Angina
The main symptom of angina is a dull, heavy or tight pain in
the chest that can sometimes spread to the left arm, neck, jaw or back. The
pain is usually triggered by physical activity or stress and usually only lasts
for a few minutes.
The two main types of angina are
stable angina and unstable angina.
If you have stable angina, your symptoms will
usually develop gradually over time and follow a set pattern. For example, you
may only experience symptoms when
climbing stairs or if you are under a lot of stress.
The symptoms of
stable angina usually only last for a few minutes and can be improved by taking
medication called glyceryl trinitrate. Stable angina is not life-threatening
on its own. However, it is a serious warning sign that you have an increased
risk of experiencing more serious conditions, such as a heart
attack or stroke.
In cases of unstable angina, the symptoms develop
rapidly, can persist even at rest and can last up to 30 minutes. The symptoms of
unstable angina may
also be resistant to treatment with
glyceryl trinitrate.
You may experience symptoms of
unstable angina after
previously having symptoms of
stable angina.
However, unstable angina can also occur in people who do not
have a previous history of stable angina.
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. Unstable angina can be treated with medication and
surgery.
There are three main goals in treating angina.
They are:
- to relieve the symptoms during an angina attack
- to reduce the number of angina attacks that a person has
- to prevent the restricted blood supply to the heart becoming more severe because this could trigger a heart attack or stroke.
Schematic diagram showing a healthy coronary artery and an atherosclerotic coronary artery.
A number of medications can be
used to try to achieve these goals. Surgery may be recommended if a
person’s symptoms do
not respond to other forms of treatment. There are
two types of surgical techniques that are used to treat angina. They are:
- coronary artery bypass graft - where a section of blood vessel is taken from another part of the body and used to re-route the flow of blood past a blocked or narrow section of artery
- percutaneous coronary intervention (also known as a coronary angioplasty) - where a narrowed section of artery is widened using a tiny tube called a stent.
What causes angina?
Most cases of angina are caused by atherosclerosis,
which is a condition where the arteries become hardened and narrowed due to a
build-up of fatty substances that are known as plaques. This can restrict the
blood supply to the heart and trigger the symptoms of angina. Risk factors for atherosclerosis include:
- advanced age
- smoking
- obesity
- a high-fat diet.
Conditions that affect the
normal flow of blood, such as atherosclerosis, are
known as cardiovascular diseases (CVD).
Angina is a common condition among older
adults. In England it is estimated that 1 in every 12 men and 1 in every
30 women between 55 and 64 years of age have angina. This figure rises to 1 in
every 7 men and 1 in every 12 women who are over 65 years of age.
Angina is thought to be more common in men
than women because in the past more men smoked and smoking is a significant
risk factor.
A major concern for people with angina is that their atherosclerosis will
continue to get worse. This can lead to the blood supply to their heart
becoming blocked, which could trigger a heart attack.
Similarly, a blockage of the blood supply to the heart could trigger a stroke.
It is important to emphasise
that you can considerably reduce your risk of developing complications by
making a series of lifestyle changes. For example, if you are obese and you
smoke, and you successfully quit smoking and achieve a healthy weight,
your risk factor will be significantly reduced.
Outlook
Each year it is estimated that
just,1 in every 100 people with stable angina will have a fatal heart attack or stroke. However, it is thought that as
many as 1 in 40 people may experience a non-fatal heart attack or stroke, both of which can have a
considerable impact on a person’s quality of life.
Depending on a number of
possible risk factors, the outlook for people with unstable angina can vary considerably. These
risk factors include:
- age
- whether there is a history of previous heart disease
- whether you have high-blood pressure (hypertension)
- whether you have a long-term condition, such as type 2 diabetes mellitus (DM).
Causes
Like all of the body’s organs and
tissues, your heart needs a constant supply of oxygen-rich blood to function
normally. Blood is supplied to the heart by
two large blood vessels that are known as the left and right coronary arteries.
Stable angina is most commonly caused when the coronary arteries become narrow
and hardened (atherosclerosis), which restricts the blood flow to the muscles
of the heart.
Stable angina is essentially a
supply and demand problem. When you are at rest, the muscles of your
heart only need a relatively small supply of blood, so you will not experience
any symptoms. However, when you exercise or feel stressed, your heart muscles
have to work harder and the demand for blood increases.
