Angina Pectoris

What is angina pectoris?

Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of your heart does not receive enough blood and oxygen. Angina is a symptom of coronary artery disease (CAD). This occurs when arteries that carry blood to your heart become narrowed and blocked due to atherosclerosis or a blood clot.

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There are 2 other forms of angina pectoris, including:

Variant angina pectoris
(or Prinzmetal's angina)

Microvascular angina

  • Is rare
  • Occurs almost exclusively when a person is at rest
  • Often does not follow a period of physical exertion or emotional stress
  • Attacks can be very painful and usually occur between midnight and 8 a.m.
  • Is related to spasm of the artery
  • Is more common in women
  • Can be helped by medications
  • A recently discovered type of angina
  • Patients with this condition experience chest pain but have no apparent coronary artery blockages
  • Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs
  • Can be treated with some of the same medications used for angina pectoris
  • Was once called Syndrome X
  • Is more common in women

What causes angina pectoris?

Angina pectoris occurs when your heart muscle (myocardium) does not receive an adequate amount of blood and oxygen needed for a given level of work. (Insufficient blood supply is called ischemia).

Who is at risk for angina pectoris?

Anything that triggers your heart muscle to require a greater blood supply or need for oxygen can result in angina. Risk factors include physical exertion, emotional stress, extreme cold and heat, heavy meals, excessive alcohol consumption, and cigarette smoking.

What are the symptoms of angina pectoris?

The following are the most common symptoms of angina. However, each individual may experience symptoms differently. Symptoms may include:

  • A pressing, squeezing, or crushing pain, usually in the chest under your breast bone. Pain may also occur in your upper back, both arms, neck, or ear lobes 
  • Pain radiating in your arms, shoulders, jaw, neck, and/or back
  • Shortness of breath
  • Weakness and/or fatigue

Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications, such as nitroglycerin.

The symptoms of angina pectoris may resemble other medical conditions or problems. Always consult your health care provider for more information.

How is angina pectoris diagnosed?

In addition to a complete medical history and medical exam, a health care provider can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary artery disease, and may include:

  • Electrocardiogram (ECG). Records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  • Stress test (usually with ECG; also called treadmill or exercise ECG). Given while you walk on a treadmill or pedal a stationary bicycle, to monitor your heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.
  • Cardiac catheterization. X-rays are taken after a contrast agent is injected into your artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.

How is angina pectoris treated?

Your health care provider will determine specific treatment for angina pectoris, based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Medications may be prescribed if you have angina. The most common is nitroglycerin, which helps to relieve pain by widening your blood vessels. This allows more blood flow to your heart muscle and decreases the workload of your heart.

What are the complications of angina pectoris?

An episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate, however, that you have coronary artery disease and that some part of your heart is not receiving an adequate blood supply. If you have angina, you have an increased risk for a heart attack.

Can angina pectoris be prevented?

Maintaining a healthy lifestyle can help to delay or prevent angina pectoris. Healthy lifestyle management includes:

  • A healthy diet
  • Physical activity and exercise
  • Stress management
  • Not smoking or quitting smoking if you do smoke
  • Keeping or working toward a healthy weight
  • Taking medications as prescribed
  • Treating any related conditions (such as high blood pressure, high cholesterol, diabetes,  and overweight/obesity) appropriately. 
 

Living with angina pectoris

If you have angina, you should note the patterns of your symptoms. For example, pay attention to what causes your chest pain, what it feels like, how long episodes usually last, and whether medication relieves your pain. Call for medical assistance if your angina episode symptoms change sharply. This is called unstable angina.

It is important to work with your health care provider to treat your underlying coronary artery disease, which causes angina. You need to control your existing risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, lack of exercise, excess weight, and a diet high in saturated fat. Taking you medications as your health care provider directs is an important part of living with angina pectoris. If your provider prescribes nitroglycerin, it important that you have it with you at all times and follow his or her directions for using it whenever you have an episode of angina.

When should I call my health care provider?

You should call your health care provider if:
  • Your angina symptoms become worse or you notice new symptoms
  • You have side effects from your medications
  • If your pain lasts longer than usual or doesn’t go away even after treatment – in this case, you should call 911.

Key points

  • Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of your heart does not receive enough blood and oxygen.
  • Angina is a symptom of coronary artery disease. This occurs when arteries that carry blood to your heart become narrowed and blocked, due to atherosclerosis or a blood clot.
  • Angina can present as a pressing, squeezing, or crushing pain in the chest under your breast bone or upper back, both arms, neck, or ear lobes. It may also include shortness of breath, weakness, and/or fatigue 
  • Nitroglycerin is the most common medication prescribe for angina
  • Managing angina includes managing high blood pressure, stopping cigarette smoking, reducing high blood cholesterol levels, decreasing your intake of high saturated fat diet, exercising, and losing weight

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.