What is Angina Pectoris (Chest Pain)?

Angina is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease.

Angina is also called angina pectoris.

Angina is often described as tightness, pressure, heaviness, tension, or pain in the chest. You may feel like there is a heavy weight on your chest. Angina may be a new pain that needs to be checked by a healthcare professional, or it may be a recurring pain that goes away with treatment.

Angina is relatively common. But some people may not be able to distinguish it from other types of chest pain, such as heartburn. If you have unexplained chest pain, seek medical help immediately.

Types

There are different types of angina. The type depends on the cause and whether rest or medication relieves symptoms.

Stable angina. Stable angina is the most common form of angina. It usually occurs during activity, also called exertion. It is relieved with rest or angina medication. Pain that begins while walking uphill or in cold weather may be angina.
Stable angina is predictable. It is often similar to previous attacks of chest pain. Chest pain typically lasts for a short time, perhaps five minutes or less.
Unstable angina, which is a medical emergency. Unstable angina is unpredictable and occurs at rest. Or the pain worsens and occurs with less physical exertion. Unstable angina is usually severe and lasts longer than stable angina, perhaps 20 minutes or longer. The pain is not relieved by rest or conventional angina medications. If blood flow does not improve, the heart cannot receive enough oxygen. A heart attack occurs. Unstable angina is dangerous and requires urgent treatment.
Variant angina is also called Prinzmetal’s angina. This type of angina is not due to coronary artery disease. It is caused by spasm in the heart arteries. The spasm temporarily reduces blood flow. Severe chest pain is the main symptom of variant angina. It often occurs in cycles, typically at rest and throughout the night. Pain can be relieved with angina medication.
Refractory angina. Angina attacks are common despite medications and lifestyle changes.

Symptoms

Angina symptoms include chest pain and discomfort. Chest pain or discomfort may feel like:

On fire.
Fullness.
Pressure.
Squeezing.

Pain may also be felt in the arms, neck, jaw, shoulder or back.

Other symptoms of angina include:

Dizziness.
Burnout.
Nausea.
Shortness of breath.
Sweating.

Angina The severity, duration and type of angina may vary. New or different symptoms may indicate unstable angina or a heart attack.

New or worsening angina symptoms need to be checked by a healthcare professional immediately. The healthcare team can determine whether you have stable or unstable angina.

Angina in women

Angina symptoms in women may differ from classic angina symptoms. These differences may cause delays in seeking treatment. For example, chest pain may not be the only symptom or the most common symptom. Other symptoms of angina in women may include:

Discomfort in the neck, jaw, teeth or back.
Nausea.
Shortness of breath.
Stabbing pain in the chest instead of pressure.
Stomach ache.

When should you see a doctor?

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medications may be due to a heart attack. Call 112 emergency medical help. Only go to the hospital yourself if there is no other way to get there.

If chest discomfort is a new symptom for you, see a healthcare professional to determine the cause and receive appropriate treatment. If you have stable angina and your condition worsens or changes, seek medical help immediately.

Reasons

Angina is caused by reduced blood flow to the heart muscle. Blood carries the oxygen the heart muscle needs to survive. When the heart muscle does not receive enough oxygen, it causes a condition called ischemia.

The most common cause of decreased blood flow to the heart muscle is coronary artery disease (CAD). The heart arteries, called coronary arteries, can become narrowed due to fatty deposits called plaque. This condition is called atherosclerosis.

Plaque in the blood vessel can rupture or cause blood clots. These events can quickly block or reduce flow in a narrowed artery. This can suddenly and severely reduce blood flow to the heart muscle.

The heart muscle can continue to work when oxygen demand is low without triggering angina symptoms. One example is rest time. However, angina can occur when oxygen demand increases, such as when exercising.