Due to the narrowed coronary
arteries, the required amount of blood is unable to reach the heart in time,
which means that the demand for blood outstrips the supply, triggering the
symptoms of angina.
Unstable
angina
One of the underlying causes of
atherosclerosis is a build-up of fatty deposits, known as plaques, in the
arteries. If the plaques rupture (split) it will interfere with the normal flow
of blood and cause a blood clot to form.
A blood clot can
quickly grow, blocking one of the coronary arteries and significantly reducing
the blood supply to the heart, triggering the symptoms of unstable angina.
Anything that causes the coronary
arteries to narrow is a risk factor for both stable and unstable angina. For
example:
- high blood pressure
- a diet that is high in fat and cholesterol
- a lack of exercise
- drinking too much alcohol
- smoking
- type 1 diabetes and type 2 diabetes
- age
- family history.
These individual risk factors can
often be inter-related. They are explained below in more detail.
Your arteries are designed to
pump blood at a certain pressure. If that pressure is exceeded, the artery
walls will be damaged. High blood pressure can be caused by:
- being overweight
- drinking excessive amounts of alcohol
- smoking
- stress
- a lack of exercise.
For reasons that are not fully
understood, high blood pressure is more common among people of Afro-Caribbean
and south Asian (Indian, Pakistani and Bangladeshi) origin. A tendency to develop high blood
pressure also often runs in families. This is known as a genetic
predisposition.
Cholesterol is a type of fat that
is essential for the functioning of the body. It helps produce hormones,
protects nerve endings and makes up cell membranes (the walls that protect
individual cells). There are two main types of cholesterol:
- low density lipoprotein (LDL) - is mostly made up of fat, plus a small amount of protein; this type of cholesterol can block your arteries so it is often referred to as ‘bad cholesterol’
- high density lipoprotein (HDL) - is mostly made up of protein, plus a small amount of fat; this type of cholesterol can help reduce a blockage in your arteries so it is often referred to as ‘good cholesterol’
Most of the cholesterol that the
body needs is manufactured by the liver. However, eating foods that are high in
saturated fat results in cholesterol being broken down into LDL (bad
cholesterol).
Lack of
exercise
A lack of regular exercise can
raise your blood pressure and increase your risk of developing type 2 diabetes.
Both of these factors increase your risk of developing angina.
Drinking excessive amounts of
alcohol will also increase your risk of developing angina. Excessive drinking is defined as
regularly exceeding the recommended daily allowance of three to four units of
alcohol a day for men and two to three units a day for women. A unit of alcohol
is approximately half a pint of normal strength lager, a small glass of wine or
a single measure (25ml) of spirits.
Regularly exceeding the
recommended alcohol limits will raise your blood pressure and your cholesterol
level, both of which are risk factors for angina.
Smoking can damage the walls of
your arteries. If your arteries are damaged by smoking, blood cells called
platelets will form at the site of the damage in an attempt to repair it. This
can cause your arteries to narrow.
Smoking also decreases your
blood's ability to carry oxygen around your body, which increases the chances
of a blood clot occurring.
If you have poorly controlled
diabetes, the excess amount of glucose in your blood can damage the walls of
your arteries.
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.
Heart disease can run in families,
so if you have a first degree relative (mother, father, brother or sister) with
a history of heart disease or angina, your risk of developing angina is
increased.
Symptoms
The most common symptom of angina
is a feeling of pain or discomfort in your chest. The pain can feel tight, dull
or heavy and usually passes within a few minutes. This type of angina is known
as stable angina.
The pain can spread from your
chest to your left arm, neck, jaw and back. It usually follows a period of
physical activity or emotional stress. In some cases, the pain can also develop
after eating a meal or during cold weather. Factors that can cause the symptoms
of angina to occur are called angina triggers. Some people with angina may also
experience symptoms of:
- breathlessness
- feeling sick
- feeling unusually tired
- dizziness
- belching (burping)
- restlessness.
The onset of angina symptoms is
sometimes known as an angina attack.
Schematic diagram showing the symptoms of angina.
Unstable
angina
The symptoms of unstable angina
are the same as those of stable angina, but they do not follow the usual
pattern. For example, in unstable angina the symptoms:
- can develop without any angina triggers being
present
- can persist even when you are resting
- can last longer than five minutes
- may not respond to treatment with glyceryl
trinitrate.
Dial 999 to request an ambulance
if you think that you or someone you are with is experiencing the symptoms
of unstable angina.
