Understanding Angina: Causes, Symptoms, and Risk Factors

Important Disclaimer

This guide gives detailed information about angina, based on the latest medical understanding as of December 2025 and trusted sources including the NHS, British Heart Foundation (BHF), and NICE guidelines. It is intended to help you understand the condition, but it is not a substitute for professional medical advice, diagnosis, or treatment. If you or someone close to you experiences chest pain or other possible angina symptoms, seek medical attention promptly. In an emergency—such as severe or ongoing chest pain—call 999 in the UK immediately, or contact the British Heart Foundation Heart Helpline on 0300 330 3311.

What This Guide Covers

Angina affects roughly 2 million people in the UK, and many may worry when they feel chest discomfort. It is often dismissed as “just a bit of pain” or confused with indigestion, but angina signals that the heart isn’t getting enough blood and oxygen at that moment.

While it can be unsettling and interfere with daily life, angina is usually very manageable. People who recognise it early and take steps to manage risk factors often regain control and continue with their daily activities. This guide focuses on symptoms, causes, and risk factors in a clear and practical way, helping you understand what’s happening, clear up common misconceptions, and feel confident about the next steps.

What is Angina?

Angina—short for angina pectoris—is your heart’s way of signalling that it isn’t getting quite enough oxygen at a given moment. It happens when blood flow to the heart muscle temporarily falls short of its oxygen demand. Think of it as a safety alert: the discomfort encourages you to slow down or rest, helping protect the heart from overexertion.

The main difference between angina and a heart attack is that angina is usually temporary and reversible. Symptoms appear, last a few minutes, and ease once you rest, the trigger passes, or you use fast-acting medication such as glyceryl trinitrate (GTN). Unlike a heart attack, typical angina does not cause permanent heart muscle damage.

In the UK, angina almost always indicates underlying coronary heart disease (CHD), where arteries supplying blood to the heart narrow or stiffen over time. CHD is the most common heart condition, and angina is one of its main symptoms. It affects around 2 million adults, with prevalence increasing with age—approximately 8% of men and 5% of women aged 65–74 experience it, rising further in older adults. It can appear earlier if multiple risk factors are present.

Angina can affect anyone, regardless of background or fitness level, but it tends to be more pronounced when several risk factors accumulate. Episodes can disrupt daily activities—walking, gardening, driving, or even intimacy—and often bring anxiety, such as wondering, “Will it happen now?” or “What if it gets worse?” This emotional response is normal and part of why angina can feel overwhelming.

The encouraging news is that angina is highly manageable. Proper assessment, lifestyle changes, and, where appropriate, medication can make episodes less frequent, less intense, and less distressing. Long-term management also lowers the risk of more serious events, allowing people to maintain active, fulfilling lives. With support, angina can fade into the background, letting you focus on what matters most.

Recognising the Symptoms of Angina

The most common sign of angina is a feeling of discomfort in the centre of your chest. People often describe it as tightness, heaviness, pressure, squeezing, or a dull ache—like a heavy weight pressing down or a belt being pulled too tight. Symptoms usually build gradually, peak, and ease within 5–10 minutes once you rest.

Discomfort often spreads beyond the chest, which can help with recognition:

To one or both arms (the left arm is classic, but it can be either)
Up into the neck, throat, or jaw (sometimes feeling like toothache)
Across the shoulders or into the back
Occasionally down into the upper stomach, mimicking severe indigestion

Other accompanying signs may include:

Shortness of breath or difficulty catching your breath
Unusual tiredness or sudden weakness
Nausea, cold or clammy sweating, or feeling sick
Dizziness or light-headedness
A wave of anxiety or a “something’s wrong” feeling

Symptoms typically appear when the heart needs more oxygen, such as during:

Brisk walking, climbing stairs, or carrying heavy loads
Emotional stress or upset
Large meals, especially high-fat
Exposure to cold air or wind
Smoking

In stable angina, episodes are fairly predictable: the same level of effort triggers symptoms, and rest or GTN spray brings relief reliably.

