Everything you need to know about angina
Angina occurs when part of the heart does not receive enough oxygen. It may feel like pain, squeezing, or pressure in the chest.
In this article, learn about the types of angina, which doctors classify, at least in part, according to their pattern of occurrence.
We also describe symptoms specific to females, when anyone should contact a doctor, signs of an emergency, and the range of treatments.
What is angina?
Angina is tightness, squeezing, pressure, or pain in the chest. It occurs when an area of the heart muscle receives less blood oxygen than usual.
Angina is not a disease but a symptom. It usually happens due to ischemia, when one or more of the coronary arteries becomes narrow or blocked. It is often a symptom of coronary heart disease (CHD).
Alone, angina is not life threatening, but it can resemble the symptoms of a heart attack, and it is a sign of heart disease.
Receive medical attention if angina occurs unexpectedly, does not go away, or does not respond to rest or medication.
What else might be causing chest pain? Find out here.
There are several types of angina, including:
Stable angina occurs when the heart is working harder than usual — for instance, during exercise. It usually lasts around 5 minutes.
It has a regular pattern, and a person may experience it for months or years. Rest or medication often relieves the symptoms.
Unstable angina does not follow a regular pattern and usually occurs during rest. It mostly results from atherosclerosis, which involves a blockage preventing blood from reaching the heart.
The pain lasts longer than 5 minutes and may worsen over time. Rest and medication alone maynot improve the symptoms.
Unstable angina can indicate the risk of a heart attack. Anyone with unexpected angina should receive emergency care.
Microvascular angina can occur with coronary microvascular disease (MVD). This affects the smallest coronary arteries.
As well as chest pain, a person may experience:
- fatigue and low energy
- sleep problems
- shortness of breath
Microvascular angina tends to be more persistent than stable angina. It often lasts longer than 10 minutes and sometimes longer than 30 minutes.
Variant angina is rare. Doctors sometimes call it Prinzmetal angina, and it can develop when the body is at rest, often around midnight or the early morning.
It happens when a spasm occurs in the coronary arteries. Possible triggers include exposure to cold, stress, medicines, smoking, or cocaine use.
It is a chronic condition, but medication can help manage it.
Angina involves any of the following sensations in the chest:
- burning or aching across the chest, usually starting behind the breastbone
The pain often spreads to the neck, jaw, arms, shoulders, throat, back, or teeth.
Other possible symptoms include:
- shortness of breath
The duration of these symptoms depends on the type of angina.
Anyone who experiences severe or persistent chest pain should call 911 or otherwise seek emergency care.
Symptoms in females
In anyone, angina may stem from CHD or MVD.
MVD affects females more often than males, and as a result, the American Heart Association (AHA) explain, females may experience different symptoms that accompany angina.
As well as chest pain, which may be sharp, a female with angina may experience:
- nausea and vomiting
- abdominal pain
- shortness of breath
The AHA urge females to seek help for symptoms of heart disease. They emphasize that cardiovascular disease is the main cause of death among females in the United States and that it occurs in almost half of Black American females.
Learn more about chest pain in females.
Treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of a heart attack. A doctor may recommend medication, lifestyle changes, a surgical procedure, or a combination.
The following strategies can help:
- stopping smoking
- managing weight
- regularly checking cholesterol levels
- resting when necessary
- getting regular exercise
- learning how to handle or avoid stress
- having a diet that is rich in fruits, vegetables, whole grains, low-fat or no-fat dairy products, and lean sources of protein
Doctors often prescribe nitrates, such as nitroglycerin, for angina. Nitrates prevent or reduce the intensity of angina by relaxing and widening the blood vessels.
Other drug options include:
- calcium channel blockers
- angiotensin covering enzyme inhibitors
- oral antiplatelet medications
- statins, which are cholesterol-lowering medicines
Medications to manage high blood pressure may help manage angina. These aim to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming.
Are there any natural anticoagulants? Find out here.
Alternatives other than surgery
If medications do not help, other treatments include:
- Enhanced external counterpulsation therapy: This involves wearing a device like a blood pressure cuff to improve oxygen flow to the heart.
- Spinal cord stimulators: These block the sensation of pain but do not directly improve heart health.
- Transmyocardial laser therapy: This stimulates the growth of new blood vessels or otherwise enhances blood flow in the heart.
In some cases, a procedure is necessary. A heart specialist may recommend an angioplasty, possibly with a stent placement.
Learn more about stents here.
Alternately, the cardiologist may recommend coronary artery bypass grafting, in which a surgeon uses a healthy artery or vein from another part of the body to bypass narrowed arteries in the heart.
Angina usually results from underlying coronary artery disease.
The coronary arteries supply the heart with oxygen-rich blood. When cholesterol collects on the wall of an artery and forms hard plaques, this effectively narrows the arteries.
Other factors, including damage to the arteries and smoking, increase the risk of plaque buildup.
When the arteries narrow, it becomes harder for oxygen-rich blood to reach the heart. Also, plaques may break off and form clots that block the arteries.
If blood cannot carry oxygen to the heart, the heart muscle cannot work properly. This causes angina.
Angina can develop as a result of:
- an overuse of alcohol or recreational drugs
- exposure to particle pollution, for example, at work
- low physical activity
- an unhealthful diet
- high cholesterol levels
- overweight or obesity
- genetic factors
- conditions such as heart disease, diabetes, low blood pressure, metabolic syndrome, and anemia
- an age of over 45, for males, or 55, for females
- certain medical treatments and procedures
Angina results from a fall in the oxygen supply to the heart. For people with stable angina, the following may trigger an attack:
- physical exertion
- exposure to low temperatures
A correct diagnosis is important because it can predict the likelihood of a heart attack.
The doctor will:
- perform a physical exam
- ask about symptoms
- discuss any risk factors
- check the individual’s personal and family medical histories
If the doctor believes that the issue is angina, they may recommend one or more of the following tests:
- blood tests, to check fat, cholesterol, sugar, and protein levels
- an EKG, to record electrical activity in the heart and detect any lack of oxygen
- a stress test, involving physical activity, blood pressure readings, and an EKG
- a nuclear stress test, to detect abnormalities in blood flow to the heart during physical activity
- a chest X-ray, to see the structures within the chest
- coronary angiography, which involves using dye and special X-rays to show the insides of the coronary arteries
The following strategies can help prevent angina:
- having a varied, nutritious, “heart-healthy” diet
- avoiding or quitting smoking
- getting regular exercise
- practicing ways to manage stress
People should receive consistent, effective treatment for cardiovascular disease and other aspects of metabolic syndrome, such as high blood cholesterol, high blood pressure, diabetes, and obesity.
Angina involves sensations of pain, squeezing, or pressure in the chest, and it results from too little oxygen reaching the heart muscle. It is not necessarily dangerous, but it can be a sign of heart disease.
Effective medical treatments and lifestyle changes can manage angina or prevent it from returning.
Anyone who experiences sudden, unexplained, or worsening or chest pain should receive medical attention right away.