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. Aspirin helps to prevent
blood clots and will reduce your risk of experiencing a heart attack or a
stroke.
Diagnosis
Your doctor will probably start
by asking you about the pattern of your symptoms, such as whether you have noticed
any particular triggers. Your physician will then carry
out a general assessment to assess whether you have any signs and symptoms that
could suggest that you are at increased risk of developing atherosclerosis,
which in turn could lead to the symptoms of angina.
As part of the assessment you
will have:
- blood pressure tests
- your weight and waist size measured
- blood tests to measure the amount of
cholesterol and glucose (if you are diabetic) in your blood and also to
determine how well your liver is working
- a urine test to determine how well your
kidneys are working.
(Some angina medications are
not suitable for people with liver or kidney disease.) You are also likely to
discuss whether you smoke, how much you drink, whether you you have a
high fat diet and any family history of heart disease.
If angina is suspected, it is
likely that you will be referred to a cardiology department or clinic for
further assessment to:
- confirm or disprove a suspected diagnosis of
angina, and
- assess your risk of having a heart attack
or stroke in the future.
The assessment involves a series
of tests that are explained below.
Schematic diagram showing how angina may present.
An electrocardiogram (ECG)
records the rhythms and electrical activity of your heart. A number of
electrodes (small metallic discs) are placed on your arms, legs and chest. The
electrodes are connected to a machine that records the electrical signals of each
heartbeat. An abnormal ECG reading may
indicate that the muscles of your heart are not receiving enough blood.
An exercise tolerance test (ETT)
is similar to an ECG but it is carried out when you are exercising, usually on a
treadmill or an exercise bike.
An ETT can be used to measure how
much exercise your heart is able to tolerate before the symptoms of angina are
triggered. This information is useful for assessing how severe your angina is
likely to be.
A myocardial perfusion
scintigraphy (MPS) is an alternative test to an ETT that can be used if a
person is unable to exercise or when the results of an ETT are unclear.
MPS involves injecting a small
amount of a radioactive substance into your blood. A special camera, known as a
gamma camera, is used to track the substance as it moves through your blood
vessels and into your heart. This allows healthcare professionals to determine
how well blood is reaching your heart.
MPS is usually carried out both
at rest and when you are exercising. If you are unable to exercise, medication
can be used to replicate the effects of exercise on your heart.
A coronary angiography is a
test that can be used to identify whether your coronary arteries are narrowed
and determine how severe any blockages are. During an angiography, a catheter
(a thin, flexible tube) is passed into a vein or artery in your groin or arm,
and X-rays are used to guide it into your coronary arteries. A dye is injected
into the catheter to highlight the arteries supplying blood to your heart. A
number of X-ray images (angiograms) are taken that will highlight any
blockages.
Coronary angiographies carry a
small risk of serious complications, such as a stroke or a heart attack, which
is estimated to be around 1 in 500. Although this risk is small, healthcare
professionals are usually unwilling to perform an angiogram unless the benefits
of the procedure outweigh the potential risks.
Therefore, it is likely that you will only be referred for a coronary angiogram
if:
- the diagnosis of angina remains unclear
- your angina symptoms persist despite treatment
and/or you are thought to be at significant risk of having a heart attack
or stroke and surgery is being considered.
Unstable
angina
If unstable angina is suspected,
you will be admitted to hospital. Depending on the severity of your symptoms,
you may be placed in a general ward or in the intensive care unit (ICU). You will be given an ECG as soon
as you arrive at hospital to quickly assess whether your heart has been
significantly damaged.
Blood tests will also be carried
out to help identify increased enzyme levels that are known to be released when
the heart is damaged. A coronary angiography may also be performed to assess
the size and location of the blockage in your coronary artery. Due to the urgent need to prevent
serious complications arising from unstable angina, treatment may be started
before all of the test results are known.
After receiving suitable
treatment for symptoms of unstable angina, it will be necessary to assess your
likelihood of developing recurring symptoms, or possibly the symptoms of a
heart attack, in the next six months. The outcome will have an important
bearing on your recommended treatment plan.
The Global Registry of Acute
Cardiac Events (GRACE) is a widely used method of assessing the risk of further
heart problems occurring. GRACE is essentially a scoring system that is based
on factors such as:
- your age
- the number of times that your heart beats
every minute
- your blood pressure
- how much of a substance called creatinine is
present in your blood - higher than expected levels can be a sign of heart
damage
- whether you have any signs and symptoms of
heart failure, such as excess fluid inside your lungs - heart failure is
where your heart is unable to meet your body’s need for oxygen-rich blood.
