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For many people there are warning signs that the blood supply to the heart muscle is becoming poor. These warning signs can appear long before any permanent heart damage, a heart attack, occurs. One of these warning signs is 'angina'. Angina is the pain or discomfort that occurs when the heart muscle isn't getting enough oxygen from the blood to meet its needs. Like a heart attack, angina pain can involve the chest, neck, jaw, shoulders, arms and back, but it is relieved quickly by rest, or sometimes by medications such as nitroglycerine, and no permanent heart damage occurs. In addition, some people become aware that the blood supply to their heart is reduced because they begin to have shortness of breath or unusual tiredness when doing activities they used to find easy.
At first, angina pain may only happen during times when the heart has to work harder. For example, during exercise, when out in cold weather or extreme heat, following a large meal or during periods of increased excitement or stress. As the blood flow through the 'coronary arteries' (the arteries that supply the needs of the heart - see diagram below) continues to decrease, however, angina may begin to occur at rest as well.

Angina pain usually occurs as a result of gradual narrowing and hardening of the coronary arteries (atherosclerosis), but may also occur as a result of a blood clot, spasms in the arteries, rapid heart rate or irregularities in the heart beat (arrhythmias).

Symptoms of angina may include:

an uncomfortable squeezing, fullness, pressure or pain in the centre of the chest
pain involving your neck, jaw, shoulders, arms and back. This pain may have spread from the chest area or may occur in one of these areas independently.
the pain you experience may be mild or severe
sweating or clamminess of the skin
weakness
pale or bluish colored skin
shortness of breath
nausea or vomiting
feeling like you have indigestion
dizziness or lightheadedness
a feeling of anxiety for no obvious reason.
If you have never had angina pain before, do not assume that it is angina and not a heart attack (even if the pain goes away).

- Stop any activity you are doing.
- Dial 911 to obtain immediate medical attention.
- Sit or lie down and try to relax.
- Do not drive yourself to the hospital.

The diagnosis of angina (as opposed to a heart attack) is made based on the results of a physical exam, an electrocardiogram and blood tests (See - 'Common Heart Tests). If you have angina, the tests may show that the heart isn't getting quite enough oxygen, but that no permanent heart damage has occurred. In other cases, however, the initial tests may appear normal. With further testing, the changes associated with angina may show up. Often angina is diagnosed based on the results of a 'cardiac stress test' (an electrocardiogram done while your heart is working harder because you are walking on a treadmill).

If it is determined that you have angina, you can work with your doctor(s) to improve or prevent worsening of the blood and oxygen supply to your heart by:

stopping nicotine exposure. If you smoke, are exposed to second hand smoke or use nicotine containing products, such as chewing tobacco, snuff or nicotine gum or patches, you will need to STOP. Nicotine makes blood vessels narrow and reduces the amount of oxygen carried by the blood.
avoiding sudden, excessive physical exertion. This seems to be particularly true of exertion that involves the arms (e.g. shovelling snow).
beginning a regular moderate exercise program, such as walking, under the careful guidance of your doctor.
not over exerting yourself in extremely hot or cold temperatures.
avoiding or learning to deal constructively with situations that you find stressful. (See - 'Managing Stress')
avoiding large heavy meals. Eat smaller amounts of food more frequently or make sure to rest following a larger meal.
losing some weight, if you are overweight.
learning to use nitroglycerin (as prescribed by your doctor) to:
increase the blood flow to your heart
to prevent angina attacks (if you know a certain activity will cause angina)
to relieve the pain of an angina attack.

Nitroglycerine causes the arteries in your body (including the coronary arteries) to widen -- this improves the blood flow to your heart. Nitroglycerine can be given as a small tablet under the tongue or a spray under the tongue to work immediately. It can also be used as skin patches or sustained-release tablets. Nitroglycerine patches or sustained-release tablets allow a small amount of nitroglycerine to be absorbed into the blood stream all throughout the day. People using the skin patches or sustained-release tablets may also require nitroglycerine tablets or spray under the tongue on occasion to relieve symptoms of angina should it occur. If you have questions about the use of nitroglycerine for the treatment and prevention of angina, discuss them with your doctor(s) and pharmacist.