Angina

What is angina?

Angina is a symptom rather than a disease in itself. It is the discomfort felt when the heart muscle is temporarily not receiving enough oxygen-rich blood, most commonly because the coronary arteries that supply the heart have become narrowed by a gradual build-up of fatty deposits, a process called atherosclerosis. This underlying problem is known as coronary artery disease, the most common form of heart disease.

At rest, a narrowed artery may still deliver enough blood for the heart's needs. During exertion, emotional stress or cold weather, the heart has to work harder, and the restricted supply cannot keep up with demand. The result is the characteristic tightness or heaviness of angina, which typically settles within a few minutes of resting.

Angina matters for two reasons. First, it can significantly limit your day-to-day life. Second, and more importantly, it is a warning sign: the same narrowings that cause angina can rupture and cause a heart attack. Identified early, both the symptoms and the risk are very treatable.

Symptoms

Angina is classically felt as:

• A tight, heavy, squeezing or burning discomfort in the centre of the chest
• Discomfort that may spread to the left arm, both arms, the neck, jaw, back or upper abdomen
• Breathlessness accompanying the discomfort, or occasionally as the only symptom
• Sometimes sweating, nausea or unusual fatigue with exertion

Symptoms are typically triggered by physical activity, stress, heavy meals or cold air, and relieved within minutes by rest. Some people, particularly women, older adults and people with diabetes, experience less typical symptoms such as breathlessness, fatigue or discomfort in the jaw or back without obvious chest pain, which is why unexplained exertional symptoms always deserve proper assessment.

Stable and unstable angina

Stable angina follows a predictable pattern: it comes on with a familiar level of exertion and settles with rest. Unstable angina is different and is a medical emergency. Warning signs include chest discomfort that occurs at rest or with minimal activity, pain that is more severe, more frequent or lasts longer than your usual pattern, or angina that does not settle within a few minutes of rest.

If you have chest pain that lasts more than a few minutes at rest, is severe, or is accompanied by sweating, breathlessness or nausea, call 999 immediately. Do not wait to see whether it passes.

Causes and risk factors

The narrowings that cause angina develop silently over many years. The main factors that drive this process include:

• High cholesterol, particularly raised non-HDL cholesterol, and high lipoprotein(a)
• High blood pressure
• Smoking, diabetes and excess weight
• A family history of early heart disease
• Age, and lifestyle factors including inactivity, poor diet, stress and poor sleep

Less commonly, angina can occur with unobstructed arteries, for example due to spasm of a coronary artery or disease of the heart's smallest vessels (microvascular angina). These conditions are increasingly recognised, particularly in women, and require a specialist approach to diagnosis and treatment.

Diagnosis

An accurate diagnosis answers two questions: is your chest discomfort coming from the heart, and if so, how significant is the underlying artery disease?

Your assessment begins with a detailed consultation and examination, followed by an electrocardiogram (ECG) and blood tests to assess cholesterol, blood sugar and other risk markers. The key imaging test for most people is a CT coronary angiogram, a rapid, non-invasive scan that shows the coronary arteries in fine detail and detects both narrowings and early plaque. Depending on your circumstances we may also recommend an exercise ECG, a stress echocardiogram to see how the heart performs under stress, or a cardiac MRI. If a severe narrowing is found, an invasive angiogram allows detailed assessment and, where appropriate, treatment at the same time.

Dr Assomull specialises in the assessment of coronary artery disease using advanced cardiac imaging, allowing a precise, personalised picture of your arteries rather than a one-size-fits-all answer.

Treatment

Treatment for angina has two goals: relieving your symptoms so you can live normally, and lowering the risk of a future heart attack.

Medication

Medication is the foundation of angina care. Symptom-relieving treatments include a fast-acting GTN spray for use when angina occurs, alongside regular tablets such as beta-blockers or calcium channel blockers that reduce the heart's workload. Risk-reducing treatments include statins and other cholesterol-lowering therapy, antiplatelet medication such as aspirin, and careful control of blood pressure and diabetes. Most people with stable angina can be managed very effectively this way.

Lifestyle

Targeted lifestyle change is powerful medicine. Stopping smoking, a heart-healthy dietary pattern, structured physical activity built up safely, weight management, and attention to sleep and stress all directly slow, and can partly stabilise, the disease process that causes angina. We will build these into a plan that is realistic for your life.

Procedures

If symptoms persist despite good medical treatment, or if testing shows severe narrowings in critical vessels, further treatment such as angioplasty and stenting, or in some cases bypass surgery, may be recommended. Dr Assomull practised as an interventional cardiologist for ten years and will give you a clear, balanced view of when a procedure genuinely adds benefit and when it does not.

Our integrative cardiology approach

At Cardiologist London, angina care goes beyond a prescription. We combine precise imaging-based diagnosis with aggressive risk factor control and personalised lifestyle medicine, addressing cholesterol, blood pressure, weight, nutrition, activity, sleep and stress together. The result is a plan that treats today's symptoms and protects tomorrow's heart.

If you have noticed chest tightness or unusual breathlessness on exertion, do not wait for it to worsen. Book a consultation at our Harley Street clinic, usually available within one working day.