However, experiences vary. Women, older adults, people with diabetes, and certain ethnic groups often have “atypical” symptoms, which may include minimal chest pressure but prominent breathlessness, fatigue, nausea, or pain in the jaw, back, or arms. These atypical signs can be mistaken for ageing, stress, or digestive issues, delaying recognition.

Angina can also affect daily life beyond physical discomfort. Repeated episodes may cause avoidance of previously enjoyed activities—like skipping walks, limiting work tasks, or holding back in social situations. Over time, this can lead to low mood, frustration, or isolation.

Keeping a diary is strongly recommended by the BHF: record what you were doing, how severe the discomfort felt on a scale of 1–10, how long it lasted, and what eased it. This turns vague worries into clear patterns that your healthcare professional can use to support diagnosis and management.

Common Types and Presentations of Angina

Angina isn't one-size-fits-all; it shows up in different ways depending on the underlying cause. Understanding the main types can help explain why your experience feels unique and what it might mean.

Stable angina: The most common type. It's predictable—triggered by effort or stress, follows a consistent pattern month after month, lasts a short time, and responds well to rest or medication. Think of it as a reliable warning system when you've pushed a bit too far.
Unstable angina: More serious and unpredictable. Episodes can occur with minimal effort, at rest, last longer (20–30 minutes or more), or worsen over days. This often signals an unstable plaque and requires urgent medical attention, as it increases the risk of heart attack.
Variant angina (Prinzmetal or vasospastic angina): Rare, caused by a sudden spasm in a coronary artery rather than fixed narrowing. Episodes are usually severe but cyclical, happening at rest or in the early morning. It can affect younger people or those with minimal plaque.
Microvascular angina: Involves the heart’s small blood vessels not working properly. More common in women, especially around or after menopause. Causes longer episodes of breathlessness, fatigue, or chest discomfort during activity, even when larger arteries appear normal on tests.

Each type brings different challenges: stable angina can limit daily energy, unstable angina requires urgent attention, variant angina can disrupt sleep, and microvascular angina may feel “invisible” to others. Recognising the type helps healthcare professionals create the most effective management plan.

What Causes Angina?

Angina happens when part of your heart muscle temporarily doesn’t get enough oxygen-rich blood. This mismatch between what the heart needs and what it receives triggers the warning discomfort.

In over 90% of cases, the problem is narrowing of the main coronary arteries due to a build-up of fatty plaques, a process called atherosclerosis or coronary heart disease. These plaques form over many years and consist of cholesterol, fats, inflammatory cells, and scar tissue. They make the arteries narrower and stiffer, so when your heart beats faster or harder, blood flow can’t increase enough to meet demand.

Plaque stability affects the type of angina:

Stable plaques cause predictable, exertion-related angina.
Vulnerable plaques have soft, fatty centres and thin caps that can crack, leading to clot formation and unstable angina.

Other, less common causes include:

Sudden artery spasms: The artery contracts sharply, cutting off flow temporarily. Triggers can include smoking, stress, cold, or certain drugs.
Problems with tiny blood vessels: Small branches of the heart fail to relax properly, common in microvascular angina.
Higher oxygen demand: Conditions like very high blood pressure, fast heart rate, or overactive thyroid make the heart need more oxygen than usual.
Lower oxygen supply: Severe anaemia or serious lung problems reduce oxygen delivery even if blood flow is normal.

Angina is your body’s protective alert. Most episodes are reversible and give you a chance to act before damage occurs. But it’s also a clear sign that underlying issues need attention to prevent progression.

Risk Factors: Things You Can Change and Things You Can't

Risk factors are the things that increase the chances of developing narrowed arteries, angina, or other heart problems. They are not “faults” and not something to feel guilty about. The key is knowing which ones you can influence—small changes can add up to major protection over time.

