Introduction
Angina is chest pain that occurs when the blood supply to the muscles of the heart is restricted. It usually happens because the arteries supplying the heart become hardened and narrowed.

The pain and discomfort of angina feels like a dull, heavy or tight pain in the chest that can sometimes spread to the left arm, neck, jaw or back. The pain is usually triggered by physical activity or stress and typically only lasts for a few minutes. This is often referred to as an angina attack.

When to seek medical help
Dial urgently to request an ambulance if you experience chest pain and you haven’t previously been diagnosed with a heart problem.

If you have an angina attack and you’ve previously been diagnosed with the condition, take the medication prescribed for you (glyceryl trinitrate). A second dose can be taken after five minutes if the first dose is ineffective. If there’s no improvement five minutes after the second dose, call for an ambulance.

[color=Types of angina[/color]
The two main types of angina are stable angina and unstable angina.

stable angina – where angina attacks occur due to an obvious trigger (such as exercise) and improve with medication and rest

unstable angina – where angina attacks are more unpredictable, occurring with no obvious trigger and continuing despite resting

Stable angina is not life-threatening on its own. However, it is a serious warning sign that you have an increased risk of life-threatening problems, such as a heart attack or stroke.
You may experience symptoms of unstable angina after previously having symptoms of stable angina. However, unstable angina can also occur in people who do not have a previous history of stable angina.
Unstable angina should be regarded as a medical emergency because it is a sign that the function of your heart has suddenly and rapidly deteriorated, increasing your risk of having a heart attack or stroke.

Why angina happens
Most cases of angina are caused by atherosclerosis, which is the hardening and narrowing of arteries due to a build-up of fatty substances known as plaques. This can restrict the blood supply to the heart and trigger the symptoms of angina.
Advanced age, smoking, obesity and eating a high-fat diet all increase your risk of developing atherosclerosis.

Treating angina
Treatment for angina aims to to relieve the symptoms during an angina attack, reduce the number of angina attacks that a person has and reduce the risk of further complications.
A number of medications can be used to try to achieve this. Some of these are only taken when needed, while others are taken everyday.

Surgery to widen or bypass the narrowed arteries may be recommended if the symptoms do not respond to medication

Complications
A major concern for people with angina is that their atherosclerosis will continue to get worse. This can lead to the blood supply to their heart becoming blocked, which could trigger a heart attack. Similarly, a blockage of the blood supply to the brain could trigger a stroke.

Each year it is estimated that 1 in every 100 people with stable angina will have a fatal heart attack or stroke and as many as 1 in 40 people will have a non-fatal heart attack or stroke.
You can considerably reduce your risk of developing these complications by making lifestyle changes. For example, if you are obese and you smoke, you can significantly reduce your risk by stopping smoking and achieving a healthy weight.

G Mohan.