Your GRACE score will provide a
relatively accurate predictor of your risk of developing further heart problems.
The score can range from very low (less than 1 in 65) to the highest (more than
1 in 10). Surgery is usually recommended as a precaution for
people who have a GRACE risk score of 1 in 33 or above.
Treatment
There are three aims in treating
stable angina. They are:
- to provide immediate relief from the symptoms
of angina
- to prevent future episodes of angina symptoms
- to reduce your risk of having a heart
attack or stroke.
The last aim is important when
deciding on your recommended treatment plan. If your risk of having a heart
attack or stroke is thought to be high because your arteries are significantly
narrowed and you have other risk factors, such as high blood pressure or
diabetes, a combination of surgery and medication will probably be recommended.
Surgery may also be recommended if your symptoms fail to respond to treatment
with medication.
If your risk of having heart
attack or stroke is thought to be low to moderate, it should be possible to
significantly reduce the risk by using a combination of medication and
lifestyle changes.
Providing immediate relief
Glyceryl trinitrate is a
medication that is widely used to provide immediate relief from the symptoms of
angina. It can also be used as a preventative measure before undertaking
activities that are known to trigger angina. Glyceryl trinitrate belongs to a
group of medication called nitrates. Nitrates work by relaxing and widening the
blood vessels that increase the blood supply to the heart.
Glyceryl trinitrate is available
in tablet form, which you dissolve under your tongue, or as a spray. The side
effects of glyceryl trinitrate include headache and dizziness. You should avoid drinking alcohol
while taking glyceryl trinitrate because it can make the side effects worse. If
you experience symptoms of dizziness, avoid driving and operating complex or
heavy machinery.
One dose of glyceryl trinitrate
usually eases the pain within two to three minutes. If the first dose does not
work, a second dose can be taken after five minutes and a third dose after a
further five minutes. You should dial 999 to request an
ambulance if the pain persists despite taking three doses of glyceryl
trinitrate over a 15 minute period.
Your family doctor or cardiologist (an
expert in treating heart conditions) will usually try one medication first to
see whether it helps prevent your symptoms. This is known as monotherapy. If
one medication is not effective, two medications may be recommended. This is
known as combination therapy.
The first medication that is used
to try to reduce the frequency of angina attacks is either a medication called
a beta-blocker or alternatively a medication called a calcium channel blocker.
Exactly which medication you will be prescribed may depend on your current level
of health and, in some cases, your personal preference.
Beta-blockers make the heart
beat slower and with less force. This means that the heart needs less blood and
oxygen after exercise, so angina is prevented or occurs less frequently. Common side effects of
beta-blockers include:
- tiredness
- cold hands and feet
- diarrhoea
- feeling sick.
Less common side effects of
beta-blockers include:
- insomnia
- nightmares, and in men erectile
dysfunction.
Beta-blockers can also interact
with other medicines, causing possible adverse side effects. Therefore, you
should check with your doctor or pharmacist before taking other medicines in
combination with beta-blockers, including those available over the counter.
Calcium channel blockers work by
relaxing the muscles that make up the walls of your arteries, increasing the
blood supply to the heart. Side effects of calcium channel
blockers include:
- flushed face
- headaches
- dizziness
- tiredness
- skin rashes.
However, these side effects
should pass within a few days once your body gets used to the medicine. You should never drink grapefruit
juice if you are taking calcium channel blockers because they can cause a drop
in your blood pressure.
If you are unable to take
beta-blockers or calcium channel blockers for medical reasons, or if you find
the side effects too unpleasant, your doctor or cardiologist may recommended
alternative medication.
Long-acting nitrates are a
similar medication to glyceryl trinitrate, except they are designed for the
long-term prevention of symptoms rather than providing short-term relief. Side effects of long-acting
nitrates include headache and a flushed face. Both of these side effects should
improve with time.
If you are taking long-acting
nitrates, you should not take the anti-erectile dysfunction medication known as
sildenafil (Viagra). This is because the combination of the two medications can
lead to a dangerous drop in blood pressure.
