- Mary: Why did you stop, I felt I could have done some more.
- Nurse: Mary we had to stop the treadmill test because we saw some changes on the ECG when you had some chest pain.
- Mary: I don’t understand why this has all happened my angina hadn’t been bothering me for a long time and now all this.
- Nurse: Certain things can make your angina worse. Is there anything you can think of that brings the angina on?
- Mary: I’m having a difficult time at home. My daughter’s marriage has ended and I’m helping with the kids. I’m so worried about the family how they’ll manage, the finances….
- Nurse: anxiety is a known trigger for angina and can aggravate your symptoms.
- Mary: Do you think if I cope better with my worries my angina will get better?
- Nurse: It will probably help things but the test that we just did suggests we may have to do a further test called an angiogram.
- Mary: What is that?
- Nurse: A fine tube called a catheter is passed into an artery in your groin or arm. It is then gently passed through until it reaches your coronary arteries and dye passes through so that x-rays can be taken. It is not usually painful as you will receive a local anaesthetic. This allows us to see if and where the arteries are narrowed and if this is the cause of an increase in your angina.
- Mary: That makes me feel less anxious but what if my angina gets worse at home while I am waiting for this?
- Nurse: If you get angina symptoms the best thing to do is to sit down and take a couple of sprays of GTN under your tongue and wait 5 minutes. If the symptoms go away just remain seated, if not do the same again and wait another 5 mins. If the symptoms are still there wait another 5 mins so remember if the symptoms are still there after 15 mins you must dial 999. If at any time the pain is severe or you feel very unwell, do not wait for 15 mins, just call 999.
Pulse point
Mary’s nurse suspects that she is experiencing significant anxiety problems, given that she reports regularly experiencing angina when she is feeling anxious and panicky. The nurse decides in a letter to the GP that there is an anxiety issue requiring follow up. The GP may decide to a mental health screening questionnaire with her, e.g. the CORE-10. If her score is elevated the GP can signpost Mary to her local Primary Care Mental Health Service, where she will receive self-help information on anxiety and panic, including breathing and relaxation techniques.
Emotional arousal i.e. anxiety or anger, can contribute to an angina episode in those with stable angina. It is important for people with stable angina to recognise and manage emotional problems which may underlie an increase in symptoms (in addition to a full set of physical investigations). However, watch out for unhelpful and inaccurate beliefs such as “I must avoid getting excited” and “stress is harmful for me”.
Reference for evidence based treatment for anxiety in primary care:NHS Education for Scotland: A Guide to delivering evidence-based Psychological Therapies in Scotland: “The Matrix – 2011” [.pdf]
Page last reviewed: 03 Jun 2020