Things you can't change (non-modifiable risk factors):

These are factors you are born with or naturally acquire with age. They don’t make angina inevitable but highlight where awareness is important:

Age: Arteries stiffen and plaque builds up naturally over time. Risk rises noticeably after around 45 for men and 55 for women.
Gender: Men generally develop heart problems about 10 years earlier than women. After menopause, women’s risk catches up.
Family history: Early heart disease in close relatives raises your risk due to inherited traits like cholesterol or blood pressure tendencies.
Ethnicity: South Asian, Black African, or Black Caribbean backgrounds have higher risk, linked to genetics, diabetes prevalence, and lifestyle factors.

Things you can influence (modifiable risk factors):

These are the areas where action can make a real difference:

Smoking: Damages artery lining, reduces oxygen, raises heart rate and pressure. Benefits start almost immediately after quitting, and risk halves within a year.
High blood pressure (hypertension): Puts strain on arteries, thickens and narrows them over time. Influenced by diet, weight, activity, and stress.
High cholesterol: Elevated LDL (“bad”) and low HDL (“good”) levels contribute to plaque formation. Diet and medication help manage this.
Diabetes: High blood sugar damages vessels and accelerates atherosclerosis. Lifestyle changes can prevent or control type 2 diabetes.
Being overweight or inactive: Extra weight, especially around the middle, increases heart workload, blood pressure, cholesterol, and diabetes risk. Regular movement improves heart and vessel function.
Poor diet: Too much saturated/trans fats, salt, sugar, and processed foods worsens risk. A Mediterranean-style diet protects arteries.
Excessive alcohol and chronic stress: Over-drinking raises blood pressure and contributes to weight gain. Long-term stress triggers hormones that tighten arteries and can encourage unhealthy habits.

How Risk Factors Add Up and Interact

Risk factors rarely act alone—they often amplify each other. For example:

Smoking makes high blood pressure more damaging.
Diabetes combined with overweight accelerates plaque faster than either alone.
Inactivity worsens cholesterol and stress effects.

This “clustering” explains why metabolic syndrome (high pressure, cholesterol, sugar, and waist size) strongly predicts risk.

Tools like the NHS QRISK calculator provide a personalised 10-year risk score based on age, blood pressure, cholesterol, smoking, and more.

The good news: modifiable risk factors respond very well to change. Even with several non-modifiable risks, tackling lifestyle factors can outweigh them. Quitting smoking, improving diet, increasing activity, and controlling pressure/cholesterol can cut heart risk by 80% or more, stabilise plaque, improve blood flow, and often reduce or eliminate angina episodes. Benefits can appear within months, giving more energy, fewer symptoms, and reassurance for the future.

Myths, Facts, and Frequently Asked Questions

This section tackles some of the most common misunderstandings about angina, as well as those questions that often linger in people's minds. Clearing up myths is really important because they can lead to unnecessary worry, delays in getting help, or brushing off symptoms that deserve attention. The facts here are based on solid evidence from sources like the NHS and British Heart Foundation, and they're meant to give you a clearer, more balanced picture. We'll also cover frequently asked questions with straightforward, practical answers to help you feel more informed.

Myth: Angina is basically just heartburn, indigestion, or "wind"—it's nothing serious and will pass on its own.

Fact: This is one of the most common and potentially harmful mix-ups. While angina can sometimes feel a lot like indigestion—especially with discomfort in the chest or stomach area—the key difference is that it's coming from your heart, not your stomach. Heartburn usually worsens after certain foods or lying down, whereas angina comes on with effort, stress, or cold weather and eases with rest. Ignoring angina risks missing early opportunities to manage underlying artery narrowing and prevent heart attacks.

Myth: Angina is mainly a "man's problem"—women don't really get it, or if they do, it's milder.

Fact: This outdated idea contributes to under-diagnosis in women. Women often experience angina later in life and with different symptoms, such as breathlessness, extreme fatigue, nausea, or pain in the jaw, back, or arms. These subtler signs are sometimes mistaken for menopause, stress, or aging, causing delays in proper evaluation. Recognising that angina affects women equally ensures timely diagnosis and treatment.

