Heart attacks and strokes are the most serious complications that can occur in cases of angina.

However, the stress of living with a long-term condition can also have an impact on your emotional wellbeing and, in some cases, trigger depression. These complications are discussed in more detail below.

Heart attack

The leading cause of angina is when the blood supply to the heart becomes clogged up by fatty deposits called plaques.

When this happens, there is a small chance that one of the plaques will break away (rupture), causing a blood clot to form. The blood clot can then block the supply of oxygen-rich blood to the muscles of the heart, causing extensive damage to the heart muscles and triggering a heart attack.

The risk of having a heart attack depends on a number of things, such as age, blood pressure and the extent of the blockage.

Depending on these factors, the risk of having a heart attack in any given year can range from less than 1 in a 100 to 1 in 12. It is always possible to lower this risk by making lifestyle changes (see preventing angina for more information).

Symptoms of a heart attack include:

• chest pain - the pain is usually in the centre of your chest and can feel like a sensation of pressure, tightness or squeezing
• pain in other parts of your body - it can feel as if the pain is travelling from your chest to your arms (usually the left arm is affected but it can affect both arms), jaw, neck, back and abdomen
• shortness of breath
• nausea
• an overwhelming sense of anxiety (similar to having a panic attack)

You should dial 999 immediately if you suspect that you or someone you know is having a heart attack.

Heart attacks are treated using a combination of medication to improve the blood flow to the heart and surgery to bypass the blockage (coronary artery bypass graft) or widen the artery (percutaneous coronary intervention).

Stroke

If you have fatty plaques clogging up your coronary arteries, you may also have plaques clogging up the main blood vessel that supplies your brain with blood (the carotid artery).

If one of the plaques ruptures, it could cause a blood clot to develop, blocking the supply of blood to your brain and triggering a stroke.

As with a heart attack, you can also reduce your risk of having a stroke by making lifestyle changes.

The main symptoms of a stroke can be remembered using the word FAST which stands for Face-Arms-Speech-Time.

• Face - the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
• Arms - the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
• Speech - the person’s speech may be slurred or garbled or they may not be able to talk at all despite appearing to be awake
• Time - you should dial 999 immediately if you see any of these signs or symptoms

A stroke can be treated using medication to dissolve the blood clot and surgery to unblock the carotid artery.

Depression

Living with a condition such as angina can cause feelings of stress and anxiety in some people, which can lead to symptoms of depression. You may be feeling depressed if during the last month:

• you have often felt down, depressed or hopeless
• you have little interest or pleasure in doing things

It is important that you speak to your GP if you think that you have depression. Depression does not only affect your mental health, it can also have an adverse affect on your physical health as well.

Treatments for depression include antidepressant medications and a type of talking therapy called cognitive behavioural therapy (CBT).