What is Angina

If you've been told you have angina, or you're trying to make sense of a chest discomfort that comes on with effort and eases when you rest, the most useful thing to know up front is that angina is a symptom, not a disease in its own right. It's the pain or pressure your heart produces when its muscle isn't getting enough oxygen-rich blood, usually because the coronary arteries that supply it have become narrowed. Most often, angina shows up as a tight, heavy or pressing sensation in the chest, sometimes spreading to the jaw, neck, arm or back, and it tends to come on with exertion, stress or cold weather.

In my experience caring for patients across Kingston-upon-Thames and South West London, the people who come to clinic with angina often describe it in very ordinary language. It's rarely the dramatic, crushing chest pain you see on television. More often it's a discomfort that builds when they walk uphill, hurry for a bus or climb stairs with shopping, and then quietly settles within a few minutes of stopping. That pattern matters, because it tells me the heart muscle is being asked to do more work than its blood supply can comfortably support. Understanding what's behind it, and treating it properly, is genuinely one of the most rewarding parts of my practice.

What's Happening Inside the Heart

Your heart is a muscle, and like any muscle it needs a constant supply of oxygen-rich blood to do its work. The coronary arteries are the small blood vessels that deliver this supply, and they're only 3 to 4 millimetres wide. Over years, they can narrow gradually through a process called atherosclerosis, where fatty plaque builds up on the artery walls. When that narrowing reaches around 70 per cent or more, the heart muscle can struggle to get the blood it needs, particularly when demand goes up.

Angina is the symptom of that mismatch. At rest, the narrowed arteries can usually deliver enough blood to keep things ticking along. The moment the heart has to work harder, however, the supply falls short and the muscle complains. That complaint is angina. The relief you feel when you slow down is the heart finding its balance again as demand drops back to what the arteries can manage.

The Different Types of Angina

Patients sometimes assume angina is a single thing, but in clinic I treat it as a spectrum.

Stable angina is the most common form. The pattern is predictable. The same kind of effort brings on the same kind of discomfort, and rest or a glyceryl trinitrate (GTN) spray usually settles it within a few minutes. Stable angina tells us the underlying coronary disease is established but not actively unstable.

Unstable angina is more concerning. It comes on with less effort than before, at rest, or wakes you from sleep. It's often more severe and lasts longer. Unstable angina is a warning that a plaque inside an artery may have become inflamed or partially ruptured, and it sits on the spectrum towards a heart attack. If your symptoms have changed in this way, that warrants urgent assessment rather than waiting.

Microvascular angina affects the very small blood vessels of the heart rather than the main coronary arteries. The arteries may look normal on standard tests, but the smaller vessels aren't dilating properly. This form is more common in women and is sometimes missed because the larger investigations come back clean.

Vasospastic (or Prinzmetal's) angina is caused by temporary spasm of a coronary artery rather than a fixed narrowing. It often happens at rest, sometimes during the night, and can affect people whose arteries look reasonably healthy on imaging.

In my experience, distinguishing between these types changes what we do next. The treatment for stable angina with significant artery narrowing looks very different from the treatment for microvascular angina, and getting the diagnosis right is what makes treatment work.

What It Actually Feels Like

The classic textbook description of angina is a heavy, tight, crushing sensation in the centre of the chest. In real life, patients describe it in a much wider range of ways. Some say it's a pressure or a band tightening across the chest. Others describe heaviness, burning, or a sensation that feels like indigestion. The discomfort can spread to the left arm, both arms, jaw, neck, upper back or stomach. Sometimes it's accompanied by breathlessness, sweating, nausea or unusual fatigue.

What I want patients to know is that heart symptoms are rarely the dramatic, crushing chest pain you see on television. From working with patients in clinic, I'd say the most reliable feature of angina isn't where it hurts or how it feels, but the pattern. Pain that comes on with exertion, builds gradually, eases with rest within a few minutes, and is reproducible by the same level of effort is the classic clinical signature. In our practice, around two out of three patients referred with chest pain turn out not to have classical angina once we've put the full picture together, which is why a proper assessment matters before anyone is labelled.

