What causes chest pain?
Around 1-2% of all consultations in GP surgeries are complaints of chest pain. While this can indicate both a heart attack or angina, in this setting, the most common causes are usually much less severe, ranging from a pulled muscle in the chest, or pain that is actually coming from the stomach. Angina is the third most common cause, followed by psychological issues and lung disease. For around one in six patients, no cause will be found. However, for patients who arrive at an A&E department, the picture is very different – half will have angina as the cause of their chest pain, some of whom will also be experiencing a heart attack.1
What is the difference between angina and a heart attack?
Doctors use the term ‘acute coronary syndrome’ to describe a spectrum of heart conditions, from very stable angina at one end, to a heart attack at the other. As such, when it comes to angina and heart attacks, both are caused by the same process in the body. A build-up of fat called plaque blocks the blood vessels to the heart, usually leading to a blood clot. This means that less blood is able to reach the heart, which deprives the heart muscle of oxygen, causing pain. The key difference between angina and a heart attack is in how much blood, carrying precious oxygen, reaches the heart muscle. If the blood vessel is only partially blocked, a reasonable amount of blood can still reach the heart muscle and the person will most likely be diagnosed with angina. They may experience chest pain during exercise, but this will subside during rest. In the case of angina, this pain typically has three features:
- It feels tight or heavy – this pain might be felt only in the chest, or might spread to the neck, arm or jaw.
- It is brought on by exercise, which doesn’t have to mean running a marathon – walking to the bus, or up a flight of stairs might be enough.
- It goes away with rest.
If angina worsens, it can develop into a heart attack. When the blockage in the blood vessels is complete, or nearly complete, usually due to a developing blood clot, then the heart muscle will become severely deprived of oxygen. In this case, if the pain will not go away when resting, this is a likely sign that someone is experiencing a heart attack. As such, the key difference between angina and a heart attack isn’t the type of pain, or where it is felt – it is the way that the pain is associated (or not) with exercise and goes away (or doesn’t) with rest. For more information on angina, see our detailed guide.
What to do if you’re experiencing a heart attack
If you experience crushing chest pain that does not subside even when you’re resting, you should call an ambulance immediately. You’ll either be treated with a drug that dissolves blood clots in the body, or with a primary angioplasty, where cardiologists put a wire directly into the blood vessel to open it up and remove the clot2. Time is a key factor in your outcome and recovery, and these methods can only work if they are done soon after the onset of the pain, so it's important to respond as quickly as possible.
Angina and heart attacks: How to prevent them
As previously mentioned, angina, when it worsens, can lead to a heart attack. As such, prevention methods for both conditions fall under the same umbrella. Stopping angina when it is at a more manageable stage can ultimately reduce your risk of experiencing a full-on heart attack.
A healthy lifestyle
Leading a generally healthy lifestyle is one of the best ways to improve heart health. This includes cutting down on excessive drinking and replacing these habits with regular exercise and a healthy diet. Since smoking can affect your ability to absorb nutrients, quitting can also have a significant impact on improving your overall heart health. The risk of heart disease will halve within a year of stopping smoking, and after 15 years the risk of a heart attack drops down to the same as that of a non-smoker, so it’s never too late to start making these changes.3
While losing weight may seem like a daunting task, evidence suggests that shedding just 5-10% of your body weight can significantly reduce your risk of heart disease. Start by making simple changes like getting off the bus one stop earlier and taking the stairs instead of the lift — it all adds up4. When you feel a bit more confident, the NHS Couch to 5K plan is the perfect introduction to regular exercise. On top of this, everyone who turns 40 should have an NHS health check to get their blood pressure and cholesterol recorded – even if they are high, lifestyle changes can often be used instead of medication like statins. For a more natural alternative, introducing more omega 3 into your diet by eating more fish, and eating more fruit and vegetables, might be a good place to start.
If you have already been diagnosed with angina or have experienced a heart attack, then these methods can still apply. Alongside recommending lifestyle changes, your GP will probably also prescribe you medication such as aspirin, paying close attention to your blood pressure and cholesterol as you go. In most cases, aspirin is not recommended for those who don’t have proven heart disease, as the benefits do not always outweigh the associated risks. Remember to see your GP regularly to ensure that you keep a close eye on your condition. As such, there are a number of steps that you can take to reduce your risk of angina and a heart attack, even if you’ve experienced them before.
For more information on angina and a range of other heart conditions, visit our heart health hub, where you’ll find a number of articles to help you maintain a healthy heart.
1(2017). Chest Pains, NICE
2Focus on heart attacks, British Heart Foundation
3(2017). What happens when you quit?, NHS Smokefree
4(2017). Exercise, NHS Choices
5(2018). Antiplatelet treatment, NICE Clinical Knowledge Summary