Ivabradine is a relatively new
type of medication that has a similar effect to beta-blockers in that it slows
down the speed of your heart beat. However, it achieves this effect in a different way to beta-blockers, which
means that it can often be used in people who are unable to take beta-blockers
for medical reasons, such as those with a lung infection.
A common side effect of
ivabradine is that people experience temporary flashes of brightness in their
field of vision. If you have this side-effect, it may not be safe for you to
drive at night. You should ask your personal doctor for advice.
Nicorandil is a potassium channel
activator. Potassium channel activators work in a similar way to calcium
channel blockers by widening the coronary arteries in order to increase blood
flow to the heart.
However, as potassium channel
activators achieve this effect in a different way to calcium channel blockers,
they can often be used by people who are unable to take calcium channel blockers
for medical reasons. Side effects of nicorandil
include:
- dizziness
- headaches
- feeling sick.
Ranolazine works by relaxing the
muscles of the heart in order to improve blood flow and prevent angina attacks. Unlike the other medications that
are used to prevent angina attacks, ranolazine does not affects the speed at
which the heart beats, so it may be a more suitable alternative treatment for
people with heart failure or an abnormal heart rhythm. Common side effects of ranolazine
include:
- constipation
- dizziness
- feeling very weak.
If your symptoms fail to respond
to one medication, a combination of medications will probably be recommended,
which is known as combination therapy. If your symptoms fail to respond
to two medications, you may be referred for surgical treatment (see below).
In some cases, where people are
unable or unwilling to have surgery, three different medications are
prescribed.
Three medications are available
to help reduce the risk of a heart attack and stroke in people with angina.
They are:
Statins work by blocking the
effects of an enzyme in your liver that is used to make cholesterol. Reducing
blood cholesterol levels should prevent further damage to your coronary
arteries and should reduce the risk of a heart attack or stroke occurring. Statins sometimes have mild side
effects that can include, constipation, diarrhoea and abdominal pain.
Antiplatelets are medications
used to reduce the 'stickiness' of platelets to prevent blood clots.
Platelets are tiny particles in the blood that help the blood to clot. Taking antiplatelet medicine
reduces your risk of having a heart attack.
Low-dose aspirin (usually 75mg
daily) is the preferred antiplatelet medicine. If you are allergic to aspirin,
or you are unable to take it due to having another health condition that may be
aggravated by it, such as stomach ulcer, alternative antiplatelet medications
are available.
Angiotensin-converting enzyme
(ACE) inhibitors are medicines that can be used to reduce your blood pressure. ACE inhibitors block the activity
of a hormone called angiotensin II, which narrows blood vessels. As well as
stopping the heart working so hard, ACE inhibitors improve the flow of blood
around the body.
ACE inhibitors have been known to
reduce the supply of blood to the kidneys, which can reduce their efficiency.
Therefore, blood and urine tests may be carried out before you start taking ACE
inhibitors to make sure there are no pre-existing problems with your kidneys. Annual blood and urine tests may
also be required if you continue to use ACE inhibitors.
Side effects of ACE inhibitors
include, dizziness tiredness or weakness and a persistent, dry cough, although
these should pass within a few days. You should check with your doctor
or pharmacist before taking any other medication in combination with ACE
inhibitors as they can cause side effects.
Surgery is usually recommended if
your angina symptoms fail to respond to medication. However you will probably
need to continue taking some medication after having surgery. There are two main types of
surgery that can be used to treat angina are:
- coronary artery bypass graft - where a section
of blood vessel is taken from another part of the body and used to
re-route the flow of blood passed a blocked or narrow section of artery
- percutaneous coronary intervention (also known
as a coronary angioplasty) - where a narrowed section of artery is widened
using a tiny tube called a stent.
In some circumstances it may not
be possible to choose whether you have a CABG or a PCI. For example, PCI may
not be suitable for people whose blood vessels have an unusual structure
because it can make the PCI technique particularly challenging.
Both PCI and CAGB are broadly
similar in their effectiveness in treating angina and preventing fatal
complications in the long-term, although each technique has its own set of pros
and cons. As PCI does not involve making
major incisions in the body, the recovery time from surgery is much quicker and
it involves much less post-operative pain.
One main disadvantage of PCI is
that there is a higher risk of the unblocked section of artery becoming blocked
again which would require further surgery to treat. The most recent data shows
that further surgery is required in around 1 in 25 cases. CABG is usually the preferred
surgical option for people who:
- have diabetes, and/or
- are over 65 years of age, and/or
- have blockages in three or more of the blood
vessels that supply the heart with blood.
