A type of chest pain caused by reduced blood flow to the heart is called angina. This is usually the primary symptom of coronary artery disease. Sometimes, this condition is called angina pectoris.
In most cases, this condition is described as pressure, heaviness, tightness, squeezing, or pain in the chest. It may also feel like a heavy weight lying on the chest. Almost everyone who experiences angina requires medical attention and treatment if the pain returns.
Angina happens commonly, but some people may not tell it apart from other types of chest pain (such as heartburn). Immediately contact your healthcare professional if you experience chest pain, especially if it appears suddenly without an obvious reason.
Angina Types
- Stable angina – This is the most common type of angina, and it often occurs during activity (also known as exertion). Doctors usually recommend angina medications and rest to relieve this type of chest pain. This type of condition is often predictable because it is similar to previous episodes of chest pain. Stable angina often lasts a short time (between 2-5 minutes).
- Unstable angina – This type of chest pain is considered a medical emergency, which means that without treatment can be fatal. Unstable angina is usually unpredictable and worsens at rest. In most cases, this type of angina lasts longer than stable angina, and it is more severe. If you do not get relief with angina medications and rest, you may experience a myocardial infarction (heart attack).
- Variant angina (also called Prinzmetal angina) – This type of condition does not happen due to coronary artery disease but due to a spasm in the arteries of the heart. The pain caused by variant angina is often severe but lessens with angina medicines.
- Refractory angina – In such cases, people experience frequent angina episodes nonetheless lifestyle changes and medicines.
Symptoms
The primary symptoms of this condition are chest pain and discomfort. Usually, the pain may feel like burning, fullness, pressure, or squeezing. The pain may spread to nearby parts of the body, including the arms, neck, jaw, shoulder, or back. However, angina may also cause other symptoms. For example:
- Nausea
- Dizziness
- Extreme tiredness (fatigue)
- Sweating
- Shortness of breath
The severity and duration of this type of chest pain vary among people. However, if you experience a new or different symptom, it may indicate unstable angina. Seek emergency care if you experience a sudden pain in the chest because it may indicate a heart attack.
Angina in Women
The symptoms of angina in females can be different from the typical angina symptoms. These often include:
- Shortness of breath
- Stomach pain
- Stabbing pain that often happens instead of chest pressure
- Nausea
- Discomfort in the jaw, teeth, back, or neck
Causes
Usually, this condition occurs when the heart muscle does not get enough blood. It causes the heart to get less oxygen, which may lead to functional problems. When the heart does not get enough oxygen, it is called ischemia.
The most common cause of angina is coronary artery disease. The arteries of the heart are called coronary arteries, and when they become narrowed or blocked due to fatty deposits (called plaques), the risk of angina increases. Commonly, coronary arteries become clogged due to a condition called atherosclerosis. If these plaques rupture, they can form a blood clot that suddenly reduces blood flow to the heart. As a result, it may lead to heart failure. While the heart may continue to work even with reduced oxygen levels, angina happens in certain situations, such as during physical exercise.
Risk Factors
Doctors have identified some factors that could increase your risk of developing heart-related chest pain. For example:
- Age – The risk of developing angina significantly increases in older adults over 60 years old.
- A family history of heart disease – If you have a parent or sibling with heart disease, your risk of developing chest pain increases.
- Smoking – Those who smoke cigarettes, chew tobacco, or are exposed to secondhand smoke for long periods may also experience angina.
- Diabetes – This condition increases the risk of coronary artery disease, which may cause angina.
- Hypertension (high blood pressure) – Those who suffer from this condition for a long time may also experience angina.
- High cholesterol or triglycerides – Coronary arteries may become narrowed or clogged due to high bad cholesterol (also known as low-density lipoprotein or LDL) or triglycerides in the blood.
- Lack of physical exercise – People who choose an inactive lifestyle are also at higher risk of high cholesterol, type 2 diabetes, obesity, hypertension, and other conditions that increase the risk of angina.
- Certain health conditions – These include chronic (long-term) kidney disease, peripheral artery disease, metabolic syndrome, a medical history of stroke, and others.
- Obesity – Excessive body weight may also cause angina.
- Emotional stress – Being exposed to stressful situations for long periods may increase your blood pressure.
- Medications – There are some medications that may tighten blood vessels, which often leads to Prinzmetal angina. In most cases, people experience it when taking migraine medications.
- Substance misuse – Those who use illegal drugs (such as cocaine) and other stimulants are at higher risk of blood vessel spasms, which is a risk factor for angina.
- Cold temperatures – Some people may experience Prinzmetal angina when exposed to cold temperatures.
What Are The Potential Complications of Angina?
This condition often occurs when you are doing some activities (such as walking). One of the most dangerous complications is myocardial infarction. Check below the most common signs that indicate a heart attack:
- A squeezing pain, fullness, or pressure in the chest that lasts more than several minutes
- Pain spreads to the shoulder, arm, or back
- Fainting
- Threatening sense of doom
- Multiple episodes of angina
- Nausea
- Vomiting
- Trouble breathing
- Increased sweating
If any of the previous symptoms appear, immediately go to the nearest emergency room or call 911 in the U.S.
