Angina, stable - What will happen?

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If you've been told you have angina, you may feel anxious about your future and worry that you could have a heart attack.

The good news is that with treatment, many people with angina can live for a long time.[3] And making some changes in the way you live, such as stopping smoking and eating sensibly, can also help you live longer and stay in good health. For more, see What you can do to help yourself.

The bad news is that having angina probably means that you have coronary artery disease. With this disease, the arteries that carry blood to your heart are narrowed, so less blood can get through. If an artery gets badly blocked, you can have a heart attack. Having angina means you are more likely to die early from a heart attack.[4]

One study looked at men aged 42 to 65 who had recently started having angina but who had not had a heart attack.[5] Here's what it showed.

  • Five years later, nearly 90 percent of the men with angina were alive. This compared with 96 percent of men who didn't have signs of coronary artery disease.
  • Ten years later, slightly more than 70 percent of the men with angina were alive. This compared with slightly more than 90 percent of the men who didn't have signs of coronary artery disease.

Getting a diagnosis of angina at least gives you some warning that you have coronary artery disease, so that you and your doctor can do something about it. Only a third of people with the disease get this warning.[6] A third die suddenly (from a condition called sudden cardiac death). And a third get a heart attack without any warning

The outlook for you depends on many things, including how badly your arteries are narrowed. For example, the outlook is good if you don't need surgery. On average, each year only 1 percent to 2 percent of people with heart problems, such as angina, who don't need surgery die from a heart attack, and a further 2 percent to 3 percent have a heart attack but get better.[7] [8] [9] [10]

But some people with angina are more likely to have a heart attack. Here are some things that can increase your risk of having one.

  • You are a man.[11]
  • You get angina without much exercise.
  • You have an abnormal electrocardiogram (ECG for short) while you are resting.[12] About half of people with stable angina have this.[13] For more on ECGs, see Tests for angina.
  • You have had a heart attack in the past.[4]
  • Your heart isn't pumping well, especially on the left side. In this case, you might also get breathless very easily and have heart failure.[14]
  • A stress test shows that you get angina without much exercise. About one-third of people with stable angina who are sent to hospital have this.[14] For more on stress tests, see Tests for angina.
  • You have narrowing of the main coronary artery going to the left side of your heart. Or you have narrowing of all of your coronary arteries.[6] [14]
  • You have other factors that make your risk higher, such as smoking, high blood pressure, diabetes or high cholesterol.[15] [16] [2]
  • Your angina is getting worse or the pattern is changing.[1]

If you're at higher risk for a heart attack, you need to find out early so that you can get the best treatment straight away.

How will angina affect my life?

You may worry about doing your usual activities or enjoying life as normal. The good news is that with the right treatment, many people with angina can carry on with the things they enjoy.

Work

Having angina can affect certain kinds of work. For example, you may no longer be able to do a job that involves running heavy machinery or driving certain kinds of vehicles. Contact the Driver and Licensing Authority (DVLA) for further information (http://www.dvla.gov.uk).

Driving

You should still be able to drive, as long as your angina is under control. You don't need to tell the DVLA about your angina. But you do need to tell your motor insurance company.

Sex

You may worry that having sex will bring on your angina. But most people can still enjoy sex.

If you're taking medicines called nitrates or a drug called nicorandil, you shouldn't take certain drugs for erection problems. Some of these drugs (with brand names) are listed below.

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

Nitrates and nicorandil can lower your blood pressure, and these other drugs may lower it even more. That can be dangerous.

If you worry about having sex, talk to your doctor. You might feel embarrassed talking about this. But sex is a normal part of life, and your doctor is used to dealing with sexual problems. He or she may be able to help you and your partner.

If your doctor has any doubts, he or she may suggest a stress test to see how much exercise is safe for you. For more, see Tests for angina.

Flying

You may wonder if it's safe for you to travel by aeroplane. Generally, if you can climb 12 stairs and walk 50 metres on flat ground without getting very breathless and without getting angina, you can fly as a passenger.[17]

Depression

Having angina can affect how much you get out of life. You may worry so much about your condition that you feel you have to take it easy and can't live life normally.[18]

You might think of an angina attack as a sort of mini heart attack (it isn't). This might make you feel as though you have to stop doing things you enjoy.[19] And this can give you more anxiety and even depression.

