Private angina clinic in London, same-day cardiology.

What stable angina feels like

• Tightness, heaviness or pressure across the chest — often described as a band or a weight rather than a sharp pain
• brought on by exertion, cold weather, heavy meals or emotional stress, at a fairly predictable level
• settling within a few minutes of rest or after GTN
• may spread to the arms, jaw, neck or back
• sometimes felt only as breathlessness or fatigue on exertion, particularly in women, older people and those with diabetes

Using GTN properly

1. Stop and sit down — GTN lowers blood pressure and can make you dizzy.
2. One spray or tablet under the tongue. Do not swallow it.
3. Wait five minutes. If the pain persists, take a second dose.
4. Wait five more minutes. If it still persists, call 999.
5. Carry it always, check the expiry date, and replace sprays every couple of years even if unused.

Headache and flushing after GTN are expected. You can also use it before an activity you know brings on symptoms — climbing a hill, going out in the cold — which many people are never told.

Investigation

• ECG — often normal at rest, which does not exclude angina.
• Blood tests — lipids, HbA1c, kidney function, full blood count and thyroid.
• CT coronary angiography is now the recommended first-line test for new-onset stable chest pain in the UK.
• Functional testing — stress echocardiography or perfusion imaging — where CT is unsuitable or inconclusive.
• Invasive angiography where the results indicate it, with the option of stenting.

Treatment

• Symptom relief — a beta-blocker or calcium channel blocker as first-line, with others added if needed. GTN for episodes.
• Preventing heart attacks — this is separate and matters more: aspirin and a statin for everyone with confirmed angina, plus blood pressure and diabetes control.
• Stopping smoking, which halves cardiovascular risk within a few years.
• Cardiac rehabilitation and regular exercise — exercise improves angina, and avoiding activity worsens it.
• Stenting relieves symptoms in people not controlled on medication; it does not generally reduce heart attack risk in stable angina, which surprises many people.

Driving

For a car or motorcycle licence you must stop driving if angina occurs at rest, at the wheel or with emotion, and may resume once symptoms are controlled — the DVLA does not need to be told for stable angina alone. Bus, coach and lorry licence holders must notify the DVLA. We can advise on your situation.