Risk factors

The following things can increase the risk of angina:

Increasing age. Angina is most common in adults aged 60 and over.
Family history of heart disease. Let your healthcare team know if your mother, father, or any sibling has ever had heart disease or a heart attack.
Tobacco use. Smoking, chewing tobacco, and prolonged exposure to secondhand smoke can damage the lining of the arteries. Artery damage can cause cholesterol deposits to collect and block blood flow.
Diabetes. Diabetes increases the risk of coronary artery disease. Coronary artery disease can cause angina.
Hypertension. Over time, high blood pressure accelerates the hardening of the arteries, damaging the arteries.
High cholesterol or triglycerides. Too much bad cholesterol, called low-density lipoprotein (LDL), in the blood can cause narrowing of the arteries. High LDL level increases the risk of angina and heart attack. High levels of triglycerides in the blood are also unhealthy.
Other health conditions. Chronic kidney disease, peripheral artery disease, metabolic syndrome, or a history of stroke increases the risk of angina.
Not enough exercise. A sedentary lifestyle increases the risk of high cholesterol, high blood pressure, type 2 diabetes and obesity. Talk to your healthcare team about the type and amount of exercise that is best for you.
Obesity. Obesity is a risk factor for heart disease, which can cause angina. Being overweight causes the heart to work harder to supply blood to the body.
Emotional stress. Too much stress and anger can raise blood pressure. Hormones secreted by the body during stress can narrow the arteries and worsen angina.
Medicines. Some medications can trigger Prinzmetal’s angina by narrowing blood vessels. Some migraine medications are an example of this.
Drug abuse. Cocaine and other stimulants can cause blood vessel spasms and trigger angina.
Cold temperatures. Exposure to cold temperatures can trigger Prinzmetal’s angina.

Complications

Chest pain that occurs with angina can make some activities, such as walking, uncomfortable. But the most dangerous complication is a heart attack.

Warning symptoms of a heart attack include:

A feeling of pressure, fullness, or squeezing in the middle of the chest that lasts for more than a few minutes.
The pain extends beyond the chest to the shoulder, arm or back, or even to the teeth and jaw.
Fainting.
A threatening sense of doom.
Increased attacks of chest pain.
Nausea and vomiting.
Ongoing pain in the upper abdomen.
Shortness of breath.
Sweating.

If you have any of these symptoms, seek emergency medical help immediately.

Prevention

You can help prevent angina by implementing the same lifestyle changes used to treat angina:

Avoid or limit alcohol.
Do not smoke.
Eat a healthy diet.
Exercise regularly.
Maintain a healthy weight.
Manage other health conditions related to heart disease.
Reduce stress.
Sleep 7 to 9 hours a day.

Also get recommended vaccinations to prevent heart complications.

Diagnosis

To diagnose angina, a healthcare professional will examine you and ask questions about your symptoms. You’ll usually be asked about any risk factors, including whether you have a family history of heart disease.

Tests

Tests used to diagnose and confirm angina include:

Electrocardiogram (EKG or EKG). This quick and painless test measures the electrical activity of the heart. Adhesive patches called electrodes are placed on the chest and sometimes on the arms and legs. Wires connect the electrodes to a computer that displays the test results. An ECG can show whether the heart is beating too fast or too slow. The test can show whether you are having or are having a heart attack.
Chest x-ray. A chest x-ray shows the condition of the heart and lungs. A chest X-ray may be done to determine if other conditions are causing chest pain symptoms and to see if the heart is enlarged.
Blood tests. Some heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests may be done to check these proteins, called heart enzymes.
Stress test. Sometimes angina is easier to diagnose when the heart is working harder. Stress testing usually involves walking on a treadmill or riding a stationary bike while your heart is checked. Other tests may be performed at the same time as the stress test. If you cannot exercise, you can take medications that affect the heart, such as exercise.
Echocardiogram. This test uses sound waves to create images of the heart in motion. These images can show how blood flows through the heart. An echocardiogram may be performed during the exercise test.
Nuclear stress test. Nuclear stress testing helps measure blood flow to the heart muscle at rest and during stress. This is similar to a routine stress test, but during a nuclear stress test, a radioactive tracer is injected into the bloodstream. A special scanner shows how the tracer moves through the heart arteries. Poor blood flow is likely to occur in areas where little or no tracer is present.
Cardiac computed tomography (CT) or magnetic resonance imaging (MRI). These tests create images of the heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of the heart. For both tests, you usually lie on a table that slides inside a long, tube-like machine. Each test can be used to diagnose heart problems. Tests can help show the severity of heart damage.
Coronary angiogram. This test uses X-ray imaging to check the inside of the heart’s blood vessels. It is part of a general group of procedures known as cardiac catheterization.
A healthcare provider inserts a flexible tube called a catheter into a blood vessel, usually in the groin. It is directed to the heart. Dye flows through the catheter. The dye makes the heart arteries appear more clearly on the X-ray. The x-ray is called angiogram.

