Chest pain and angina :: Healthscope Corporate

Heart problems that cause chest pain (angina) are common, affecting around 3% of Australian adults at some time in their lives. While many things can cause chest pain, it is a serious symptom that needs to be investigated.

Our cardiologists offer expert care for people with chest pain. We focus on providing personalised diagnosis and treatment using the latest technologies and procedures.

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If you are experiencing any cardiac symptoms: chest pain, palpitations, shortness of breath. dizziness or fainting or signs of heart failure (swollen ankles, unable to lie flat or waking short of breath) you should contact your GP or present to an emergency department for assessment.

If you require urgent attention dial 000 (Triple Zero) and ask for an Ambulance.

What is angina?

Angina is not a disease, but a symptom of an underlying problem. Most often, angina is caused by coronary heart disease (CHD). In this condition, the arteries that supply blood to your heart become narrowed or blocked, leading to reduced blood flow to the heart muscle. This causes the symptoms of angina.

Types of angina

There are two types of angina.

Stable angina – this involves chest pain that comes and goes due to temporary interruptions to the heart’s blood supply.

Unstable angina – which involves a worsening of chest discomfort or sudden, unexpected chest pain, often while you’re resting. This should be treated as a medical emergency.

Characteristics of Angina

Symptoms of angina vary from person to person and can range from mild to severe. Symptoms related to a heart problem can feel like:

pressure, tightness, heaviness, or squeezing in the chest
pain in the middle or on either side of the chest
chest discomfort
pain or discomfort anywhere in the upper body – from your jaw to your lower ribs and both your arms.

Certain people may not have textbook signs of angina, such as people with diabetes, older adults, and women. If you have chest pain and are concerned, you should seek medical help as soon as possible.

Angina episodes tend to last for a few minutes up to 15-20 minutes. Angina symptoms often occur when your heart has to work harder than usual, such as when you’re physically active or under stress.

If you have angina symptoms for more than 10 minutes at rest, or if symptoms are severe or getting worse, call triple zero (000) immediately.

Heart attack (Acute Coronary Syndrome)

If a blood vessel supplying the heart suddenly becomes blocked or blood flow is severely reduced, this can damage the structure and function of your heart. This is known as a heart attack or acute myocardial infarction (AMI) or Acute Coronary Syndrome (ACS) and is a life-threatening emergency.

Symptoms of a heart attack include:

angina
shortness of breath or difficulty breathing
feeling dizzy, faint or light-headed
indigestion, nausea, vomiting
sweating
chest pain lasting more than 20 minutes

If you suspect that you or someone around you is having a heart attack, you should ring 000 (triple zero) immediately.

Other causes of chest pain

As well as problems with the heart, chest pain can be a sign of many other conditions. These include:

indigestion or heartburn (reflux) – when stomach acid comes up the food pipe, causing a burning pain
chest infections – such as pneumonia and bronchitis
pleurisy (inflammation of the lung lining)
pericarditis (inflammation of the sac around the heart)
chest muscle strains
inflammation of the joints between the breastbone and ribs
pulmonary embolism (blockage in the blood vessel between your heart and lungs)
anxiety or a panic attack – which often mimic the symptoms of a heart attack
shingles (herpes zoster) – a viral infection that causes pain and a skin rash
gallbladder inflammation
mastitis – a breast infection usually related to breastfeeding.

If you have chest pain, it’s important to see your doctor. They can arrange tests to work out what’s causing your symptoms and refer you for specialist care if needed.

Referral for angina management

If you’re experiencing angina symptoms, your GP may refer you to a cardiologist (heart specialist) for further investigations and treatment.

To start your angina treatment with us, ask your GP for a referral to one of our experienced cardiologists.

Your doctor can address the referral to a specific cardiologist, or simply to ‘Dear Doctor’.

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Angina testing and diagnosis

To diagnose angina, your doctor will ask about your symptoms and family history. They may also do some tests.

