Angina

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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 a result, angina is a common cardiovascular condition in the United States. Approximately 10.2 million adults in the U.S. have angina, with about 500,000 new cases annually.

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, are 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).

What are the different types of angina?

There are four main types of angina. Signs and symptoms can depend on the type of angina a person has:

  • Stable angina: The cause of this type is a gradual buildup of a waxy substance called plaque inside a coronary artery. This causes signs and symptoms only when the heart is working harder than usual, such as when someone is going up stairs or exercising. Symptoms will go away in about five minutes after resting or taking medicine.

  • Unstable angina: The cause of this type is usually a blood clot that forms over plaque that has broken away from the artery wall. The artery becomes blocked. This could happen during activity or when at rest. Symptoms do not go away with rest or medication. This type of angina may lead quickly to a heart attack.

  • Variant angina: This type is less common. The cause is a spasm of a coronary artery. Signs and symptoms usually occur at night when a person is resting or sleeping. Signs and symptoms are severe, but they will go away with medication. Another name for this type of angina is Prinzmetal’s angina.

  • Microvascular angina: The cause of this type is an abnormality in the tiniest coronary arteries. Symptoms may last more than 10 minutes and be triggered by stress or physical activity. Shortness of breath and tiredness are common. Signs and symptoms usually go away with medication. This type is more common in women.

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

Angina symptoms in women

Women can have the same signs and symptoms of angina as men, but they can be slightly different. Women are more likely to have angina due to microvascular disease as opposed to blocked coronary arteries. As a result, they have angina as often as men, but they have fewer heart attacks.

Chest pain is still the most common symptom, but the following signs and symptoms may be more common in women:

  • Belly pain

  • Nausea

  • Neck, jaw, throat, arm, shoulder or back pain

  • Shortness of breath

  • Vomiting

Angina symptoms in older people

Simply getting older increases your risk of angina. It's more common in men after age 45 and women who are older than 55. Most signs and symptoms of angina remain the same as people age. However, shortness of breath is more common in older people.

Other signs and symptoms also are more common among the elderly. These include:

Serious symptoms that might indicate a life-threatening condition

In some cases, angina can be life-threatening. Seek immediate medical care (call 911) for any of these life-threatening symptoms:

  • 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

What causes angina?

Angina is caused by a lack of blood flow through the coronary arteries. This is coronary artery disease, or CAD. The coronary arteries carry oxygen-rich blood to the heart, which is a large, specialized muscle. Like other muscles and tissues in the body, the heart needs a constant supply of freshly-oxygenated blood to remain healthy and pump blood to the rest of the body. When oxygen demand exceeds oxygen supply (as happens during strenuous physical activity) the starving cardiac muscle irritates nearby nerve fibers, generating the discomfort and symptoms called angina.

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. If blood flow through the heart’s arteries is poor, even minor physical exertion, which increases demand on the heart, can lead to anginal pain or related symptoms. Plaque buildup also can lead to a heart attack if the plaque ruptures and causes a blood clot to form that blocks the artery completely.

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

  • Staying mentally healthy, reducing emotional stress, and seeking treatment for depression or anxiety, if needed

What are the diet and nutrition tips for angina?

Because angina is related to coronary heart disease, maintaining heart health is an essential step in preventing or managing angina symptoms. A balanced diet helps maintain healthy blood pressure, keep cholesterol low, and reduce the risk of cardiovascular conditions such as atherosclerosis that can lead to angina.

You can build heart-healthy eating habits by:

  • Avoiding foods that are high in sodium (salt), such as processed meats, chips, fast food, and canned soups

  • Cutting foods high in saturated fat, such as baked goods, packaged snacks, and fried foods

  • Eating fresh fruits and vegetables

  • Focusing on lean proteins, such as beans, chicken (with no skin), fish and tofu

  • Minimizing your consumption of cheese, heavy cream, and eggs

  • Opting for whole grains, such as brown rice, bulgur, or whole-wheat breads, over products with white, refined flour

  • Planning meals and snacks ahead of time so you don’t reach for unhealthy foods when hungry

  • Watching portion sizes and eating more slowly to avoid excess calorie intake

Talk to your doctor before making any significant changes to your diet. If necessary, your healthcare provider can also refer you to a licensed dietitian or nutritionist who can provide guidance on a healthy meal plan that meets your goals.

What are some conditions related to angina?

The chest pain of angina can often be mistaken for a symptom of a heart attack, but in cases of stable angina, the pain goes away after a few minutes of rest or with medication. In cases of unstable angina, when pain persists even at rest, the person may be experiencing a heart attack and needs emergency care (call 911).

Angina is associated with coronary artery disease, which itself is linked to a variety of causes, including:

  • Atherosclerosis (narrowing of the arteries due to plaque buildup)

  • Diabetes

  • High blood pressure

  • High LDL (low-density lipoprotein) cholesterol, often called the “bad” cholesterol

  • High triglyceride levels

  • Obesity

  • Reduced HDL (high-density lipoprotein) cholesterol, aka the “good” cholesterol

Angina pain may also be misdiagnosed as pain caused by other conditions in the chest or abdominal region, such as acid reflux, gallstones, and stomach ulcers.

How do doctors diagnose angina?

Doctors diagnose angina by performing a physical exam, medical history, and, when needed, a variety of diagnostic tests.

Your healthcare provider will likely ask you several questions about your symptoms, including:

  • What kind of symptoms are you experiencing?

  • How long does your chest pain last?

  • Does your pain improve with rest?

  • Do you have any diagnosed cardiovascular conditions?

  • Do you have a family history of cardiovascular conditions?

  • Do you have any other chronic conditions, such as diabetes?

  • Are you currently on any medication(s)?

Tests to diagnose angina

Doctors may also run tests to diagnose the cause of the angina and determine the severity of the underlying coronary heart disease. These tests include:

  • Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

  • Blood tests: The presence of troponin and creatine kinase concentrations indicates myocardial infarction, or blocked blood flow to the heart.

  • Stress test (usually with ECG; also called treadmill or exercise ECG): This test is given while a patient walks on a treadmill or pedals a stationary bicycle to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.

  • Cardiac catheterization: With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions (blocks), and other abnormalities of specific arteries.

How is angina treated?

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 to treat angina

Antiplatelet drugs help prevent blood clot formation and include:

Nitrates to treat 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 to treat angina

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

Calcium channel blockers to treat 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 to treat angina

Statin medications may be prescribed to help lower your blood cholesterol levels if you have angina. A lower cholesterol level may help prevent further plaque buildup. 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. If you have concerns about the medication(s) or experience bothersome side effects, talk with your doctor about all your medication options. There may be a different dose or medication with fewer side effects. Do not stop taking your medicine unless your healthcare provider instructs you to.

Severe symptoms that do not go away with medication alone are treated with invasive techniques, including coronary angioplasty (opening up the clogged arteries with a catheter and possibly placing a stent to keep the artery open) and coronary artery bypass graft surgery (heart bypass 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 healthcare 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

  • Avoiding situations that make you upset or stressed, if emotional stress triggers angina

  • Learning ways to handle stress that cannot be avoided

  • Slowing down or take rest breaks if physical exertion 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:

  • Arrhythmias (irregular heartbeats)

  • Heart attack (myocardial infarction)

  • Heart damage

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 24
View All Heart Health Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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