Overview

Angina (an-JIE-nuh or AN-juh-nuh) is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease.

Angina is also called angina pectoris.

Angina pain is often described as squeezing, pressure, heaviness, tightness or pain in the chest. It may feel like a heavy weight lying on the chest. Angina may be a new pain that needs to be checked by a health care provider, or recurring pain that goes away with treatment.

Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the discomfort of indigestion. If you have unexplained chest pain, seek medical help right away.

Types

There are different types of angina. The type depends on the cause and whether rest or medication relieve symptoms.

  • Stable angina. Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you're walking uphill or in the cold weather may be angina.

    Stable angina pain is predictable and usually similar to previous episodes of chest pain. The chest pain typically lasts a short time, perhaps five minutes or less.

  • Unstable angina (a medical emergency). Unstable angina is unpredictable and occurs at rest. Or the angina pain is worsening and occurs with less physical effort. It's typically severe and lasts longer than stable angina, maybe 20 minutes or longer. The pain doesn't go away with rest or the usual angina medications. If the blood flow doesn't improve, the heart is starved of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.
  • Variant angina (Prinzmetal angina). Variant angina, also called Prinzmetal angina, isn't due to coronary artery disease. It's caused by a spasm in the heart's arteries that temporarily reduces blood flow. Severe chest pain is the main symptom of variant angina. It most often occurs in cycles, typically at rest and overnight. The pain may be relieved by angina medication.
  • Refractory angina. Angina episodes are frequent despite a combination of medications and lifestyle changes.

Symptoms

Angina symptoms include chest pain and discomfort. The chest pain or discomfort may feel like:

  • Burning
  • Fullness
  • Pressure
  • Squeezing

Pain may also be felt in the arms, neck, jaw, shoulder or back.

Other symptoms of angina include:

  • Dizziness
  • Fatigue
  • Nausea
  • Shortness of breath
  • Sweating

The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Any new or worsening angina symptoms need to be evaluated immediately by a health care provider who can determine whether you have stable or unstable angina.

Angina in women

Symptoms of angina in women can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also have symptoms such as:

  • Discomfort in the neck, jaw, teeth or back
  • Nausea
  • Shortness of breath
  • Stabbing pain instead of chest pressure
  • Stomach (abdominal) pain

When to see a doctor

If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Only drive yourself to the hospital if there is no other transportation option.

If chest discomfort is a new symptom for you, it's important to see your health care provider to determine the cause and to get proper treatment. If you've been diagnosed with stable angina and it gets worse or changes, seek medical help immediately.

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Causes

Angina is caused by reduced blood flow to the heart muscle. Blood carries oxygen, which the heart muscle needs to survive. When the heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). The heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

If plaques in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery. This can suddenly and severely decrease blood flow to the heart muscle.

During times of low oxygen demand — when resting, for example — the heart muscle may still be able to work on the reduced amount of blood flow without triggering angina symptoms. But when the demand for oxygen goes up, such as when exercising, angina can result.

Risk factors

The following things may increase the risk of angina:

  • Increasing age. Angina is most common in adults age 60 and older.
  • Family history of heart disease. Tell your health care provider if your mother, father or any siblings have or had heart disease or a heart attack.
  • Tobacco use. Smoking, chewing tobacco and long-term exposure to secondhand smoke can damage the lining of the arteries, allowing deposits of cholesterol to collect and block blood flow.
  • Diabetes. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing cholesterol levels.
  • High blood pressure. Over time, high blood pressure damages arteries by accelerating hardening of the arteries.
  • High cholesterol or triglycerides. Too much bad cholesterol — low-density lipoprotein (LDL) — in the blood can cause arteries to narrow. A high LDL increases the risk of angina and heart attacks. A high level of triglycerides in the blood also is unhealthy.
  • Other health conditions. Chronic kidney disease, peripheral artery disease, metabolic syndrome or a history of stroke increases the risk of angina.
  • Not enough exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. Talk to your health care provider about the type and amount of exercise that's best for you.
  • Obesity. Obesity is a risk factor for heart disease, which can cause angina. Being overweight makes the heart work harder to supply blood to the body.
  • Emotional stress. Too much stress and anger can raise blood pressure. Surges of hormones produced during stress can narrow the arteries and worsen angina.
  • Medications. Drugs that tighten blood vessels, such as some migraine drugs, may trigger Prinzmetal's angina.
  • Drug misuse. Cocaine and other stimulants can cause blood vessel spasms and trigger angina.
  • Cold temperatures. Exposure to cold temperatures can trigger Prinzmetal angina.

Complications

The chest pain that occurs with angina can make doing some activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.

Warning signs and symptoms of a heart attack include:

  • Pressure, fullness or a squeezing pain in the center of the chest that lasts for more than a few minutes
  • Pain extending beyond the chest to the shoulder, arm, back, or even to the teeth and jaw
  • Fainting
  • Impending sense of doom
  • Increasing episodes of chest pain
  • Nausea and vomiting
  • Continued pain in the upper belly area (abdomen)
  • Shortness of breath
  • Sweating

If you have any of these symptoms, seek emergency medical attention immediately.

Prevention

You can help prevent angina by following the same lifestyle changes that are used to treat angina. These include:

  • Not smoking.
  • Eating a healthy diet.
  • Avoiding or limiting alcohol.
  • Exercising regularly.
  • Maintaining a healthy weight.
  • Managing other health conditions related to heart disease.
  • Reducing stress.
  • Getting recommended vaccines to avoid heart complications.

March 30, 2022
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