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Angina Pectoris

Angina Pectoris

Angina Pectoris - symptoms, causes, treatment options available in Australia, and when to see a doctor. Evidence-based medical information.

Dr. Louis J Sisk
Dr. Louis J Sisk
BSc(Hons) MBChB MRCS(Glasg) MTrauma
Published: August 23, 2025

What You Need to Know – The Basics

Angina is chest pain caused by your heart not getting enough blood and oxygen.

The main things to know:

  • It often feels like squeezing, pressure, tightness, or heaviness in the chest.
  • Pain can spread to the shoulders, neck, jaw, back, or arms.
  • It’s serious, but usually manageable with the right treatment and lifestyle changes.
  • Angina is more common as we get older, especially if you have risk factors like high blood pressure, high cholesterol, diabetes, or you smoke.

Overview

Angina happens when the coronary arteries (the heart’s blood vessels) can’t deliver enough blood to the heart muscle — usually because the arteries are narrowed.
Less blood = less oxygen → the heart complains with pain or pressure.

There are two common patterns:

  • Stable angina: Predictable. Comes on with exertion or stress, eases with rest or your GTN spray/tablet.
  • Unstable angina: New, worsening, or at rest. This is an emergency.

Symptoms and What It Can Feel Like

  • A band-like tightness or pressure in the centre or left of your chest
  • Discomfort that spreads to the arm(s), neck, jaw, back, or shoulders
  • Breathlessness, nausea, sweating, light-headedness
  • Some people (especially women, older adults, and those with diabetes) notice indigestion-like discomfort, unusual fatigue, or breathlessness instead of obvious chest pain

If it feels different, worse, or lasts longer than usual, treat it as urgent.

What to Do During an Angina Episode (Example)

Important: This is general information and does not replace your personalised plan. Always follow the instructions given by your medical practitioner.

  1. Stop and sit (rest with your head and shoulders supported).
  2. Use your GTN spray/tablet exactly as prescribed (usually under the tongue).
  3. Wait 5 minutes. If pain is still present, take a second GTN dose.
  4. After another 5 minutes, if pain is still there or worsening, call 000.
    • If your doctor has advised, you may take a third GTN dose while waiting.
  5. Chew one aspirin only if previously advised and you’re not allergic.
  6. Do not drive yourself to hospital. If possible, unlock the door, keep your phone nearby, and have someone stay with you.

A response (or no response) to GTN doesn’t prove what’s causing the pain. Seek medical review if the pain was severe, unusual, or keeps coming back.

Why It Happens (Causes & Risk Factors)

Most common cause: Coronary artery disease (fatty build-up/narrowing in the heart arteries).

Things that raise your risk:

  • Smoking, high blood pressure, high cholesterol
  • Diabetes, kidney disease, overweight/obesity
  • Family history of early heart disease
  • Low activity levels, highly processed diet, unmanaged stress
  • Getting older

The more of these you tackle, the lower your future risk.

How Doctors Diagnose Angina (What to Expect)

  • Questions & exam: when it started, what brings it on, what eases it, and your health history.
  • ECG (heart tracing): quick and painless, often done straight away.
  • Blood tests (e.g. troponin): check for heart strain/damage; may be repeated after a few hours.
  • Imaging if needed: chest X-ray, heart ultrasound (echo), stress tests, or a CT coronary angiogram to look at the heart arteries.

You’ll leave with either:

  • A clear cause and treatment plan, or
  • A safety-net plan (what to watch for, when to come back) plus follow-up tests.

Treatment Options (Australia)

Medicines

  • GTN spray/tablets to relieve attacks
  • Beta-blockers or calcium channel blockers to reduce heart workload
  • Antiplatelets (e.g. aspirin) and statins to reduce future risk
  • Other anti-anginal options if needed (your clinician will tailor these)

Procedures

  • If arteries are very narrowed:
    • Angioplasty and stent (opens the artery), or
    • Bypass surgery (reroutes blood around blockages)

Costs & access

  • Many tests and medicines are supported by Medicare and the PBS. Your team will discuss options and any out-of-pocket costs.

Living Well with Angina

Daily management

  • Take medicines exactly as prescribed
  • Carry your GTN and know how to use it
  • Keep a simple symptom diary (what brought pain on, how long it lasted, what helped)
  • Attend follow-ups and complete any planned tests

Lifestyle that helps (small steps, big gains)

  • Stop smoking (ask for quit support)
  • Move most days (your team will advise safe levels)
  • Heart-healthy eating: more vegetables, fruit, whole grains, legumes; fewer ultra-processed foods
  • Sleep & stress: aim for a steady sleep routine; try simple breathing/relaxation techniques
  • Know your numbers: blood pressure, cholesterol, glucose — check with your GP

Cardiac rehabilitation

  • A structured programme of exercise, education, and support that improves fitness and confidence and lowers future risk. Ask your clinician for a referral.

Quick Safety Checklist

  • ☐ Chest discomfort that is new, worse, or lasting >10 minutes
  • ☐ Pain spreading to arm/neck/jaw/back OR breathlessness, nausea, cold sweats, dizziness
  • ☐ Not settling with rest and GTN
    → Call 000. Do not delay.