How to Prevent Angina?
Check below some tips that may reduce the risk or even prevent angina:
- Limit or avoid alcoholic drinks
- Stop smoking (if you face problems with smoking cessation, do not hesitate to discuss it with your healthcare professional)
- Regularly perform physical exercises
- Try to get and keep a healthy weight
- Manage stress and chronic health conditions (such as diabetes or hypertension)
- Get at least 7 hours of sleep per day
Some people need vaccines to prevent serious heart complications.
Diagnosis
First, doctors will evaluate your medical history and perform a physical examination to check for irregularities linked with the disease. They may also ask some questions about your symptoms and family history. To confirm the condition, physicians usually perform the following tests. For example:
- Electrocardiogram (EKG or ECG) – This is a quick and painless test that is used to measure the electrical activity of the heart. It helps determine if you have or have had a myocardial infarction.
- Blood tests – These tests are used to check for proteins that leak into the blood after heart damage or myocardial infarction. These proteins are called cardiac enzymes.
- Stress test – During this test, doctors will check your heart while walking on a treadmill or riding a stationary bike.
- Echocardiogram – This test uses sound waves to make images of the heart in motion. It helps see how the blood flows through the heart and its valves.
- Chest X-ray – This is an imaging test used to see heart and lung conditions.
- Nuclear stress test – This test is very similar to a stress test but involves a radioactive substance that is injected into the bloodstream. It helps determine areas where blood flow is poor.
- CT (computerized tomography) or MRI (magnetic resonance imaging) scans – These are certain imaging tests that help doctors get detailed images of the heart and chest. CT and MRI scans can show the severity of heart damage.
- Coronary angiogram – This test involves a flexible tube (catheter) that is inserted into a major blood vessel (in most cases, in the groin) and then is guided to the heart arteries by X-ray imaging.
Treatment
While treatments for people with angina are different, doctors often prescribe medicines, lifestyle and dietary changes, angioplasty and stenting, and open-heart surgery called coronary artery bypass grafting (CABG). The goal of the treatment is to lessen the symptoms, prevent life-threatening complications of angina, and reduce the frequency of chest pain episodes.
Medicines
The following medications are often prescribed by doctors when lifestyle changes alone do not work. For example:
- Nitrates – This group of medications is often recommended by doctors for angina treatment. These drugs help relax blood vessels, which allows more blood to flow to the heart muscle. Physicians usually prescribe Nitroglycerin.
- Aspirin – This medicine is used to reduce clotting of the blood, which helps blood to flow more easily through the arteries. However, you should not take this medicine without a doctor’s recommendation.
- Clot-preventing drugs – These include Clopidogrel, Prasugrel, and Ticagrelor. Previous medications are prescribed by doctors when Aspirin is not an option.
- Beta-blockers – This group of medications is used to reduce the heart rate.
- Statins – These medicines are used to reduce blood cholesterol, which is a risk factor for heart-related chest pain.
- Calcium channel blockers – These medicines are used to relax and widen blood vessels.
- Antihypertensives – These include angiotensin-converting enzyme (ACE) inhibitors, angiotensin 2 receptor blockers (ARBs), and others. Doctors recommend ACE inhibitors and ARBs for people with hypertension, diabetes, chronic kidney disease, and others.
- Ranolazine – This medicine is usually recommended for people with chronic stable angina and when other treatments do not work.
Therapies
In some cases, people need enhanced external counterpulsation (EECP). This procedure is used to improve blood flow. To notice improvements, you need multiple EECPs. It may also help reduce frequent and uncontrollable angina episodes (also known as refractory angina).
Other Treatments
The following treatments are recommended by doctors when lifestyle changes and medicines are not effective and you still experience angina episodes. For example:
- Angioplasty with stenting – Sometimes, this treatment is called percutaneous coronary intervention. During this procedure, doctors use a small balloon that is inserted into the narrowed artery. Thereafter, this balloon is inflated, which helps widen the artery and improve blood flow. Hence, doctors place a small wire mesh coil (also known as a stent) to keep the artery open.
- Coronary artery bypass grafting (CABG) – This type of open-heart surgery is used to make a new pathway across the blocked or narrowed heart artery. It helps restore normal blood flow to the heart. It is often recommended for people with severe, unstable angina who do not respond to other treatments.
Frequently Asked Questions
Is angina serious?
Usually, chest pain is a symptom of another condition (such as coronary artery disease) that limits blood flow to the heart muscle. However, it may happen due to other conditions as well.
What helps angina go away?
Most people get rid of angina with the following medicines and some lifestyle and dietary changes. These include:
- Anticoagulants
- Statins
- Calcium channel blockers
- Antihypertensives
- Ranolazine
- Nitrates
- Over-the-counter (OTC) pain relievers (such as Aspirin)
What drink is good for angina?
There are some drinks other than water that may help improve angina. Check some examples below:
- Tea
- Coffee
- A small glass of 100% fruit or vegetable juice
- Plant-based milk with added calcium (such as almond, rice, oat, or soy milk)
- Unflavored milk
- Sparking water
Ask your healthcare provider if you have additional questions.