Blood tests

Blood tests (troponin) can show signs of a heart attack and measure the levels of substances that can affect your heart function (such as blood sugar and fats).

Physical examination

Your doctor will probably check your blood pressure and heart rate and listen to your heart with a stethoscope.

Electrocardiogram (ECG)

This test measures the heart’s electrical activity. Your doctor might use an ECG to check for signs of a heart attack or reduced blood flow through the heart.

Exercise tests (stress test)

Also known as ‘stress tests’, they check how your heart reacts to physical activity. They involve monitoring your heart while you walk on a treadmill or ride an exercise bike.

CT Coronary Angiogram (Non-Invasive)

In this test, a CT scan takes images to check the health of the coronary arteries.

Coronary Angiogram (Invasive)

This involves taking images of the heart arteries by passing a thin tube (called a catheter) through an arm or leg artery to the heart. A small amount of contrast dye is injected and an x-ray camera outside the body takes the images.

Angina prevention

Angina and heart attacks are usually caused by coronary heart disease. Some risk factors for coronary heart disease (such as being male and having a family history of the condition) cannot be prevented.

However, healthy habits can lower your risk of heart attack and coronary heart disease. To keep your heart healthy, try to:

maintain control of your blood pressure and cholesterol levels
stick with any treatment for diabetes or other health conditions
achieve and maintain a healthy weight
quit smoking
eat a healthy diet and drink less alcohol
be physically active
stay socially connected
do things to support your mental wellbeing.

Angina treatment

Treatment for angina is about reducing the symptoms so you can feel better and get back to doing what you enjoy. It also involves lowering your risk of a heart attack.

There are surgical and non-surgical options for angina treatment.

Non-surgical (conservative) treatment for angina

Lifestyle changes – working on your heart health can help to prevent or reduce angina episodes. The Heart Foundation recommends taking five simple steps:

Eat a heart-healthy diet and maintain a healthy weight
Spend more time being physically active
Be smoke free
Control your cholesterol levels
Control your blood pressure

It can also help to understand what triggers your angina. For example, you might need to limit stress or cut down on alcohol.

Medications – your doctor might prescribe medicines to improve blood flow to your heart. These come as a spray or dissolvable tablet. Some relieve angina symptoms, and others help to prevent them. You might also be prescribed medicines that can lower your risk of a heart attack.

Cardiac rehabilitation – these programs involve education and exercise sessions to help you get stronger, fitter and make heart-healthy changes. Led by healthcare professionals, you’ll get advice and exercises tailored to your needs. Cardiac rehabilitation can improve your wellbeing and quality of life.

Surgery for angina

Your doctor might recommend surgery that can improve blood flow to the heart. Procedures for angina include:

Coronary angioplasty and stenting – this procedure is used to reopen blocked or narrowed coronary arteries. It involves passing a thin tube through an artery in the arm or leg to the heart. Specialists inflate a tiny balloon and place an expandable metal scaffold (stent) into the affected artery to restore blood flow. This procedure is often performed with sedation under local anaesthetic.

Coronary artery bypass grafting (CABG) – in this procedure, another artery or vein is used to ‘bypass’ a blocked one and restore blood flow to your heart muscle. This procedure may be performed through small incisions or as traditional open surgery.

Heart attack treatment

If doctors believe you’ve had a heart attack, they will focus on quickly restoring blood supply to the heart. At the hospital, an interventional cardiologist might perform a coronary angioplasty to help open up narrowed arteries and allow blood to flow more freely to your heart.

Recovery

Recovery time can vary significantly depending on the procedure you’ve had and individual factors like your age, general health, and lifestyle. If you have a procedure that doesn’t require a general anaesthetic, you can often go home the same day. If you have open surgery, recovery could take several months.

You might benefit from rehabilitation to help you get stronger and return to your usual activities. Other health professionals such as physios, dietitians and exercise physiologists might work with you to create habits that promote heart health.

Your heart specialist can discuss how long it might take to recover from your procedure.