We know: All About Angina

What is angina?

Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

What causes angina?

Angina is caused by reduced blood flow to an area of the heart. This is most often due to coronary artery disease. Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

What are the common signs and symptoms of angina?

The pain or discomfort of angina:

Is often described as pressure, squeezing, burning, or tightness in the chest
Usually starts in the chest behind the breastbone
May also occur in the arms, shoulders, neck, jaw, throat, or back
May feel like indigestion.

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

Are there different types of angina?

Yes. There are 3 types of angina-stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.

Stable angina. Stable angina is the most common type. It occurs when the heart is working harder than usual. There is a regular pattern to stable angina.

After several episodes, you learn to recognize the pattern and can predict when it will occur.
The pain usually goes away in a few minutes when you rest or take your angina medicine.
Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.

Unstable angina. Unstable angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.

Variant angina. Variant angina is rare. It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medication.

Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

How is angina treated?

Treatment for angina includes lifestyle changes, medication, surgery, and rehabilitation.

What are medications commonly used?

Nitrates, including nitroglycerin, are the most commonly used medicines to treat angina. Fast-acting preparations are taken when angina occurs or is expected to occur. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload.

Other medicines used to treat angina include:

Beta blockers, which slow heart rate and lower blood pressure. They can delay or prevent the onset of angina.
Calcium channel blockers, which relax blood vessels so that more blood flows to the heart, reducing pain from angina. Calcium channel blockers also lower blood pressure.
ACE inhibitors lower blood pressure and reduce the strain on the heart. They also reduce the risk of a future heart attack and heart failure.

We are grateful to the National Heart, Lung and Blood Institute for information in preparing this article.