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Angina

Key points (drop down)

1.2 million people in the UK have angina

More men than women suffer from angina and this increases with age

Angina is caused by coronary heart disease

Coronary heart disease is the most common cause of premature deaths in the UK

In 2001 in the UK 1:4 deaths in men and 1:6 deaths in women was due to coronary heart disease

Physical inactivity, obesity, smoking and diabetes are major risk factors for coronary heart disease

Some occupations are a total bar for a person with angina whilst others have some restrictions e.g. lorry drivers, FLT truck drivers, working in hot environments

Commonly asked questions (drop down)

What is Angina?

Angina is a pain in the centre of your chest, which comes from the heart. It sometimes may spread into the left arm and jaw.

What causes Angina?

Angina is caused by the muscles of the heart not receiving enough blood for the work they are performing. This is due to the narrowing of the coronary arteries that may be due to age, smoking, high cholesterol, obesity and other conditions such as diabetes.

What are the symptoms?

The most common symptoms of angina are a pain, ache or discomfort, which is felt in your chest upon exertion such as running or strenuous lifting. The pain may spread into your neck, jaw, or arms, which does not last long usually easing on rest.

The pain may also be triggered by other causes of fast heart rates, after meals or in cold winds.

What treatment will I need if I am diagnosed?

You will initially be asked to address some lifestyle issues, which will improve your general health. Medication is usually prescribed to relieve an attack whilst other forms of medication will help improve the blood supply to the muscles of the heart.

If medication fails to control angina pains then surgery maybe required to unblock the coronary arteries or to bypass them.

What can I do to help with angina?

Certain risk factors increase the risk of developing angina by allowing fatty deposits to build up on the walls of the coronary arteries. Altering your lifestyle will help reduce the risk of developing angina or prevent it from getting worse.

Risk Factors

✓ Stop smoking

✓ High blood pressure - make sure you get your blood pressure check at least once a year. If it is high it can be treated.

✓ Overweight - losing weight is advised

✓ High cholesterol - can be treated if high

✓ Lack of exercise - You should aim to carryout 30 minutes of exercise per day 5 times a week. E.g. brisk walking, swimming, gardening, golf etc

✓ Diet - A healthy diet consists of:

❑ Five portions of fruit and vegetables per day.

❑ You should cut down on saturated fats such as cheese, full cream milk fried foods etc and use low fat products.

❑ Include 2-3 portions of fish per week such as Kippers, mackerel, salmon

❑ Eat red meat 1-2 times per week only or eat poultry

❑ Reduce your salt intake

❑ Reduce your alcohol intake. The recommended amount is 21 units for men and 14 units for women

Treatment

The treatment of angina depends on how severe and how frequent the attacks are. The aim of treatment is to prevent angina pains, limit further fatty deposits building up and reducing the risk of a heart attack.

Three main drug treatments for angina:

GTN (Glyceryl Trinitrate)

Comes in a spray or tablets. This is taken when an angina attack occurs either by popping a tablet under the tongue or a spray. Most people with angina carry their GTN around with them in case of an attack.

GTN works by relaxing the blood vessels, which reduces the workload on the heart as well as increasing the blood flow to the heart muscle.

Statins (drugs which lower cholesterol)

Cholesterol is a chemical, which is made in the liver from fatty foods eaten. Statin drugs lower the blood cholesterol level by blocking an enzyme, which is needed to make cholesterol in the liver.

The aim is to reduce cholesterol levels by 25-305 or below 5.0mmol/l.

Aspirin

Aspirin reduces the stickiness of platelets. Platelets are particles in the blood that help blood clots after cuts. Lots of platelets stuck to the fatty deposits will develop into a clot (thrombosis) therefore increasing a risk of a heart attack. Aspirin reduces this risk.

Surgery and Angioplasty

These treatments are options when medicines fail to control the symptoms of angina

□ Angioplasty - In this procedure a tiny wire with a balloon at the end is fed from the artery in the groin or arm until it reaches the narrowed section of the coronary arteries. The balloon is inflated to open the artery wide again

□ Surgery - This involves major surgery in which the narrowed section of the arteries are bypassed either by artificial grafts or grafts from other parts of the body. The operation is called a coronary bypass graft surgery (CABG).

Managers Section

There are some occupations, which do not allow people with angina to resume their former roles due to the hazard involved:

□ Airline pilots

□ Train drivers

□ Sea merchants

However other occupations may have a temporary bar either due to surgery, or depending on an individual's physical fitness to work. These include

□ HGV

□ LGV

□ PCV

□ FLT Drivers

□ Night shift workers

Relicensing of an individual with angina is subject to various conditions. Most can resume driving after 6 weeks providing that an exercise test has been carried out and that they are free from any symptoms. Once treatment has been commence or surgery has taken place there is no reason why an individual may not resume their role after a rehabilitation period.

However further advice must be sought from occupational health.

Some individuals only require slight adjustments to their roe with no adverse effects on capability or performance.

Short Term Sickness Absence

When carrying out a sickness review with an employee, who is known to suffer from angina, a manager is recommended to ask the following questions:

Is there anything at work that is contributing to your problem?

Do you think your poor attendance is related to your condition?

Have you seen your GP?

Have you adjusted your lifestyle which you may have been advised to look at?

Long Term Sickness Absence

All cases of long term sickness absence must be referred to the OH Consultant for an on site review.

Further Information Links

British Heart Foundation

.uk

Medical Information



Patient UK

patient.co.uk

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