Research indicates that using the
CABG technique in such circumstances is more likely to prolong lifespan than
using the PCI technique. There is also recent evidence that people who have had
a CABG usually report a slightly better quality of life in the long-term.
The disadvantage of CABG is that
it causes more post-operative pain than PCI and it also has a longer recovery
time which is usually around 12 weeks compared to about one to two weeks for
PCI.
Unstable
angina
If you have unstable angina
(where symptoms develop rapidly and persist even at rest), upon being admitted
to hospital you will be given medication to prevent blood clots developing and
reduce your risk of having a heart attack or stroke. This will usually be aspirin
(used for its blood thinning abilities rather than as a pain killer) unless
there is a reason you are unable to take aspirin, such as having a history of
liver disease.
You will probably also be
prescribed another blood-thinning medication called clopidogrel, which you may
need to take for at least 12 months (if you are unable to take aspirin you will
just be prescribed clopidogrel). You may also be given an
injection of an additional blood thinning medication such as fondaparinux or
heparin.
It is likely that you will then
have a series of tests to assess your risk of having a heart attack in the
future (see Angina - diagnosis). If the risk is moderately high,
a coronary angiography may be carried out to assess the size and location
of the blockage in your coronary artery. If the blockage is significant, a CABG
or a PCI can be performed to widen the artery.
Prevention
Lifestyle
changes
Making lifestyle changes is the
most effective way to prevent getting angina. If you already have angina,
making lifestyle changes will also help prevent your symptoms getting worse and
reduce your risk of having a heart attack or stroke.
The best way to achieve these
goals is to eat a healthy, balanced diet, try to keep your blood pressure at a
healthy level and avoid smoking. This will lower your blood pressure, reduce
your cholesterol levels and strengthen your heart, which are three of the most
effective ways of preventing angina and reducing the risk of a heart attack and
stroke.
Eating an unhealthy diet that is
high in fat will make your atherosclerosis worse and increase your risk of
developing a heart attack or stroke. Continuing to eat high fat foods
will cause more fatty plaques to build-up in your arteries. This is because
fatty foods contain cholesterol. There are two main types of cholesterol:
- low-density lipoprotein
(LDL) - is mostly made up of fat plus a small amount of protein;
this type of cholesterol can block your arteries so it is often referred
to as ‘bad cholesterol’
- high-density lipoprotein
(HDL) - is mostly made up of protein plus a small amount of fat;
this type of cholesterol can reduce a blockage in your arteries so it is
often referred to as ‘good cholesterol’.
There are also two types of fat -
saturated and unsaturated. Avoid foods that contain saturated fats because they
will increase the levels of bad cholesterol in your blood. Foods high in
saturated fat include:
- meat pies
- sausages and fatty cuts of meat
- butter
- ghee (a type of butter often used in Indian
cooking)
- lard
- cream
- hard cheese
- cakes and biscuits
- food that contains coconut or palm oil.
Eating a small amount of
unsaturated fat will increase the level of good cholesterol and help reduce any
blockage in your arteries. Foods that are high in unsaturated fat include:
- oily fish
- avocados
- nuts and seeds
- sunflower, rapeseed and olive oil.
Smoking
Smoking is a major risk factor
for both heart attacks and strokes because it causes atherosclerosis and raises
your blood pressure.
If you decide to stop smoking, your doctor will be able to refer you to your local Stop Smoking
Service, which will provide you with dedicated help and advice about
the best ways to give up smoking. The specially trained helpline staff will be able
to offer you free expert advice and encouragement.
If you are committed to giving up
smoking but do not want to be referred to a stop smoking service, your doctor must be able to prescribe medical treatment to help with any withdrawal
symptoms that you may experience after giving up.
High
blood pressure
Persistent high blood pressure
can put both your arteries and your heart under extra strain, increasing your
risk of developing a heart attack or stroke. High blood pressure can often be
reduced by eating a healthy diet, moderating your consumption of alcohol,
maintaining a healthy weight and taking regular exercise.
The dietary advice above also
applies if you have high blood pressure. In addition, you should cut down on
the amount of salt in your food and eat plenty of fruit and vegetables. Salt raises your blood pressure.
The more salt you eat, the higher your blood pressure. You should aim to eat
less than 6g (0.2oz) of salt a day, which is about a teaspoonful.
