If you see your GP after experiencing chest pain, they'll probably ask about the pattern of your symptoms forexample, if you've noticed any particular triggers.
Your GP will then assess whether you're at increased risk of developing Atherosclerosis . This iswhere the arteries become cloggedby fatty substances,which can lead to the symptoms of angina.
As part of the assessment you'll have:
Tests are necessary because some angina medications aren't suitable for people with liver or kidneydisease.
You're also likely to discusswhether you smoke, if you drink and how much, whether you have a high-fat diet, and any family history of heart disease.
If angina is suspected, you'll usually be referred to a specialist cardiology department or clinic fordiagnosis and to assess your risk of having a heart attack or stroke in the future.
You may be prescribed a medication calledglyceryl trinitrate to provide immediate relief for any angina while you wait to see a specialist (see treating angina for more information).
The assessment involves a series of tests that are explained below.
An ECG records the rhythms and electrical activity of your heart. A number of electrodes (small metallic discs) are placed on your arms, legs and chest. The electrodes are connected to a machine that records the electrical signals of each heartbeat.
An abnormal ECG reading may indicate that the muscles of your heart aren't receiving enough blood.
An ETT is similar to an ECG, but it's carried out when you're exercising, usually on a treadmill or an exercise bike.
An ETT can be used to measure how much exercise your heart is able to tolerate before the symptoms of angina are triggered. This information is useful for assessing how severe your angina is likely to be.
An MPS is an alternative test to an ETT used if a person is unable to exercise or when the results of an ETT are unclear.
MPS involves injecting a small amount of a radioactive substance into your blood. A special camera, known as a gamma camera, is used to track the substance as it moves through your blood vessels and into your heart. This allows healthcare professionals to determine how well blood is reaching your heart.
MPS is usually carried out both at rest and when you're exercising. If you're unable to exercise, medication can be used to replicate the effects of exercise on your heart.
A coronary angiography is a test to identify whether your coronary arteries are narrowed and determine how severe any blockages are.
During an angiography, a thin, flexible tube called a catheteris passed into a vein or artery in your groin or arm, and X-rays are used to guide it into your coronary arteries. A dye is injected into the catheter to highlight the arteries supplying blood to your heart. A number of X-ray images (angiograms) are taken,which highlight any blockages.
Coronary angiographies carry a small risk of serious complications, such as a stroke or a heart attack, which is estimated to be around 1 in 1,000. Although this risk is small, healthcare professionals are usually unwilling to perform an angiogram unless the benefits of the procedure outweigh potential risks.
Therefore, it's likely you'll only be referred for a coronary angiogram if:
If it's thought you may have unstable angina, you'll be admitted to hospital. Depending on the severity of your symptoms, you may be placed in a general ward or in thecoronary care unit (CCU).
You'll be given an ECG as soon as you arrive at hospital to quickly assess whether your heart has been significantly damaged.
Blood tests will also be carried out to help identify increased enzyme levels(these arereleased when the heart is damaged). A coronary angiography may also be performed to assess the size and location of the blockage in your coronary artery.
Treatment may be started urgently, before all of the test results are known, to prevent serious complications arising from unstable angina.
After receiving suitable treatment for unstable angina,doctors will want to assess how likelyyou are todevelop another angina attack, or possibly the symptoms of a heart attack, in the next six months. The outcome will have an important bearing on your recommended treatment plan.
GRACE is a widely used method of assessing the risk of further heart problems occurring. GRACE is a scoring system based on factors such as:
Your GRACE score provides a relatively accurate predictor of your risk of developing further heart problems. The score can range from very low (less than 1 in 65) to the highest (more than 1 in 10).
Surgery is usually recommended as a precautionif you haveat least a 1 in 33 chance of developing further problems.
Angina is chest pain that occurs when the blood supply to the muscles of the heart is restricted. It usually happens because the arteries supplying the heart become hardened and narrowed.
The most common symptom of angina is a feeling of pain or discomfort in your chest. The pain can feel tight, dull or heavy.
Angina is caused by narrowing and hardening of the main blood vessels going to the heart, which limits blood supply to this major organ.
If you see your GP after experiencing chest pain, they'll probably ask about the pattern of your symptoms for example, if you've noticed any particular triggers.
Treatment of angina aims to provide immediate relief from the symptoms, prevent future attacks, and reduce your risk of having a heart attack or stroke.
Heart attacks and strokes are the most serious complications of angina. The stress of living with a long-term condition can also have an impact on your emotional health.