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What is it and how do you treat it?

Angina is a common symptom of heart disease. It is usually described as a discomfort or unpleasant feeling (like indigestion), tightness, pressure or weight on the chest.

Sometimes it is not a pain or discomfort at all, but a feeling of breathlessness or profound lethargy. Angina is usually not prolonged and can be relieved by rest and/or medication.

Angina can affect people in different ways. The symptoms may differ at various times. It is usually felt across the centre of the chest. It may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in the hands. Some people experience it in only one of these areas and not in the chest at all.

Angina is usually brought on by predictably the same exertion or emotion. It can occur after a heavy meal or in cold weather. It can occur at rest or even during the night. It can often be experienced at particular times of the day, e.g. first thing in the morning or late afternoon.


What causes Angina?

In most cases angina is caused by coronary artery disease. This occurs when fatty deposits build up under the inner lining of the coronary arteries which supply the heart muscle. As a result, these arteries become narrowed and the blood flow to the heart muscle is reduced.

Angina occurs when the blood flow to the heart muscle is insufficient for the extra demands made on it. There is no damage to the heart muscle from an episode of angina.


Action Plan

Angina Symptoms: Occasional

When you get angina, stop what you are doing and sit down. When the angina is relieved by rest, or by your GTN spray, you can resume your activities gently.


Take one or two puffs of your GTN spray. If the angina persists, you can repeat the dose safely every five minutes. If the angina is not relieved after three doses within 15 to 20 minutes, call an ambulance.

Angina Symptoms Regular Pattern

If you get angina as part of your everyday life, for example:

  • Cold temperatures

  • Walking up hills

  • Mowing lawns

  • Showering

  • During sexual activity

  • While at work


Use your GTN spray a few minutes before attempting the activity that triggers your angina. If you are experiencing angina symptoms every day consult your doctor so that further treatment can be planned.

Change In Angina Symptoms

If the pattern of your angina changes significantly in one or more of the following ways:

  • Frequency, severity

  • More prolonged

  • Occurs when you are doing very little or resting


Consult your doctor within 24 hours. In the meantime, continue to use your GTN spray.

If the angina is not relieved after three doses in 15 to 20 minutes, call an ambulance.




Glyceryl Trinitrate (GTN) Spray
  • Nitrates relax the blood vessels, causing them to dilate and allow the blood to flow more freely.

  • A metered dose of nitrate is given with each squirt. The spray droplets are absorbed quickly and give an almost immediate effect

  • Do not shake the canister

  • Hold the canister upright

  • Spray one or two puffs on, or under, the tongue, close the mouth

  • If the angina is not relieved after three doses within 15 to 20 minutes call an ambulance. Dial 111 immediately. GTN spray sometimes produces flushing, Headaches, a feeling of fullness in the head, dizziness or palpitations.

  • GTN spray may also cause a burning or tingling feeling in the mouth

  • GTN spray may temporarily lower the blood pressure and may cause a feeling of faintness when using them for the first time or taking too large a dose. It is best to be seated when taking GTN spray for the first time

  • Feeling faint can also be caused by taking the spray or a tablet when hot, e.g. after a shower

  • Despite the side effects that can occur with these medications, they are safe to use and are not habit-forming

  • Alcohol may be consumed while taking these medications. However, alcohol may increase the likelihood of faintness and dizziness]

  • Check expiry date on all medications

  • Nitrolingual spray lasts for five years

  • Store spray in a cool place

  • If you keep a spare spray in the car it should be replaced after three years

  • Carry a GTN spray at all times


Long-acting Anti-Anginal Medications

Beta-Blockers (e.g. Metoprolol)

Beta-Blocker medication reduces the frequency of angina attacks. They slow the heart rate letting the heart pump more efficiently which results in improved physical activity levels.

Calcium Antagonists (e.g. Diltiazem)

These are further options for preventing angina symptoms. Calcium antagonists help to relax the arteries, allowing more blood to flow through so that the heart beats more efficiently. A common side effect is swollen ankles.

Nitrate Tablets (e.g. ISMN, Duride)

These are a long acting form of the spray and are absorbed through the stomach instead of the mouth and have a longer-acting effect. It is important to have a nitrate free interval to avoid the development of tolerance (the development of immunity to the effect of the medication).

This is achieved by taking the medication ONLY ONCE A DAY.


Other Medications used in Angina

Statins (e.g. Simvastatin, Atorvastatin)

These act on the liver and stop the production of cholesterol that in turn retards, and even regresses the build up of fatty deposits in the arteries, of not only the heart, but through out the bodies circulation.

Muscle aches and pains are not uncommon and although statins can cause muscle and liver damage, the actual incidence of this is rare. If symptoms persist a blood test may help to clarify whether there are significant enzyme changes before discontinuing potentially life saving therapy.


This time proven medication impairs the clotting of platelets (clotting cells in the blood) that can contribute to acute


What else can be done for Angina?

Coronary artery bypass surgery or angioplasty and stenting (opening up the arteries with a special balloon and propping them open with a scaffold) can also help control angina. An X-ray of the coronary arteries (angiogram) is required to decide whether surgery or angioplasty is necessary or possible.


What is the difference between Angina and a heart attack?

Angina symptoms are associated with a temporary reduction in blood flow to part of the heart muscle leaving no damage to the muscle. Angina pain is relieved by rest and GTN spray. Angina that lasts more than 15 minutes will need more treatment.

  • A heart attack results from a blockage in a coronary artery and causes permanent damage to the heart muscle. The pain associated with a heart attack usually lasts longer than fifteen minutes and is not relieved by GTN spray.

  • If the angina is not relieved after three doses in 15 to 20 minutes, call an ambulance. DIAL 111 IMMEDIATELY!


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