Overview

Angina is a term used for chest pain caused by reduced blood flow to the heart muscle. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms

Symptoms associated with angina include:

  • Chest pain or discomfort
  • Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
  • Nausea
  • Fatigue
  • Shortness of breath
  • Sweating
  • Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion.

The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina, and it typically occurs with exertion and goes away with rest. If chest discomfort is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.

Characteristics of stable angina

  • Develops when your heart works harder, such as when you exercise or climb stairs
  • Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
  • Lasts a short time, perhaps five minutes or less
  • Disappears sooner if you rest or use your angina medication

Characteristics of unstable angina (a medical emergency)

  • Occurs even at rest
  • Is a change in your usual pattern of angina
  • Is unexpected
  • Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
  • May not disappear with rest or use of angina medication
  • Might signal a heart attack

Angina in women

A woman's angina symptoms can be different from the classic angina symptoms. For example, women often experience symptoms such as nausea, shortness of breath, abdominal pain or extreme fatigue, with or without chest pain. Or a woman may feel discomfort in her neck, jaw or back or stabbing pain instead of the more typical chest pressure. These differences may lead to delays in seeking treatment.

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. Arrange for transportation. Only drive yourself to the hospital as a last resort.

Causes

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

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

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

  • Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors, such as emotional stress, cold temperatures, heavy meals and smoking, also can narrow arteries and trigger angina.
  • Unstable angina. If fat-containing deposits (plaques) in a blood vessel rupture and a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels.

    Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.

  • Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina can occur even when you're at rest, and is often severe. It can be relieved with medications.

Risk factors

The following risk factors increase your risk of coronary artery disease and angina:

  • Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and block blood flow.
  • Diabetes. Diabetes is the inability of your body to produce enough insulin or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis.
  • High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries.
  • High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
  • History of heart disease. If you have coronary artery disease or if you've had a heart attack, you're at a greater risk of developing angina.
  • Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
  • Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program.
  • Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
  • Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

Complications

The chest pain that can occur with angina can make some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.

Common signs and symptoms of a heart attack include:

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

Prevention

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

  • Quitting smoking
  • Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes
  • Eating a healthy diet
  • Increasing your physical activity after you get your doctor's OK
  • Maintaining a healthy weight
  • Reducing your stress level
April 09, 2016
References
  1. Angina. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/angina/. Accessed Nov. 18, 2014.
  2. Papadakis MA, ed., et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.mhmedical.com/book.aspx?bookId=330. Accessed Nov. 18, 2014.
  3. Stock EO, et al. Cardiovascular disease in women. Current Problems in Cardiology. 2012;37:450.
  4. Angina in women can be different than men. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Angina-in-Women-Can-Be-Different-Than-Men_UCM_448902_Article.jsp. Accessed Nov. 18, 2014.
  5. Kannam JP, et al. Stable ischemic heart disease: Overview of care. http://www.uptodate.com/home. Accessed Nov. 18, 2014.
  6. Meisel JL, et al. Differential diagnosis of chest pain in adults. http://www.uptodate.com/home. Accessed Nov. 18, 2014.
  7. Jneid H, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126:875.