​Angina
Understanding Chest Pain and Finding Effective Treatment
​It's essential to recognise symptoms of angina and seek prompt medical help if you experience it. Dr. De Silva, a top cardiologist in London, specialises in angina management, assisting patients in managing their symptoms and enhancing their heart health.
Seek Urgent Medical Attention
Call 999 immediately if you or someone else has symptoms such as:
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Persistent central chest pain or discomfort.
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Chest pain spreading to the left arm, both arms, neck, jaw, back, or stomach.
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Loss of consciousness.
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Seizures.
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Breathing difficulties.
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Chest pain with breathlessness, nausea, and sweating.
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If you've already been diagnosed with angina:
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Contact your doctor promptly if your angina worsens, becomes more frequent, or changes in character.
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Call 999 immediately if chest pain persists after a few minutes of rest and one or two doses of nitrate medication.
​What is Angina?
Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle. This often results from coronary artery disease where cholesterol deposits accumulate in the coronary arteries, narrowing them (termed a plaque) and reducing blood supply.
Recognising Angina Symptoms​
Typical angina sensations include:
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Chest pressure, tightness, or squeezing: This can vary from a dull ache to a sharp, intense pain.
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Pain radiating to other areas: The pain may extend to the shoulders, arms, neck, jaw, back, or stomach.
Additional symptoms may include:
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Lightheadedness
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Sweating
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Nausea
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Tiredness
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Shortness of breath
Types of Angina
Angina has several forms:
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Stable Angina: The most common type, usually triggered by physical activity or stress. It typically lasts a few minutes and improves with rest or medication.
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Unstable Angina: Less predictable and can occur even when resting. It may signal an impending heart attack.
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Vasospastic Angina: Caused by spasms in the coronary arteries, leading to temporary vessel constriction.
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Microvascular Angina: Affects the smaller coronary arteries, often causing pain during exertion or stress.
Triggers of Angina
The primary cause of angina is coronary artery disease. Other triggers include:
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Physical exertion
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Emotional stress
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Cold temperatures
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Large meals
While waiting for the ambulance:
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Help the person sit or lie down in a comfortable position.
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If they are conscious and not allergic to aspirin, they can chew and swallow a 300mg aspirin tablet. Aspirin helps thin the blood and can improve blood flow to the heart.
Risk Factors for Angina
Several factors can elevate your risk of developing angina:
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Smoking
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Diabetes
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High cholesterol
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High blood pressure
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Obesity
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Family history of heart disease
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Stress
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Older age (Over 45 for men and 55 for women)
Diagnosing Angina
Dr. De Silva will perform a comprehensive evaluation to diagnose angina, which may involve:
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Discussing your symptoms and medical background.
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Physical examination.
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Electrocardiogram (ECG): This records your heart's electrical activity to identify any abnormalities.
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Anatomic and functional imaging of the heart – including CT, MRI or echocardiography imaging to assess the heart and blood flow in more detail.
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Coronary angiogram: A specialised X-ray using dye to visualise blood flow in the coronary arteries.
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Other tests: These may include stress tests (exercise ECG) or echocardiograms (ultrasound of the heart).
Treating Angina
Angina treatment aims to alleviate symptoms, reduce the frequency and intensity of episodes, and lower the risk of heart attack and other complications. Dr. De Silva provides various treatment approaches:
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Medications include:
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Nitrates (to dilate blood vessels and improve blood flow to the heart muscle)
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Beta-blockers (to slow heart rate and decrease blood pressure)
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Calcium channel blockers (to relax blood vessels)
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Metabolicl agents such as Ranolozine
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Statins (to lower cholesterol and stabilise coronary disease)
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Aspirin (to reduce the risk of heart attack events)​
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Procedures:
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Coronary angiogram – to define and characterise coronary disease
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Coronary angioplasty and stenting (PCI) – to open and treat narrowed coronary arteries.
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Coronary artery bypass graft (CABG) surgery
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Lifestyle Modifications:​​
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Healthy diet: A balanced diet low in saturated and trans fats can help lower cholesterol and promote heart health.
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Increased exercise: Regular physical activity strengthens the heart and improves blood circulation.
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Stress management: Stress can trigger angina, so finding healthy ways to cope with stress is important.
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Reduced alcohol consumption: Excessive alcohol intake can elevate blood pressure and contribute to heart issues.
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Smoking cessation: Smoking harms blood vessels and increases the risk of heart problems.
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Managing blood pressure and cholesterol: Maintaining healthy levels through diet, exercise, and medication can reduce strain on the heart.