Angina

Scope of the Guidance

A key difference is that the Resuscitation Council UK guidance focuses on cardiac-sounding chest pain, which includes suspected heart attacks and other heart-related causes of chest pain. In contrast, the NHS, St John Ambulance and British Heart Foundation guidance focuses specifically on angina, including recognising symptoms and managing an angina attack.

Recognition

The sources are largely consistent in their description of angina and cardiac chest pain.

Common signs and symptoms identified across the sources include:

• Chest pain, tightness, pressure, squeezing, discomfort, or heaviness
• Pain or discomfort that may spread to the arms, shoulders, neck, jaw, back, or stomach
• Shortness of breath
• Sweating, dizziness, nausea, or feeling generally unwell

The NHS, St John Ambulance and BHF provide additional detail, stating that symptoms are often triggered by physical activity, emotional stress, excitement, or cold weather and usually improve with rest or prescribed GTN (nitroglycerine) medication.

The BHF also highlights that people may describe angina in different ways, including tightness, pressure, burning, or indigestion-like discomfort. Symptoms can vary between individuals and may not always present in the same way.

The Resuscitation Council does not provide detailed symptom recognition for angina, instead referring more broadly to cardiac-sounding chest pain that may indicate a serious cardiac event requiring emergency treatment.

Treatment

All four sources agree that the person should:

• Stop what they are doing and rest
• Be reassured and placed in a comfortable position
• Use their own prescribed GTN (nitroglycerine) spray or tablets if available
• Receive emergency help if symptoms do not improve or worsen

Key Differences in Treatment

Resuscitation Council UK

Treats cardiac-sounding chest pain as a potential medical emergency.
Advises calling 999.
Recommends assisting the person to take their prescribed GTN.
Recommends giving 300 mg aspirin as soon as possible, unless the person has a known aspirin allergy.
Advises staying with the person until help arrives.

NHS

Advises rest and use of prescribed GTN.
Recommends calling 999 if symptoms have not improved after GTN, if symptoms last longer than usual, become worse, or occur at rest.
Emphasises that new or unexplained chest pain should be treated urgently.

St John Ambulance

Advises helping the person to rest and take their prescribed GTN.
Recommends calling 999 if symptoms do not improve, become worse, or are different from their usual angina symptoms.
Focuses on recognising when an angina attack may actually be a heart attack.

British Heart Foundation

Advises stopping activity and resting.
Recommends using prescribed GTN medication.
States that symptoms should normally ease within a few minutes of rest or GTN.
Advises calling 999 immediately if symptoms do not improve, become more severe, or are different from the person’s normal angina symptoms, as this may indicate a heart attack.

Conclusion

The four sources are consistent in recognising angina as chest discomfort caused by reduced blood flow to the heart and in advising rest, reassurance, and the use of prescribed GTN medication. All stress the importance of seeking emergency medical help when symptoms do not improve, worsen, or suggest a heart attack.

The main difference is that the Resuscitation Council UK takes a broader emergency-care approach to any cardiac-sounding chest pain and recommends early use of aspirin and calling 999. The NHS, St John Ambulance and British Heart Foundation focus more specifically on recognising and managing angina attacks while helping first aiders identify when symptoms may indicate a heart attack requiring urgent medical assistance.

Teaching Points for Trainers

• First aiders are not expected to diagnose angina or a heart attack. Their role is to recognise that chest pain may be heart-related and respond appropriately
• Emphasise that angina is not always described as pain. People may describe pressure, tightness, heaviness, squeezing, burning, or indigestion-like discomfort
• Reinforce that symptoms which do not improve with rest or GTN, become worse, occur at rest, or are different from usual angina symptoms should be treated as a possible heart attack
• Remind learners that GTN should only be taken by the person it has been prescribed for
• Explain that aspirin may be given for suspected cardiac chest pain in accordance with Resuscitation Council UK guidance, provided the person is an adult, can swallow, and has no known aspirin allergy
• Use realistic scenarios to help learners recognise both typical and less typical presentations of cardiac chest pain
• Reinforce the key message: if in doubt, treat chest pain as potentially serious and seek emergency medical assistance