Health
What is angina?
By Anh Nguyen, PharmD Apr 30, 2020 • 6 min
Angina is chest pain that is the result of the heart being deprived of oxygen-rich blood.
Angina is not a disease; rather, it is a symptom of an underlying heart problem, like coronary heart disease. Angina may be a warning sign before a heart attack. If you have chest pain that doesn't go away, call 911.
What are the causes of angina?
Angina, or angina pectoris, is caused by the heart not getting as much oxygen as it needs. This may be due to ischemia (blockage) or atherosclerosis (fatty buildup) or a blood clot inside the vessels surrounding the heart.
What are the symptoms of angina?
Symptoms of angina may or may not include the following:
- Chest pain
- Shortness of breath
- Belching, nausea, indigestion
- Sweating, dizziness
- Lightheadedness
- Clamminess
- Fatigue
Is angina painful?
There are many different types of angina pain. Some people describe angina pain as a squeezing feeling or like something heavy has been placed on their chest. Angina pain can come and go and most commonly occurs with exercise. Some patients also feel pain in the neck, jaw, shoulders or back. Angina in women might cause different types of pain, like stabbing pain.
What are the types of angina?
Stable angina. Stable angina is chest pain or discomfort that usually follows a pattern, such as discomfort occurring after exercise or when you are under stress. The pain usually goes away after you rest or take anti-angina medicine. If these symptoms occur for at least two months, you may have stable angina. Stable angina can develop into unstable angina.
Unstable angina. Unstable angina, also referred to as acute coronary syndrome, usually lasts longer than five minutes and is described as unexpected chest pain while resting. This type of angina typically is not resolved with rest or medicine. The most common cause is atherosclerosis, or reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildup (plaques). In addition to the narrowing, these plaques can rupture, causing blockages leading to cardiac arrest or stroke. Unstable angina is a medical emergency—someone experiencing it should go to the ED.
Microvascular angina. Microvascular angina is a sign of ischemic heart disease that affects the tiny arteries of the heart and can be stable or unstable. The pain associated with this type of angina can be more intense and last longer than other types of anginas and may occur at rest or with exercise. Medication may not relieve this type of chest pain.
Variant angina. Variant angina, or Prinzmetal angina, almost always occurs when a person is at rest and can be very painful. Variant angina is caused by spasms in the arteries surrounding the heart. This type of angina is relatively rare, accounting for 2 out of 100 cases of angina.
How is angina diagnosed?
Your provider may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests may include any of the following:
- Blood tests. If your heart has been damaged, certain enzymes, called cardiac troponins, will appear in your blood and help to determine If you had a heart attack. Your healthcare provider may also check levels of cholesterol, fats and other indices in your blood.
- Electrocardiogram (ECG or EKG). This test records patterns of your heartbeat. Certain patterns are associated with variant angina and unstable angina or may indicate heart damage. However, it is possible to experience angina and have a normal EKG.
- Stress test. Stress tests assess how well your heart functions during exercise. During this test, you will be on a treadmill or stationary bike while an EKG is done during and, possibly, immediately after you exercise.
- Echocardiogram. This test uses sound waves to take pictures of the heart to assess the strength of your heart while beating. It can sometimes also help determine your potential risk of future heart problems.
- Chest X-ray. Although an X-ray alone is not enough to diagnose angina or ischemic heart disease, it can identify lung disorders or other causes of chest pain.
- Cardiac magnetic resonance imaging (MRI). This noninvasive test looks for problems with the heart’s movement or with blood flow within the heart’s small blood vessels.
- Computerized tomography (CT) scan. CT scans may be used to take pictures of your heart to examine blood flow and find any damage to your heart muscle.
- Coronary angiography with cardiac catheterization. This studies the flow of blood through your heart and blood vessels to confirm whether ischemic heart disease is the cause of your chest pain. A small catheter will be guided through your artery to find exactly where the blockage is. You may be given medications during the test to provoke your coronary arteries to spasm.
- Hyperventilation testing. Rapid breathing with careful medical monitoring may bring on EKG changes that help your provider diagnose variant angina.
What are the treatment options for angina?
Your healthcare provider will discuss treatment options with you based on the type of angina you have, your test results and the risk of complications. Some of the major treatments are outlined below.
Medications
- Anticoagulant medicines, or blood thinners, will help prevent dangerous blood clots and future complications
- Antiplatelet medicines to prevent blood clots from forming
- Beta blockers to help your heart beat slower, requiring less force
- Calcium channel blockers to keep calcium from entering the cells of your heart and blood vessels, allowing blood vessels to relax
- Nitrates that widen and relax blood vessels, allowing more blood to flow to the heart and reducing the heart’s workload
- Statins to prevent plaque from forming and to relieve blood vessel spasms or inflammation
Procedures
If lifestyle changes and medications do not control angina, or you have unstable angina, you may need a medical procedure to treat the underlying heart disease.
- Coronary artery bypass grafting (CABG) is a procedure to improve poor blood flow to the heart. Surgeons use blood vessel(s) from another part of the body (usually arteries from the arm or chest, or veins from the legs) and connect them to blood vessels above and below the narrowed artery in the heart, bypassing the narrowed or blocked coronary arteries, allowing blood to flow to the heart muscle, like a detour in traffic.
- Percutaneous coronary intervention (PCI), also known as coronary angioplasty, requires a small flexible catheter (tube) to be inserted in the groin or arm. This tube is then threaded under fluoroscopy (a form of X-ray) to the narrowed or blocked blood vessels that supply blood to the heart. Once in place, a balloon tip covered with a stent is inflated, compressing the plaque open and expanding the stent, which is an open tube to support adequate blood flow. Once the stent is in place, the balloon is removed, and blood flow is improved.
Whatever type of angina you have, early treatment is vital to your heart health and to your quality of life. See a healthcare provider if you have chest or radiating pain that lasts more than a few seconds. If you have chest pain that doesn't go away, call 911.
Anh Nguyen is a resident pharmacist, University of Minnesota and Walgreens.
Clinically reviewed and updated March 2022.
