Patient information · Cardiovascular
Angina
and how to tell when it has stopped being stable
Angina is chest discomfort caused by narrowed coronary arteries limiting blood flow to the heart muscle. Stable angina comes on predictably with exertion and settles with rest. When that pattern changes — more often, less exertion, or at rest — it has become unstable, and that is a medical emergency.
Call 999 if chest pain
- lasts more than 15 minutes, or does not settle with rest and GTN
- occurs at rest, or wakes you from sleep
- is more severe, more frequent or comes on with less effort than usual
- comes with sweating, nausea, vomiting or breathlessness
- spreads to the jaw, neck, back or either arm
- is your first ever episode of chest pain
If you have GTN, take one dose, wait five minutes, take a second, wait five more — and if the pain persists, call 999 and chew a 300mg aspirin unless you are allergic. Do not drive yourself. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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
It does not always feel like pain
A significant proportion of people — especially women, people with diabetes and those over 75 — describe breathlessness, unusual fatigue, jaw ache, indigestion-like discomfort or nausea rather than chest pain. These 'atypical' presentations are a major reason heart disease is diagnosed later in women. If exertion reliably brings on any unusual symptom that rest relieves, that pattern deserves a cardiac assessment regardless of how it feels.
Using GTN properly
- Stop and sit down — GTN lowers blood pressure and can make you dizzy.
- One spray or tablet under the tongue. Do not swallow it.
- Wait five minutes. If the pain persists, take a second dose.
- Wait five more minutes. If it still persists, call 999.
- 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.
GTN and erectile dysfunction medication
Nitrates must never be combined with sildenafil, tadalafil or similar, or with recreational nitrites (poppers). The combination causes a catastrophic drop in blood pressure. If you use or are considering ED medication, tell us — there are ways to manage this, but not by guessing.
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.
Why come to us. New exertional chest pain needs assessing quickly, and waiting weeks for a rapid access chest pain clinic is common. We can see you within days, perform ECG and echocardiography on site and take lipids, HbA1c, kidney function and troponin where indicated in-house with results the same visit. CT coronary angiography and cardiology procedures are arranged rapidly through our CQC-registered partners. Cardiology without a GP referral, seven days a week.
Seen within days, ECG and echo on site
Cardiology without a referral. Chest pain at rest: call 999.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.