Angina (Seene mein Dard): Symptoms, Heart Medicines and When It Is an Emergency

A tight, heavy feeling in the chest when you climb the stairs or walk fast, which eases when you stop. Many people put this down to gas or tiredness, and ignore it for months. Angina (seene mein dard, dil ka dard) is the heart’s warning that it is not getting enough blood during effort, and it must be taken seriously, because it can be a step before a heart attack.

This guide explains the symptoms of angina, how it differs from a heart attack and from acidity, the main groups of heart medicines and how they work, what never to do with them, and when to call for emergency help.

What is angina?

Angina is chest discomfort that happens when the heart muscle does not get enough blood and oxygen. The usual cause is narrowing of the heart arteries by fatty plaque (coronary artery disease). It is not a disease in itself, but a symptom of one.

• Stable angina: comes on with effort or emotional stress, lasts a few minutes, and settles with rest or a nitrate medicine.
• Unstable angina: new, more frequent, more severe, or occurs at rest. This is an emergency, close to a heart attack.

Symptoms

• Pressure, squeezing, tightness or heaviness in the centre of the chest.
• Pain that spreads to the left arm, shoulder, neck, jaw, back or upper belly.
• Breathlessness, sweating, nausea, weakness or dizziness.
• Women, older people and people with diabetes may have less typical signs: shortness of breath, tiredness, nausea or upper belly discomfort, without much pain.

When to call for emergency help

Call an ambulance (Rescue 1122 in areas where it operates, or Edhi 115) and go to a hospital with a cardiac unit immediately if:

• Chest pain lasts longer than ten to fifteen minutes, or does not settle with rest.
• Pain comes with sweating, breathlessness, vomiting, fainting or a sense of doom.
• Chest pain occurs at rest, or is worse than your usual pattern.

Do not drive yourself. Do not wait to see if it passes. If a doctor has told you to take a particular medicine during an attack, follow that plan. Time matters: every minute of delay can mean more heart damage.

Is it angina or acidity?

Heartburn and angina can feel alike. Clues that point to the heart: pain triggered by exertion and relieved by rest, pressure rather than burning, spreading to the arm or jaw, with sweating or breathlessness. Clues that point to acidity: burning that is related to meals, lying down or bending, with a sour taste, and relief with antacids. If you are not sure, treat it as the heart until a doctor says otherwise. See our guide to acidity medicines.

Tests your doctor may suggest

• ECG, echo and a treadmill or stress test.
• Blood tests, including cholesterol, sugar and kidney function, and cardiac markers in an emergency.
• CT coronary scan or angiography, to see the arteries directly, and to decide whether a stent or bypass is needed.

Medicines used for angina and how they work

These are prescription medicines. The right combination depends on you. Never start, stop or change them on your own.

Antiplatelets: keep the blood from clotting

Low-dose aspirin and clopidogrel stop platelets from sticking together and forming a clot in a narrowed artery. Products include Loprin 75, Ascard 75, Clopid 75 and Plavix 75. If you have a stent, stopping an antiplatelet suddenly can cause a clot in the stent and a heart attack. Never stop it without your cardiologist’s permission, even before dental work or surgery. Ask them first.

Nitrates: relax the arteries

Glyceryl trinitrate tablets or spray (under the tongue) work in a minute or two to relieve an attack, and long-acting nitrates such as isosorbide mononitrate and isosorbide dinitrate prevent attacks. Sustained-release products include Nitromint Retard and Angised. Side effects: headache, flushing, dizziness. Never combine nitrates with sildenafil or tadalafil (erectile dysfunction tablets). The combination can cause a dangerous fall in blood pressure.

Beta blockers: slow the heart

Medicines such as metoprolol and bisoprolol reduce the heart rate and the workload of the heart. They can cause tiredness, cold hands and a slow pulse. Avoid stopping them suddenly. People with asthma need to check with their doctor first.

Calcium channel blockers

Amlodipine and similar medicines widen the arteries, and are also used for high blood pressure. Ankle swelling is a common side effect.

Other anti-angina medicines

Trimetazidine (for example Vastarel MR) and ranolazine help the heart use energy better and are added when symptoms persist.

Statins and blood pressure control

Cholesterol-lowering statins slow down plaque, and good blood pressure control protects the arteries. See our guides to statins and cholesterol and high blood pressure in Pakistan.

Browse the angina and heart and cardiac care categories. If you have a prescription, you can upload it here.

Lifestyle: what makes the biggest difference

• Stop smoking, paan, gutka and naswar. This is the single most important step.
• Eat for your heart: less ghee, fried food, paratha, bakery items and salt, and more vegetables, daal, fruit, whole grains and fish.
• Walk regularly, as advised by your doctor. Stop and rest if you get pain.
• Control blood sugar and blood pressure. See our diabetes guide.
• Reach a healthy weight, and check your BMI. Read about weight and BMI at home.
• Manage stress and sleep well.
• Take your medicines regularly, and keep your appointments.

A home BP monitor helps. Our guide to the best blood pressure monitor in Pakistan explains how to choose one.

Frequently asked questions

Is angina the same as a heart attack?

No. In angina the blood supply is reduced temporarily, and in a heart attack a blockage cuts it off and damages the muscle. Angina is a warning sign.

Can angina be cured?

It can be controlled with medicines and lifestyle, and sometimes treated with a stent or bypass surgery. The underlying artery disease needs lifelong care.

Do I need to carry my nitrate tablets?

If your doctor has prescribed fast-acting nitrates, keep them with you, and learn when and how to use them, and when to call for help.

Can I exercise with angina?

Usually yes, and it is helpful, but only under your doctor’s guidance, starting gently.

Order heart medicines from Khasmart on prescription, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or cardiologist. It does not include doses for you; your doctor decides the medicine and amount. In an emergency, call for help or go to the nearest hospital.