Treatment

Options for treating angina include:

Lifestyle changes such as eating healthy and exercising.
Medicines.
Angioplasty and stenting.
Open heart surgery is called coronary artery bypass graft (CABG).

The goals of angina treatment are:

Reduce the number of angina attacks.
Make symptoms less severe.
Reduce the risk of heart attack and death.

If you have unstable angina or chest pain that is different than usual, you will need urgent treatment.

Therapies

Sometimes, a drug-free option called enhanced external pulse (EECP) may be done to increase blood flow to the heart. With EECP, blood pressure-type cuffs are placed around the calves, thighs, and pelvis. EECP requires multiple treatment sessions. EECP may help reduce symptoms in people with frequent, uncontrolled angina, called refractory angina.

Surgery and procedures

If lifestyle changes, medications, or other treatments do not relieve angina pain, a catheter procedure or open-heart surgery may be necessary.

Surgeries and procedures used to treat angina and coronary artery disease include:

Angioplasty with stenting. This treatment is also called percutaneous coronary intervention. A tiny balloon is placed into the narrowed artery. The balloon is inflated to expand the vein. A small coil of wire mesh, usually called a stent, is then inserted to keep the artery open.
Angioplasty with stenting improves blood flow in the heart, reducing or eliminating angina. Treatment may be a good option for those with unstable angina or if lifestyle changes and medications do not effectively treat chronic, stable angina.
Coronary artery bypass grafting (CABG). This is a type of open heart surgery. During CABG, a vein or artery taken from another part of the body is used to bypass a blocked or narrowed heart artery. The surgery increases blood flow to the heart. It is a treatment option for both unstable angina and stable angina that does not improve with other treatments.

Life style

Heart disease is often the cause of angina. Making lifestyle changes to keep the heart healthy is an important part of angina treatment. Try these strategies:

Do not smoke. Quitting smoking is the most important thing you can do to improve your heart health. Also avoid being near second-hand smoke. If you need to quit, ask your care team for help.
Exercise regularly. Regular exercise helps improve heart health. As a general goal, aim for at least 30 minutes of moderate or vigorous physical activity five or more days a week. If you have had a heart attack or heart surgery, you may have activity limitations. Ask your healthcare provider what is best for you.
Manage weight. Excess weight tires the heart. Being overweight increases the risk of high cholesterol, high blood pressure and diabetes. Ask your healthcare team what the best weight is for you.
Eat a healthy diet. Avoid or limit foods containing saturated fat, trans fat, salt and sugar. Choose whole grains, fruits, vegetables, and lean proteins like fish and beans.
Manage other health conditions. Ask your care team how often you should have your blood pressure, blood sugar, and cholesterol levels checked.
Control stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, and connecting with others in support groups are some ways to relieve stress.
Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, this means one drink per day for women and two drinks per day for men.
Get good sleeping habits. Insufficient sleep can increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep per day. Go to bed and wake up at the same time every day, including weekends. If you’re having trouble sleeping, talk to your care team about strategies that may help.