Angina: how getting tested could save your life

Written by: Professor Attila Kardos
Published: | Updated: 20/01/2021
Edited by: Cameron Gibson-Watt

Millions of patients present to A&E annually with chest pain symptoms. While some of which aren't heart-related, the most common cause of heart-related chest pain is due to furred up heart arteries - also known as angina.


We recently spoke to Professor Attila Kardos - a leading consultant cardiologist based in Milton Keynes - who provides a comprehensive service in investigating patients with chest pain to identify problems with the heart. In his latest article, he explains more about angina, why it is so important to get tested if you have symptoms and what treatment to expect if you receive a diagnosis.

 

 

What is angina?

The heart is supplied with blood via small vessels called coronary arteries. If these vessels are partially blocked, they can cause problems with blood delivery to the heart muscle resulting in angina.

 

Usually, this happens when the heart’s demand for oxygen supply increases, for example during exercise or stressful situation. The usual feature of typical angina is that it subsides at rest within a few minutes.

 

What symptoms suggest you could have angina?

The main symptoms of angina is usually discomfort in your chest or exercise-induced breathlessness, which feels different than usual. Some people describe this discomfort as a severe tightness, whereas others report it as a dull ache. This discomfort can also spread to your neck, arms, jaw, back and/or abdomen.

 

Why is it important to diagnose angina?

Angina is a warning sign of coronary heart disease, so recognising its symptoms and getting tested can help prevent a heart attack.

 

A heart attack occurs when one of your coronary arteries becomes blocked by a blood clot. This blockage is a result of fatty material called atheroma building up in the arteries and preventing blood flow and oxygen to your heart.

 

Which tests are carried out to look for angina?

Patients with angina can be referred for exercise tests to make a diagnosis. This can be combined with imaging tests to improve diagnostic accuracies, such as a stress echocardiogram or myocardial perfusion scintigraphy.

 

Stress echo lab

 

An anatomical assessment of your heart arteries can be done non-invasively by using a cardiac CT angiography (CT scan).

 

A cardiac CT angiography is a safe and simple test that usually lasts less than 10 minutes. To get a better idea of what to expect when you go in for your appointment, you can watch this short video from Milton Keynes Hospital. It explains the full process and how the test will be conducted.

 

The following images can help cardiologists rule out or make a diagnosis of angina:

 

 

Patients with a high probability and/or need for invasive treatment, like stent insertion, will be offered invasive coronary angiography, also known as a heart catheter.

 

 

What happens if you are diagnosed with angina?

If you are diagnosed with having blockages in your heart arteries, your treatment will depend on the severity and location of these blockages. You may be offered medical treatment such as:

 

  • Beta-blockers
  • Calcium channel clockers
  • Nitrate tablets to control the symptoms
  • Aspirin
  • Other medications to reduce the progression of the disease like statins or ACE-inhibitors

 

Any risk factors that promote the formation of blockages will have to be tightly controlled, such as blood pressure, cholesterol and diabetes. Smoking is a major contributor to blockages, so this will have to be addressed too. Regular physical activity will remain essential for keeping an eye on the changes of your symptoms and contribute to blood pressure, cholesterol and diabetes control in those with this risk factors.

 

If medical treatment does not improve your anginal symptoms, then heart artery interventions, such as coronary angioplasty or by-pass surgery, can be offered. By-pass surgery may well improve your life expectancy, in particular, if you have very severely diseased arteries.

 

If you are worried about any symptoms mentioned in this article, you can book an appointment with Professor Attila Kardos via his Top Doctors profile.

By Professor Attila Kardos
Cardiology

Professor Attila Kardos is a leading consultant cardiologist based at the Milton Keynes University Hospital BMI Saxon Clinic in Milton Keynes and The Manor Hospital in Oxford. His areas of expertise include chest pain, palpitations, breathlessness, valve diseasecardiovascular imaging,  general cardiology cardio-oncology and heart screening.

Professor Kardos graduated with a distinction in 1988 from Albert Szent-Györgyi Medical School Szeged in Hungary. Whilst practising as a junior doctor at Szeged University, he spent two years at the Heart Centre in Bad Krozingen as a research fellow. He then went on to receive his research fellowship of the European Society of Cardiology which allowed him to work for almost five years as a fellow at the University Department of Cardiovascular Medicine in Oxford.

Throughout his career, Professor Kardos has published and presented over 100 peer-reviewed papers and has given various lectures in over 140 national and international conferences, of which he has been a keynote speaker. He is also a member of the Scientific Committee of the XVIIIth – XXIth Congresses of the European Society of Cardiology.

In 2003, Professor Kardos was appointed as a consultant cardiologist at Milton Keynes University Hospital where he is now the Vice-Chair of Research and Development. He has established several cardiac services at Milton Keynes, such as contrast-enhanced stress echocardiography for chest pain assessment, and introduced invasive coronary angiography and permanent pacemaker implantation. In addition, he is an honorary senior lecturer to the Division of Cardiovascular Medicine at Nuffield Department of Medicine at the University of Oxford and was awarded a personal Chair in Cardiovascular Medicine at the University of Buckingham in 2018.

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