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Heart Attack and Angina


What is angina?

Angina is chest pain which is caused by reduced blood flow to the heart. This reduced blood flow is caused when the arteries supplying the heart becomes narrowed by a build-up of fatty substances (atherosclerosis). This blockage can severely decrease blood flow to the heart muscle. If this worsens, the heart is deprived of oxygen and a heart attack may occur. 

Angina is divided in 2: Stable and unstable angina.

  1. Stable angina: When chest pain occurs on exertion and goes away when resting, ex. climbing the stairs, going for a walk.

    • Can be caused by emotional stress, cold temperatures, heavy meals and smoking, as the arteries can narrow during such events.

    • Pain is usually predicted and similar to previous types of chest pain.

    • Lasts a short time

    • Disappears sooner if one rests or takes antianginal medications.        

   2. Unstable angina: occurs even at rest and happens more frequently

  • There’s a change in the usual pattern of angina

  • The pain is more severe  and lasts longer than stable angina (30mins or longer)

  • May not disappear with rest or use of antianginal medications.

  • Might signal a heart attack.

Symptoms of angina:

  • Chest pain or discomfort

  • Sharp stabbing pain (especially in women)

  • Pressure

  • Squeezing

  • Burning

  • Fullness

  • Pain radiating to the neck, arm, jaw, shoulder and back.

  • Dizziness

  • fatigue,

  • nausea,

  • sweating

  • Shortness of breath 


Heart attack

A heart attack is when a coronary artery becomes partially or totally blocked by a blood clot. The blockage is most often a build-up of fat, cholesterol and other substances.  This happens when a piece of the atheroma ruptures and a blood clot may form around it, which then blocks the artery and starve the heart muscle from oxygen. This might cause irreversible damage to part of the heart muscle.


Spasm of a coronary artery is also another cause of a heart attack. This happens when blood flow to part of the heart muscle shuts down. Tobacco and illicit drugs such as cocaine and amphetamines usually cause it.

Signs and symptoms of heart attack may include

  • Pressure, fullness or squeezing pain in the centre of the chest, which lasts more than a few minutes

  • Pain extending beyond your chest to the shoulder, arm, back, teeth or jaw

  • Increasing episodes of chest pain

  • Nausea and vomiting

  • Prolonged pain in the upper abdomen

  • Shortness of breath

  • Sweating

  • Fainting

It’s possible to have a heart attack without experiencing all these symptoms, and it’s important to remember everyone experiences pain differently.


How do you diagnose a Heart Attack?

An ECG is usually carried out to determine whether you have had a heart attack or not. If it shows you’re having a heart attack, you’re likely to have emergency treatment as soon as you arrive in hospital. 

If the ECG doesn’t confirm a heart attack you might need further tests to investigate if you are having a heart attack, including:

  • an assessment of your symptoms and medical history

  • physical examinations, including measuring your blood pressure and monitoring your heart rhythm and heart rate

  • blood tests including a troponin test to detect if there’s been any damage to your heart muscle

  • further ECGs 

  • an echocardiogram.


Treatment for a heart attack


Coronary Angiography

In order to determine the severity of blockage or narrowing in the arteries, a cardiologist performs a coronary angiogram.


In a coronary angiogram, a catheter, with a small-deflated balloon is inserted in the radial artery or femoral artery. Radio opaque dye (which is flushed in the catheter) and x-rays help to see how the blood flows through and around the arteries of the heart.  Any blockages or narrowing is determined and the cardiologist will decide the best intervention for you.


Coronary angioplasty (PCI) re-opens the blocked coronary artery by inserting one or more stents. This helps keep the narrowed artery open.


Coronary bypass surgery helps to restore normal blood flow by using a blood vessel from your leg, arm or chest in your heart to bypass the blocked artery. It is ideal for patients with multiple narrowings in multiple coronary artery branches.


Thrombolysis involves giving you ‘clot-busting’ medicine to dissolve the blood clot that's blocking the coronary artery.


Your doctor will determine whether you will benefit from having one of these treatments for your condition.


Recovering from a heart attack

Your hospital stay following a heart attack is between two to five days, depending on the treatment you’ve had and how well you are recovering.


Many people make a full recovery after a heart attack, but you might not be able to do everything you used to. Going to cardiac rehabilitation can help you get back to normal as quickly as possible.


A heart attack can be a frightening experience and it can take time to come to terms with what’s happened. It’s natural to be worried about your recovery, feel scared, frustrated and isolated.

For support and advice, visit our emotional support page.

For risk factors of heart disease, go to the how to reduce my risk for heart disease page.


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