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
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
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
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
happens at rest or on little exertion.
That should be regarded as an
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
many years, perhaps 20 or 30 years.
It's a very slow-changing process
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
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,
and it becomes much more common
as people get older.
There is a variety of risk factors
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
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,
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
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
beta-blockers which slow the heart down
and reduce the oxygen demand
for the heart and prevent it happening.
There are alternatives for
which not everybody can use.
The final part is to try and prevent
progression of the existing disease.
That includes tablets such as
something to reduce cholesterol,
which is usually a statin,
and various other medication too.
Following diagnosis, many patients
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
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
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
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
narrowings to improve the blood flow.
There are a lot of things that
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
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.
is a very different category,
and should be regarded as an emergency.