First Aid for a Patient With Angina

Angina is chest pain, pressure, or discomfort that commonly occurs when the heart muscle does not receive enough oxygen-rich blood. It is frequently associated with coronary artery disease, although the exact cause of chest symptoms requires appropriate medical assessment.

Stable angina may occur predictably during physical activity or emotional stress and improve with rest or prescribed medication. Unstable angina may occur suddenly, at rest, or become more frequent or severe and requires emergency medical assessment.

Understanding appropriate first aid is important because chest pain can also be a warning sign of acute coronary syndrome or a heart attack. New, severe, or unusual chest discomfort should not be diagnosed at home.

What Is Angina?

Angina is not a disease by itself. It is a symptom that occurs when the heart muscle's demand for oxygen exceeds the supply of oxygen-rich blood reaching it. One of the most common underlying causes is narrowing of the coronary arteries due to coronary artery disease.

Angina is often described as pressure, heaviness, squeezing, or tightness in the chest. In some people, symptoms are triggered by physical exertion, emotional stress, cold temperatures, or large meals.

Angina is not the same as a heart attack. Angina does not necessarily involve permanent damage to heart muscle. However, new, worsening, or resting angina requires urgent assessment because it may indicate a serious reduction in blood flow to the heart.

Seven Possible Symptoms of Angina

Symptoms differ between individuals, and not everyone experiences all of them. Possible symptoms include:

• Chest pain, pressure, heaviness, squeezing, or tightness.
• A burning sensation or chest discomfort in some people.
• Pain or discomfort spreading to one or both arms, the shoulders, neck, jaw, or back.
• Sweating, particularly a cold sweat when an acute cardiac problem is present.
• Nausea or vomiting.
• Shortness of breath.
• Upper abdominal discomfort in some people.

Dizziness, weakness, or unusual fatigue may also occur. Symptoms alone cannot reliably distinguish angina from a heart attack or other causes of chest pain.

Who Is More Likely to Develop Angina?

Angina is commonly associated with risk factors for coronary artery disease and cardiovascular disease. Important risk factors include:

• Smoking and tobacco use.
• High blood pressure.
• High cholesterol or unhealthy blood lipid levels.
• Diabetes.
• Overweight or obesity.
• Physical inactivity.
• A family history of premature cardiovascular disease.
• Increasing age.
• Existing coronary artery or cardiovascular disease.
• Use of certain illicit stimulant drugs that can affect the heart and blood vessels.

Severe anemia, low blood pressure, and certain other medical conditions may contribute to an imbalance between oxygen supply and demand in the heart in specific situations, but they are not traditional coronary artery disease risk factors in the same way as smoking, hypertension, and diabetes.

First Aid for a Patient With Angina

It is important to distinguish between immediate first-aid measures during chest pain and medications or procedures that should only be selected by medical professionals.

1. Stop Activity and Rest

If someone with a previous diagnosis of stable angina develops symptoms during activity, they should stop what they are doing and sit or rest comfortably.

2. Use Only the Patient's Prescribed Angina Medication

A patient previously diagnosed with angina may have a fast-acting nitrate such as glyceryl trinitrate or nitroglycerin prescribed as a tablet or spray.

The medication should be used according to the patient's individual medical instructions. Nitroglycerin prescribed to another person should not be given to the patient.

3. Call Emergency Services if Symptoms Do Not Improve

If chest pain does not improve with rest and the patient's prescribed angina treatment, or persists after the doses allowed in the patient's treatment plan, emergency medical services should be contacted immediately.

Emergency care is also required for new or severe chest pain, symptoms occurring at rest, increasingly frequent or prolonged episodes, or chest discomfort accompanied by severe sweating, shortness of breath, nausea, dizziness, or loss of consciousness.

4. Do Not Let the Patient Drive to the Hospital

When a heart attack or unstable angina is suspected, emergency medical services are preferable to the patient driving themselves because their condition can deteriorate suddenly.

5. Monitor Responsiveness and Breathing

While waiting for medical help, monitor whether the person remains responsive and is breathing normally. If the patient becomes unresponsive and is not breathing normally, call emergency services and begin CPR if trained to do so. Use an automated external defibrillator if one is available and follow its instructions.

Medical Treatment for Angina

After medical assessment, treatment may include different medications depending on the type of angina, the underlying heart disease, and the patient's cardiovascular risk. Nitrates, beta blockers, calcium channel blockers, and other anti-anginal medications may be considered.

Antiplatelet therapy such as aspirin may be prescribed in selected patients, while statins can be used to reduce cardiovascular risk associated with coronary artery disease. Anticoagulants are not interchangeable with aspirin and are not routinely used in the same way for every patient with angina.

Warfarin is therefore not a first-aid medication to be given during an angina attack and should never be taken without an appropriate medical indication and monitoring.

If symptoms cannot be adequately controlled with medication or there is significant coronary artery narrowing, coronary intervention such as PCI with stent placement or coronary artery bypass grafting may be considered according to the patient's investigations and clinical condition.

Preventing Angina and Reducing Cardiovascular Risk

Prevention and reduction of angina episodes rely on managing underlying heart disease, controlling cardiovascular risk factors, and following the treatment plan provided by the healthcare team.

• Stop smoking and avoid tobacco exposure whenever possible.
• Monitor and manage blood pressure, blood glucose, and cholesterol.
• Maintain a healthy weight or pursue gradual weight reduction when appropriate.
• Stay physically active within the limits recommended by the healthcare professional.
• Follow a balanced diet rich in vegetables, fruit, whole grains, legumes, and appropriate protein sources.
• Favor unsaturated fats and limit saturated and trans fats and heavily processed foods.
• Limit excessive sodium, especially when hypertension is present.
• Limit or avoid alcohol according to medical advice and individual health needs.
• Take prescribed cardiovascular medication as directed and do not stop medication without medical advice.
• Recognize personal angina triggers and avoid exertion beyond limits recommended by the treating clinician.

People with angina do not need to eliminate all dietary fats or carbohydrates. Overall dietary quality and an individualized cardiovascular care plan are more important than removing entire food groups without a medical reason.