Ischaemic Heart Disease (Angina)

Ischaemic heart disease occurs when the blood vessels supplying the heart muscle become narrowed, usually due to atherosclerosis, reducing blood flow to the heart. Angina is the chest discomfort that results, typically triggered by exertion and relieved by rest.

• Chest discomfort, tightness, or pressure, often brought on by physical exertion or emotional stress and relieved by rest
• Discomfort may spread to the arm, neck, jaw, or back
• Shortness of breath with exertion
• Symptoms that occur at rest, last longer, or are more severe than usual may indicate a heart attack (acute coronary syndrome) and require emergency care

• Narrowing of the coronary arteries due to atherosclerosis (fatty plaque build-up), reducing blood flow to the heart muscle, especially during exertion when demand increases.
• Major risk factors include hypertension, diabetes, high cholesterol, smoking, obesity, physical inactivity, and a family history of heart disease.

• Diagnosed based on the characteristic pattern of exertional chest discomfort relieved by rest, together with assessment of cardiovascular risk factors.
• An electrocardiogram (ECG) is used to look for evidence of reduced blood flow or a prior heart attack, and is essential in anyone with chest pain to help rule out an acute event.
• Further tests, such as exercise testing or referral for specialist cardiac assessment, may be used where available to confirm the diagnosis and assess severity.

Stable angina is managed with a fast-acting nitrate (such as sublingual glyceryl trinitrate) to relieve acute episodes of chest discomfort.

Long-term prevention includes daily low-dose aspirin, a statin to lower cholesterol, and a beta-blocker or another anti-anginal medicine to reduce the frequency of episodes and protect the heart.

Aggressive control of underlying risk factors — blood pressure, diabetes, cholesterol, and smoking cessation — is central to reducing the risk of a future heart attack.

Any chest pain that is severe, occurs at rest, lasts more than a few minutes, or is associated with breathlessness, sweating, or nausea should be treated as a possible heart attack and referred immediately for emergency assessment, since this requires urgent hospital-level care distinct from stable angina management.

• Control blood pressure, diabetes, and cholesterol through regular monitoring and treatment adherence.
• Avoid tobacco use.
• Engage in regular physical activity as advised, and maintain a healthy weight.
• Take preventive medicines (such as aspirin and statins, where prescribed) consistently.
• Seek immediate emergency care for chest pain that is severe, prolonged, or occurs at rest.