Angina

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Introduction

What is angina?

Angina pectoris is the medical term for pain or other discomfort in the chest that is due to coronary heart disease. The chest pain or discomfort associated with angina occurs when an area of the heart muscle does not receive enough oxygen-rich blood.

Coronary heart disease is the most common type of heart disease in adults. As such, angina is a common cardiovascular condition in the United States. Approximately 10.2 million adults in the United States have angina. Each year, there are 500,000 new cases of angina in the United States (Source: AHA).

Angina develops due to coronary heart disease and an underlying heart problem called myocardial ischemia. This occurs when one or more of the heart’s coronary arteries, the blood vessels that supply blood to the heart muscle, is narrowed or blocked. Angina also can occur in people with diseases of the heart valves, hypertrophic cardiomyopathy (enlarged heart), or uncontrolled high blood pressure.

The most common signs and symptoms of angina are pressure or squeezing in the chest. The pain may also occur in the arms, shoulders, jaw, neck or back. Angina pain may even feel like indigestion. It’s important to be aware that women with angina more often report unexpected ‘extracardiac’ symptoms like nausea and right-sided chest discomfort.

Left untreated, angina may lead to severe heart damage. Severe heart damage can result in shock and heart attack and can be life threatening. Seek immediate medical care (call 911) for serious symptoms, such as chest pain or pressure, sweating, and difficulty breathing, which may be combined with pale or bluish lips and fast heart rate (tachycardia).

Symptoms

What are the symptoms of angina?

Lack of blood flow resulting in lack of oxygen supply to the heart causes the symptoms of angina. The symptoms can vary in intensity among individuals.

Common symptoms of angina

The most common symptoms of angina are related to disturbances in the circulation to the heart muscle and include:

  • Chest pain or pressure that is relieved by rest or medicine

  • Chest pain that does not come as a surprise, and episodes of pain tend to be alike

  • Pain or pressure that usually lasts a short time (five minutes or less)

  • Pain that may feel like gas or indigestion

  • Pain that may spread to the arms, back or other areas

  • Pain that occurs when your heart is required to work harder, usually when you are exerting yourself physically

Serious symptoms that might indicate a life-threatening condition

In some cases, angina can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Chest pain or pressure that is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina

  • Chest pain that is not relieved by rest or medicine

  • Chest pain that occurs at rest, while sleeping at night, or with little physical exertion

  • Difficulty breathing or rapid breathing

  • Pain or discomfort in the center of the chest

  • Pain or discomfort in the arms, the left shoulder, elbows, jaw, or back

  • Pain that continually worsens

Causes

What causes angina?

Angina is caused by a lack of blood flow to the coronary arteries. These arteries carry oxygen-rich blood to the heart. The diminished blood flow is caused by plaque that narrows and stiffens the coronary arteries in the process known as atherosclerosis, sometimes called hardening of the arteries. Angina occurs when the flow of oxygen-rich blood to the heart muscle is reduced, causing chest pain.

Plaque buildup also can lead to a heart attack if the plaque ruptures and causes a blood clot to form that blocks the artery.

What are the risk factors for angina?

A number of factors increase the risk of developing angina. Not all people with risk factors will get angina. Risk factors for angina include:

  • Age (for men, risk increases after 45 years of age; for women, after 55 years of age)
  • Cigarette smoking
  • Family history of early heart disease
  • High blood pressure (hypertension)
  • Overweight or obesity
  • Unhealthy cholesterol levels

Reducing your risk of angina

You may be able to lower your risk of angina by:

  • Getting regular physical activity
  • Keeping your cholesterol at a healthy level
  • Maintaining normal blood pressure
  • Reducing cholesterol and fat in your diet
  • Quitting tobacco use

Treatments

How is angina treated?

Treatment for angina begins with seeking medical care from your health care provider. To determine if you have angina, your health care provider will ask you to undergo several diagnostic tests.

Angina treatment varies depending upon the severity of symptoms and potential risk to the individual. Drug therapy is the most commonly used treatment for stable angina and may include drugs from a number of different drug classes.

Antiplatelet drugs used to treat angina

Antiplatelet drugs help prevent blood clot formation and include:

  • Aspirin

  • Clopidogrel (Plavix)

Nitrates for the treatment of angina

Nitrates are used to dilate the coronary arteries, increasing blood flow to the heart. Nitroglycerin is the mainstay of treatment for angina.

Beta-blockers for the treatment of angina

Beta-blockers are drugs use to lower heart rate. Examples include:

Calcium channel blockers for the treatment of angina

Calcium channel blockers are a group of drugs that reduce the workload on heart muscle. Examples include:

  • Diltiazem (Cardizem, Dilacor)

  • Nifedipine (Adalat, Procardia)

  • Verapamil (Calan, Isoptin)

Angiotensin-converting enzyme (ACE) inhibitors to treat angina

Angiotensin-converting enzyme (ACE) inhibitors are another class of drugs that relax and open blood vessels. Examples include:

  • Captopril (Capoten)

  • Enalapril (Vasotec)

  • Ramipril (Altace)

Statins for treatment of angina

Statin medications may be prescribed to help lower your blood cholesterol levels if you have angina. Examples include:

There are many different medicines to treat angina, and the specific ones used are selected depending on a person’s individual characteristics. It is important to follow your treatment plan for angina precisely and to take all of the medications as instructed to avoid complications.
Severe symptoms that do not go away with medication alone are treated with invasive techniques, including angioplasty (opening up the clogged arteries with a catheter, possibly placing a stent to keep the artery open) and coronary artery bypass graft surgery. Unstable angina is an emergency condition that requires treatment in a hospital.

What you can do to improve your angina

In addition to following your health care provider’s instructions and taking all medications as prescribed, you can reduce your risk of angina by:

  • Avoiding large meals and rich foods that leave you feeling stuffed if heavy meals trigger angina

  • Learning ways to handle stress that can’t be avoided

  • Slowing down or take rest breaks if physical exertion triggers angina

  • Trying to avoid situations that make you upset or stressed if emotional stress triggers angina

What are the potential complications of angina?

You can help minimize your risk of serious complications by following your treatment plan and taking all medications as prescribed. Complications of angina include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Angina pectoris/stable angina. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Angina-Pectoris-...
  2. What is angina? National Heart, Lung, and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html
  3. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2012.
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