Who's at Risk

Angina shares the same risk factors as the rest of cardiovascular disease, and the more of them you have, the higher your risk. The big ones are:

• High blood pressure, which damages artery walls over time

• Raised cholesterol, which drives plaque build-up

• Diabetes, which accelerates artery disease

• Smoking, which damages the arteries directly and reduces oxygen delivery

• A family history of heart disease, particularly in close relatives under sixty

• Being overweight or sedentary

• Chronic stress, which I'd argue is just as important as diet or exercise

  
  

Age and sex matter too. Men tend to develop angina earlier than women, though women catch up after the menopause and often present with less typical symptoms, which is one of the reasons their diagnosis is sometimes delayed. The one thing I always tell patients, particularly those in their forties and fifties, is to know your numbers. Pay close attention to your blood pressure, your cholesterol, your diabetes risk and your waist measurement. These are the four numbers that most strongly predict whether angina is going to show up in your life.

How Angina Is Diagnosed

Diagnosing angina properly is about pattern recognition combined with the right tests. In clinic, the process usually starts with a careful history. What brings the discomfort on, how long it lasts, what relieves it, and what other symptoms come with it tell me more than almost any single test.

An ECG is almost always the first investigation. It can be completely normal between attacks, which is why we often supplement it with further imaging. An echocardiogram gives us a picture of the heart's structure and function at rest. A stress test or CT coronary angiogram lets us see what happens when the heart is asked to work harder. If those results raise enough concern, an invasive coronary angiogram gives us the most accurate map of the arteries and, where appropriate, the option to treat narrowings in the same sitting.

In my experience, a CT coronary angiogram works better than a standard exercise stress test for many patients with stable chest pain because it gives us direct anatomical information about the arteries rather than indirect functional clues. National guidance reflects this, and it's why CT is now often the first imaging test we use. The right test, though, depends on the individual, and that decision sits at the heart of a good cardiology consultation.

How Angina Is Treated

The good news is that angina is highly treatable, and most patients do very well with the right combination of approaches.

Lifestyle change comes first, and it's not optional. Stopping smoking, getting your blood pressure and cholesterol under control, moving regularly (a 20-minute walk in the fresh air every day is a brilliant starting point), and looking after your weight, sleep and stress levels genuinely slow the disease down. Patients sometimes underestimate how much lifestyle moves the needle, but the evidence is consistent and the effects compound over years.

Medication is the backbone of treatment for most patients. This usually includes a statin to lower cholesterol, aspirin or another antiplatelet to reduce clot risk, and one or more medications to reduce the heart's workload (beta-blockers, calcium channel blockers, long-acting nitrates) or to dilate the arteries when symptoms occur (GTN spray). The aim is to control symptoms, lower the risk of a heart attack, and let you live a normal active life.

Procedures are reserved for patients whose symptoms aren't controlled by medication or whose anatomy makes a stronger case for intervention. A coronary angioplasty with a stent opens a narrowed artery and props it open with a small mesh tube. Coronary artery bypass surgery, in which a healthy blood vessel is used to bypass a blocked artery, is used in more complex cases or when several arteries are involved.

In my experience, the patients who do best are those who treat angina as a long-term condition that responds well to consistent, joined-up care. It's not a disease you fix once and walk away from. It's one you manage carefully over decades, and the rewards of doing that well are substantial.

When to Seek Urgent Help

There are some patterns that always warrant urgent attention rather than waiting for a routine appointment.

If your chest pain is severe, lasts more than 15 minutes, doesn't ease with rest or GTN, or comes with sweating, sickness, breathlessness or a feeling of impending doom, call 999. This may be a heart attack and minutes matter. If your usual angina pattern has changed (coming on with less effort, at rest, or more frequently), that's unstable angina until proven otherwise and needs same-day medical assessment.

If you're getting symptoms that you can't quite explain and you've been putting them down to stress, indigestion or being out of shape, that's worth a proper cardiac assessment rather than continuing to second-guess. The earlier these symptoms are investigated, the more options we usually have.

Conclusion

Angina is your heart telling you that its blood supply isn't keeping up with what you're asking it to do. It's a serious signal, but it's also a manageable one. With the right diagnosis, the right lifestyle changes and the right combination of medication and (where needed) procedures, most patients with angina go on to live long, active, full lives. The key is taking the symptom seriously, getting properly assessed, and then committing to consistent long-term care rather than reaching for short-term fixes.

If you're experiencing chest discomfort with effort, your symptoms have changed recently, or you'd like a proper review of your cardiovascular risk and any current treatment, you can contact me, Dr Roy Jogiya, at Kingston Cardiologists to arrange a private consultation across Kingston-upon-Thames, Wimbledon, or central London. Appointments are available in person and virtually, with full diagnostic support on site.