-intensity statin
• ACE inhibitor
• beta-blocker (first-line anti-anginal)
• P2Y12 inhibitor if ACS history

Anti-anginal:

• beta-blocker — bisoprolol
• calcium channel blocker — amlodipine, diltiazem
• ivabradine, nicorandil, ranolazine — add-on

Revascularisation:

• PCI + stent — focal stenosis
• CABG — triple vessel, diabetes, LM disease

Lifestyle

• stop smoking — single biggest modifiable
• cardiac rehabilitation
• Mediterranean diet pattern
• exercise within angina limits — know stable threshold

Angina vs other chest pain

	Angina	Musculoskeletal	GERD
Trigger	Exertion	Movement	Lying, meals
GTN response	Yes	No	No
Troponin	Normal (stable)	Normal	Normal

See heart attack if prolonged pain.

New tight chest walking uphill — GP this week — not wait for heart attack.

GTN + Viagra — never combine — see erectile dysfunction guide.

Common questions

What does angina pain feel like?

Tightness, heaviness, pressure, or squeezing across chest — may spread to jaw, neck, back, or arms — usually not sharp stabbing. Breathlessness and nausea can accompany. Stable angina lasts minutes, triggered by exertion or cold weather, eases with rest.

What is the difference between stable and unstable angina?

Stable — predictable with known triggers, same pattern months, relieved by rest/GTN quickly. Unstable — rest pain, longer duration, increasing frequency, lower exertion threshold — acute coronary syndrome — emergency — artery may fully block to heart attack.

How is angina treated?

GTN spray for attacks; aspirin and statin long term; beta-blocker or calcium channel blocker reduce heart work; ACE inhibitor; lifestyle — stop smoking, exercise cardiac rehab, treat blood pressure and diabetes. Angiography if high risk — stent (PCI) or coronary artery bypass (CABG) opens blocked arteries.

Can you take Viagra if you have angina?

Never combine PDE5 inhibitors (sildenafil/Viagra) with GTN or regular nitrates — dangerous blood pressure drop — potentially fatal. If you have angina and ED, discuss with cardiologist — timing separation insufficient — generally contraindicated together.

Is angina the same as a heart attack?

Angina — reversible ischaemia — heart muscle not permanently damaged when relieved. Heart attack (MI) — artery blocked — muscle death — pain often more severe and prolonged — troponin blood test rises. Unstable angina and MI both acute coronary syndromes — emergency assessment.

Sources

• NHS — Angina
• NICE — Chest pain of recent onset