If you're worried or feeling down, talk to your doctor about a self-help angina plan. This plan is based on a workbook and a relaxation tape. If you have newly diagnosed angina, the plan can help you feel better and have less anxiety and depression. You work with a nurse who helps you change the way you live and advises you about treatments.[20]

References

  1. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA. 2002 guideline update for the management of patients with chronic stable angina. March 2003. Available at http://www.acc.org/qualityandscience/clinical/statements.htm (accessed on 16 January 2006).
  2. Rosengren A, Hagman M, Wedel H, et al. Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris: a 16-year follow-up of the Primary Prevention Study in Goteborg, Sweden. European Heart Journal. 1997; 18: 754-761.
  3. Julian DG, Bertrand ME, Hjalmarsson A, et al. Management of stable angina pectoris. European Heart Journal. 1997; 18: 394-413.
  4. Rosengren A, Wilhelmsen L, Hagman M, et al. Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Goteborg, Sweden. Journal of Internal Medicine. 1998; 244: 495-505.
  5. Lampe FC, Whincup PH, Wannamethee SG, et al. The natural history of prevalent ischemic heart disease in middle aged men. European Heart Journal. 2000; 21: 1052-1062.
  6. Gandhi MM, Lampe FC, Wood DA. Incidence, clinical characteristics and short term prognosis of angina pectoris. British Heart Journal. 1995; 73: 193-198.
  7. Coronary Artery Surgery Study Authors. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery: quality of life in patients randomly assigned to treatment groups. Circulation. 1983; 68: 951-960.
  8. Brunelli C, Cristofani R, L'Abbate A. Long-term survival in medically treated patients with ischaemic heart disease and prognostic importance of clinical and electrocardiographic data: the Italian CNR multicentre prospective study OD1. European Heart Journal. 1989; 10: 292-303.
  9. Dargie HJ, Ford I, Fox KM, et al. Total Ischaemic Burden European Trial (TIBET): effects of ischaemia and treatment with atenolol, nifedipine SR and their combination on outcome in patients with chronic stable angina. European Heart Journal. 1996; 17: 104-112.
  10. The IONA study group. Effect of nicorandil on coronary events in patients with stable angina: the Impact of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002; 359: 1269-1275.
  11. Murabito JM, Evans JC, Larson MG, et al. Prognosis after the onset of coronary heart disease: an investigation of differences in outcome between sexes according to initial coronary disease presentation. Circulation. 1993; 88: 2548-2555.
  12. Hammermeister KE, DeRouen TA, Dodge HT, et al. Variable predictors of survival in patients with coronary artery disease: selection by univariate and multivariate analyses from clinical, electrocardiographic, exercise, arteriographic and quantitative evaluation. Circulation. 1979; 59: 421-430.
  13. Connoly DC, Elveback LR, Oxman HA, et al. Coronary heart disease in Residents of Rochester, Minnesota. IV. Prognostic value of the resting eletrocardiogram at the time of diagnosis of angina pectoris. Mayo Clinic Proceedings. 1984; 59: 247-250.
  14. Mock MB, Ringqvist I, Fisher LD, et al. Survival of medically treated patients in the coronary artery surgery study (CASS) registry. Circulation. 1982; 66: 562-568.
  15. Sigurdsson E, Sigfusson N, Agnarsson U, et al. Long-term prognosis of different forms of coronary heart disease: the Reykjavik Study. International Journal of Epidemiology. 1995; 24: 58-68.
  16. Hagman M, Wilhelmsen L, Pennert K, et al. Factors of importance for prognosis in men with angina pectoris derived from a random population sample. American Journal of Cardiology. 1998; 61: 530-535.
  17. Jackson G. Sexual intercourse and stable angina pectoris. American Journal of Cardiology. 2000; 86 (supplement 1): 35-37.
  18. Lewin RJP. Improving quality of life in patients with angina. Heart. 1999; 82: 654-655.
  19. Lewin B. The psychological and behavioral management of angina. Journal of Psychosomatic Research. 1997; 43: 453-462.
  20. Lewin RJP, Furze G, Robinson J, et al. A randomised controlled trial of a self-management plan for patients with newly diagnosed angina. British Journal of General Practice. 2002; 52: 194-201.

Glossary

high cholesterol
The term high cholesterol is a bit misleading. High levels of are actually good for you. But if you've been told that you have high cholesterol it means that your total cholesterol level is 5 or higher or your is 3 or higher or both. Having high cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.
high blood pressure
Your is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure 'hypertension'.
diabetes
Diabetes is a condition that causes too much sugar (glucose) to circulate in the blood. It happens when the body stops making a called (type 1 diabetes) or when insulin stops working (type 2 diabetes).
coronary arteries
Coronary arteries are the vessels that supply blood to the heart muscle. If yours are blocked, you may have a pain in your chest (known as ) or a heart attack (what doctors call an ) because parts of the heart are not getting enough blood and oxygen.
heart failure
When the heart loses its ability to push enough blood through the blood vessels, it is called heart failure.

© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved

This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

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