Eating a low-fat diet that
includes lots of fibre, such as wholegrain rice, bread and pasta, and plenty of
fruit and vegetables, has been proven to help lower blood pressure. Fruit and
vegetables are full of vitamins, minerals and fibre and help keep your body in
good condition. You should aim to eat five 80g portions of fruit and vegetables
every day.
Alcohol
Regularly drinking alcohol above
the recommended limits will raise your blood pressure. Therefore,
staying within the recommended levels is the best way to reduce your risk of
developing high blood pressure. The recommends limits for alcohol consumption
are:
- 3-4 units a day for men
- 2-3 units a day for women.
Alcohol is also high in calories,
so you will gain weight if you drink regularly. Being overweight will also
increase your blood pressure.
Being overweight forces your
heart to work harder to pump blood around your body which can raise your blood
pressure.
If you do need to shed some weight, it is worth
remembering that just losing a few pounds will make a big difference to your
blood pressure and overall health.
Exercise
Being active and taking regular
exercise will lower your blood pressure by keeping your heart and blood vessels
in good condition. Regular exercise can also help you to lose weight which will
help lower your blood pressure.
Starting an exercise a programme
when you have angina can be challenging because physical activity may trigger
the symptoms of an angina attack. However, the more you exercise you do, the
less likely it is that you will have an angina attack.
Low-impact activities, such as
walking, swimming and cycling are recommended. More strenuous activities, such
as playing football and squash, are not recommended.
Complications
A heart attack or a stroke are
the most serious complications that can occur in cases of angina. However, the stress of living with a long-term condition can also have an
impact on your emotional wellbeing and, in some cases, trigger the onset of
depression. All three complications are discussed in more detail below.
The leading cause of angina is
when the blood supply to the heart becomes clogged up by fatty deposits called
plaques. In cases of stable angina, there
is a small chance that one of the plaques will burst open, causing a blood clot
to form. The blood clot can then block the supply of oxygen-rich blood to the
muscles of the heart, causing extensive damage to the heart muscles and
triggering a heart attack.
The risk of having a heart attack
depends on a number of factors, such as age, blood pressure and the extent of
the blockage. Depending on these factors, the
risk of having a heart attack in any given year can range from less than 1 in a
100 to 1 in 12. It is always possible to lower this risk by making lifestyle
changes.
Symptoms of a heart attack include:
- chest pain - the pain is usually in the centre of your chest and can feel like a sensation of pressure, tightness or squeezing
- pain in other parts of your body - it can feel as if the pain is travelling from your chest to your arms (usually the left arm is affected but it can affect both arms), jaw, neck, back and abdomen
- shortness of breath (SOB)
- nausea and vomiting (feeling and being sick)
- an overwhelming sense of anxiety (similar to having a panic attack).
You must call an ambulance
straight away if you suspect that you or someone you know is having a heart
attack. heart attacks are treated
using a combination of medication to improve the blood flow to the heart and
surgery to bypass the blockage (coronary artery bypass graft) or widen the
artery (percutaneous coronary intervention).
If you have fatty plaques
clogging up your coronary arteries, you may also have plaques clogging up the
main blood vessel that supplies your brain with blood (the carotid artery).
If one of the plaques bursts
open, it could cause a blood clot to develop, blocking the supply of blood to
your brain and triggering a stroke. As with a heart attack, you can also
reduce your risk of having a stroke by making lifestyle changes.
The main symptoms of a stroke can
be remembered using the word FAST which stands for Face-Arms-Speech-Time.
- Face - the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
- Arms - the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
- Speech - the person’s speech may be slurred or garbled or they may not be able to talk at all despite appearing to be awake
- Time - you must call an ambulance immediately if you see any of these signs or symptoms.
A stroke can be treated
using medication to dissolve the blood clot and surgery to unblock the carotid
artery.
Living with a condition such as
angina can cause feelings of stress and anxiety in some people, which
can lead to symptoms of depression. You may be feeling depressed if during the
last month:
- you have often felt down, depressed or hopeless
- you have little interest or pleasure in doing things.
It is important that you speak to
your doctor if you think that you have depression. Depression does not only
affect your mental health, it can also have an adverse affect on your physical
health as well.
Treatments for depression
include antidepressant medications and a type of talking therapy called
cognitive behavioural therapy (CBT).
Source: NHS Choices.
Source: NHS Choices.