Awareness and First Aid
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Angina is a type of chest pain or discomfort caused by a lack of oxygen-rich blood flowing to the heart muscle.
Learn when to seek urgent medical attention.
Signs of angina
“The symptoms of angina include pain along the shoulders, arms, neck, jaw, and even the stomach and back,” says Robert Adams, an Advanced Life Support (ALS) practitioner at ER24 West Metro. “People with angina may experience symptoms similar to gastro-oesophageal reflux (heartburn) .”
What causes angina?
The main cause of angina is coronary artery disease. This happens when your heart’s main blood vessels become narrowed by a build-up of plaque, a process called atherosclerosis. The narrowing reduces blood flow and oxygen to your heart, causing the heart muscle to become starved of oxygen, a condition known as ischaemia.
“Another mechanism that can trigger angina is a coronary vasospasm, where the coronary arteries suddenly tighten and partially close, limiting blood flow,” says Adams.
Angina can also occur when the heart’s oxygen demand increases. People may be more prone to it if they have tachycardia (a heart rate over 100 beats per minute), high blood pressure, a fever, or have been physically exerting themselves.
Other risk factors include smoking, diabetes, high cholesterol, obesity, a family history of coronary artery disease, and age.
The two types of angina
Stable angina: Stable angina is predictable chest discomfort which can be triggered by exertion, such as exercise, emotional stress, cold weather, and eating heavy meals, Adams points out. Stable angina is typically relieved by rest, or by taking prescribed vasodilators like glyceryl trinitrate or isosorbide di- or trinitrate.
Unstable angina: This type of angina can happen even when a person is at rest and may not improve with rest or medication such as nitrates. Frequent episodes of unstable angina can signal acute coronary syndrome. “Unstable angina is always a medical emergency,” warns Adams.
When is angina an emergency?
Stable angina is typically not an emergency, and tends to resolve with rest. Angina needs urgent medical attention when:
- the pain lasts more than 10-15 minutes despite rest and medication
- it occurs at rest
- it becomes more frequent, severe, or long‑lasting
- it is associated with shortness of breath, sweating, nausea, syncope (fainting) or hypotension (low blood pressure).
“These signs suggest unstable angina or myocardial infarction and require urgent medical attention,” says Adams.
How ER24 can help
The ER24 paramedics will check the patient’s airway, breathing and circulation before placing them to rest in a calm environment. “If the blood-oxygen saturation is below 92%, or they’re in respiratory distress or shock, we will give oxygen,” says Adams.
“Medications include anticoagulants to reduce platelet aggregation, like aspirin, if the patient is not allergic or there are no contraindications,” he adds. Nitrates can be given via spray or tablets. A paramedic may administer low doses of opioids for severe chest pain.
How to prevent angina
Adams says prevention starts with a holistic approach: making healthy lifestyle choices, controlling existing medical conditions, and following any treatment plans as prescribed. And before you change anything in your healthcare routine, always speak to your doctor for guidance.