Chest pain and suspected angina

What is chest pain?

Chest pain has many possible causes. Some are related to the heart, such as angina or a heart attack, while others may come from the lungs, muscles, or digestive system. The most important step is working out whether your chest pain is coming from the heart, so that the right treatment can be started.

Angina is chest pain caused by reduced blood flow to the heart muscle, usually because of narrowings in the coronary arteries.

Common symptoms

• A tight, heavy, or squeezing sensation in the chest
• Pain that may spread to the left arm, neck, jaw, or back
• The discomfort may sometimes be limited to the neck, jaw, back, left arm or epigastric area
• Discomfort brought on by physical exertion or stress
• Pain that eases with rest
• Shortness of breath accompanying the chest discomfort

How is it diagnosed?

Depending on your symptoms and risk factors, investigations may include:

• Electrocardiogram (ECG): a quick recording of your heart's electrical activity
• Blood tests: including troponin levels if a heart attack is suspected
• Exercise stress test: monitoring your heart during treadmill exercise
• CT coronary angiogram: a detailed scan of your heart arteries
• Coronary angiography: a catheter-based test for a direct look at the arteries

How is it treated?

Treatment depends on the cause. If angina is confirmed, options include:

• Lifestyle changes: stopping smoking, regular exercise, healthy diet
• Medications: such as GTN spray for acute symptoms, along with tablets to reduce the risk of heart attack
• Coronary angioplasty and stenting: opening a narrowed artery and placing a stent to keep it open
• Coronary artery bypass surgery: if multiple arteries are affected

How should you prepare?

For any appointment it helps to bring: a list of your current medications and doses; copies or details of any previous heart tests (ECGs, scans, or angiogram reports); a note of your symptoms, when they happen, and what brings them on; and your questions. If you have results from another hospital, ask that clinic to send them ahead of your visit.

When to seek urgent help

If you develop sudden, severe chest pain, especially if it lasts more than 15 minutes, is accompanied by sweating, nausea, or breathlessness, call 999 or 112 immediately. Do not wait to see if it passes. Rapid treatment for a heart attack saves lives.