Angina affects about one in 50 people, and it is particularly common in older people, with the NHS estimating that 10-15% of women over the age of 65 have angina, and 10-20% of men. Angina Pectoris is a phrase that comes from the Latin meaning “tight chest”.
People with angina experience pain in the middle of the chest, sometimes radiating down one or both arms and up into the neck or jaw. It is often described as a heaviness or pressure type of discomfort, but the pain can also be oppressive, as if something is crushing the chest. It is most often felt during exertion, stress and in cold weather.
In most cases, the cause of angina is coronary atherosclerosis: the thickening of arteries that supply blood, oxygen and nutrients to the heart. Over time, the walls of the arteries can become furred up with fatty deposits (atheroma or plaques), and if the coronary arteries become narrow, the blood supply to your heart will be restricted. This can cause the angina (chest pains).
Diseases such as angina which affect the normal flow of blood, such as the thickening of the arteries (atherosclerosis), are known as cardiovascular diseases. Risk factors for the thickening of the arteries include advanced age, obesity, a high fat diet and smoking.
Symptoms of angina may only appear at times when the heart needs more blood supply, such as at times of stress, exercise or climbing stairs. As the heart tries to pump faster to meet the body's increased demands, the narrowed arteries struggle to keep up. The heart then receives too little oxygen, which causes pain in the heart that is felt as chest pain.
There are two main types of angina – stable angina and unstable angina.
Stable angina usually develops gradually over time, and you may only experience symptoms when climbing stairs, or if you are under a great deal of stress. Symptoms usually only last for a few minutes and can be improved by taking medication that is known as glyceryl trinitrate. The most common symptom of angina is a feeling of pain or discomfort in your chest, where the pain can feel tight, dull, or heavy, and usually passes within a few minutes. Other symptoms of stable angina include breathlessness, dizziness, fatigue, restlessness and nausea. The onset of angina symptoms is sometimes called an angina attack.
With unstable angina the symptoms develop rapidly, and they can persist even at rest lasting up to 30 minutes. Unstable angina should be regarded as a medical emergency because it is a sign that the function of your heart has suddenly and rapidly deteriorated, increasing your risk of having a heart attack or stroke. The symptoms of unstable angina are that can persist even when you are resting, and they can last longer than five minutes. If you think that you are experiencing symptoms of unstable angina, you should dial 999 and ask for an ambulance. If you know that you are not allergic to aspirin, and aspirin is easily available, chew an adult size tablet while you are waiting for the ambulance to arrive. As aspirin helps to prevent blood clots, it will reduce your risk of experiencing a heart attack or a stroke.
Stable angina is not life-threatening on its own, but it is a serious warning sign that you have an increased risk of experiencing more serious conditions, such as a heart attack or a stroke. Therefore, as well as treating the symptoms of angina, to reduce your risk of developing serious health conditions, you will also receive further treatment and, in some cases, surgery.
Your heart needs a constant supply of oxygen-rich blood to function normally, and the blood is supplied to the heart by two large blood vessels - the left and the right coronary arteries. The most common cause of stable angina is the coronary arteries becoming narrow and hardened (atherosclerosis), which restricts the blood flow to the muscles of the heart. Stable angina is therefore a supply and demand problem - when you are exercising or feeling stressed, the muscles in your heart work harder and the demand for blood increases. However, due to the narrowed carotid arteries, the necessary amount of blood is unable to reach the heart in time, so the demand for blood outstrips the supply, triggering the symptoms of angina.
One of the underlying causes of atherosclerosis is a build-up of fatty deposits in the arteries, and these fatty deposits can rupture or split, interfering with the normal flow of blood. This causes a blood clot to form, and this clot can quickly grow, blocking one of the carotid arteries and drastically reducing the supply of blood to the heart, triggering the symptoms of unstable angina.
The key risk factors which can cause the carotid arteries to narrow are high-fat diets and cholesterol, a lack of exercise, a poor diet, and excess alcohol, smoking, high blood pressure (hypertension), diabetes, age, and family history.
If you smoke, it can damage the walls of your arteries, and blood cells (platelets) will form at the site of the damage in an attempt to repair it. This can cause your arteries to narrow. Smoking can also reduce your blood's ability to carry oxygen around your body, which increases the chances of a blood clot occurring.
If you have high blood pressure (hypertension) it will damage your arteries in the same way as cigarette smoke. Your arteries are designed to pump blood at a certain pressure. If that pressure is exceeded, the walls of the arteries will be damaged.
If you have diabetes that is poorly controlled, the excess amount of glucose in your blood can damage your artery walls. In addition, a person’s arteries tend to get narrower over time. Therefore, the older you are, the more likely it is that your arteries will have narrowed, increasing your risk of developing angina.