Myth: If the symptoms are mild or only happen now and then, it's not worth bothering the doctor about.

Fact: Even occasional or mild episodes are your heart signalling a problem, usually narrowed arteries. Early evaluation allows simple management and prevention before progression. Waiting for severe episodes can make treatment more complex.

Myth: If heart disease or angina runs in the family, you're pretty much doomed.

Fact: Family history raises risk, but it's not destiny. Lifestyle choices—like quitting smoking, healthy diet, exercise, and controlling blood pressure/cholesterol—often outweigh genetic factors. Healthy habits can reduce risk by up to 80% even with family history.

Frequently Asked Questions

Do symptoms of angina differ between women and men?

Yes. Men often report classic central chest pressure radiating to the left arm. Women more commonly have “atypical” symptoms: shortness of breath, overwhelming fatigue, nausea, or jaw/back/shoulder discomfort. Hormones, smaller artery size, and microvascular issues contribute. Awareness of these differences ensures timely care.

Can you have angina without having high cholesterol?

Yes. Cholesterol is a major factor, but angina can also result from artery spasms, high blood pressure, diabetes, smoking damage, or microvascular problems. Blood tests help clarify the underlying cause.

Does everyday stress directly cause angina?

Stress doesn’t usually cause artery narrowing but can trigger episodes by increasing heart rate and blood pressure. Chronic stress indirectly raises risk through unhealthy habits. Managing stress can reduce angina episodes.

Is every kind of chest discomfort a sign of angina?

No. Chest discomfort can result from muscle strain, heartburn, anxiety, lung issues, or gallstones. Angina is often linked to exertion or stress, radiates to arms/jaw, and eases with rest. Proper medical evaluation is needed for an accurate diagnosis.

Can angina affect younger adults, or is it just an older person’s condition?

It is less common under age 40–45 but can occur, particularly with strong risk factors such as heavy smoking, strong family history, diabetes, stimulant use, or microvascular problems. Early evaluation is important regardless of age.

When to Seek Help and UK Resources

If anything in this guide sounds familiar, or you’re worried about chest discomfort, breathlessness, or unusual tiredness—don’t hesitate or feel like you’re “making a fuss.” Reaching out early is one of the smartest things you can do for your heart. Doctors and nurses deal with these concerns every day; they listen, advise, and support without judgment.

When to act right away

Call 999 immediately if you have sudden, severe, or prolonged chest pain, especially if it’s:

New or happening at rest
Spreading to your arms, jaw, or neck
Accompanied by sweating, nausea, or dizziness

This could be unstable angina or another urgent cardiac event—fast action saves lives.

When to see your GP soon

Book an appointment if:

Symptoms keep returning, even if mild or occasional
They happen during everyday activities
They limit your daily life or just “don’t feel right”

Mention any risk factors like family history, smoking, or diabetes. Your GP can carry out checks, rule out other causes, and refer you to specialists or cardiac rehab if needed. Many people say they wish they had sought help sooner—it usually brings relief and a clear plan.

Key UK Resources for Support and Information

These trusted organisations provide free, confidential support:

British Heart Foundation (bhf.org.uk) : Heart Helpline (0300 330 3311, weekdays 9am-5pm) with cardiac nurses who listen and advise. Offers symptom checkers, downloadable diaries, online forums, local support groups, and free booklets.
NHS website (nhs.uk/conditions/angina) : Guides, online symptom checker, information on tests and treatments, and how to access NHS cardiac services through your GP or NHS 111 (call 111 for non-emergency advice).
Heart UK (heartuk.org.uk) : Advice on cholesterol, healthy eating, and recipes. Helpline: 0345 450 5988 for diet or cholesterol-related concerns.

You are not alone—over 2 million people in the UK live with angina or related conditions, and most manage it well while staying active and enjoying life. Understanding your symptoms and asking for help is a strong, positive first step. Support is ready and available—taking that step can make a real difference.