Angina is normally described as

Angina is normally described as
a form of chest pain,

but rather than being a severe pain,

it's a feeling of cramping and
constriction in the middle of the chest.

This lasts a few minutes and typically
happens when people begin to exercise.

It can go down the arm,
into the shoulders and neck and so on.

It can be associated with things like
sweatiness and shortness of breath.

The usual cause is narrowings
in the arteries

that provide blood to the heart.

Angina happens when the heart
is trying to do extra work,

and the oxygen it gets from the narrowed
blood vessels is insufficient

to provide for its needs.

It's almost a stitch-like symptom
that the heart develops.

Angina is usually classified into
two categories, stable and unstable.

Stable will typically come on when
somebody walks a particular distance,

it lasts a short period of time
and goes very quickly with medication.

Unstable angina tends to last longer and
happens at rest or on little exertion.

That should be regarded as an emergency
and the patient should go to hospital.

A proportion of people
will present with stable angina

that is due to Atherosclerosis,
narrowing in the arteries,

and that progresses and develops over
many years, perhaps 20 or 30 years.

It's a very slow-changing process which
is the reason why many of these patients

can be managed with tablets
and are not at high risk.

However, the unstable population
might present for the first time

with a heart attack. Obviously
that is a much higher risk situation.

Currently it's impossible to accurately
predict who is going to become unstable

from the stable population.

The sort of people who get angina,
it's more common in men

and in some ethnic groups,
particularly Asians,

and it becomes much more common
as people get older.

There is a variety of risk factors that
make people more likely to have it,

such as smoking, high cholesterol,
high blood pressure.

Angina is extremely common,
it gets more common with age

and it's estimated that perhaps as many
as 1 in 5 people over the age of 65

has some degree of angina.

A lot of those people will have
relatively mild symptoms

and will be controlled on tablets, but
some obviously will be much more unwell.

In younger populations
it is much less common,

and in women before the menopause
it's much less common.

In terms of medication, the treatment
for angina is in three groups.

One is to stop the symptoms
when they occur,

typically in the form of a spray

or a small nitrate tablet
that goes under the tongue.

The next is to prevent symptoms

which will be with medication such as
beta-blockers which slow the heart down

and reduce the oxygen demand
for the heart and prevent it happening.

There are alternatives for beta-blockers
which not everybody can use.

The final part is to try and prevent
progression of the existing disease.

That includes tablets such as aspirin,
something to reduce cholesterol,

which is usually a statin,
and various other medication too.

Following diagnosis, many patients are
advised to have further investigations

which might be a test like an angiogram,

which specifically looks at
the inside of the arteries,

to decide whether or not
further treatment is necessary,

such as angioplasty or bypass surgery.

An angiogram is a test which looks at
the inside of the arteries

by putting a tube either
in the top of the leg or the wrist

and take a fine catheter up to the heart
and put dye around the heart

to outline the arteries.

X-rays are taken and that shows you
where the narrowings are.

Then, there are several possibilities,

one is that you will be recommended
to carry on with tablets,

the next possibility is an angioplasty
will be done,

which is done through the same tube,

but involves putting in a balloon
and a stent, a wire mesh,

to keep the artery open.

That is put in the narrowed area
and blown up to keep the artery open.

If there are a lot of narrowings,
or in certain circumstance,

a bypass operation may be recommended.

This is a surgical option

which involves putting grafts beyond the
narrowings to improve the blood flow.

There are a lot of things that people
can do throughout their lives

to try and reduce their chances of
getting heart disease.

Not smoking, having a good diet,

Drinking is acceptable,
but in modest amounts.

We're all aware that the diet should be
high in fruit and vegetables,

relatively low in saturated fat
and low in salt.

Stable angina itself
does not carry a very huge risk.

People shouldn't worry
if they have stable symptoms

and the pain lasts a short time.

They will be given medication,
which is life-long.

That reduces the risk of anything
further happening quite substantially.

Unstable angina
is a very different category,

and should be regarded as an emergency.