What Is Angina? Symptoms, Causes, Diagnosis, Treatment, and Prevention

If you’ve ever experienced tightness in your chest that feels like squeezing, burning, or suffocating, it could be angina.

When plaque buildup stiffens and narrows the coronary arteries, the flow of oxygen-rich blood is reduced. The result can be pain and discomfort in your chest.

There are four types of angina with differing symptoms: stable, unstable, variant, and microvascular.

Stable angina is chest pain or tightness that commonly occurs during physical activity, such as exercising or walking up a set of stairs. Chest pain lasts about a few minutes and disappears with rest or medication.

Unstable angina is more of an emergency situation that comes without a specific trigger. It lasts longer than stable angina, perhaps 30 minutes or more. Unstable angina may be a sign of a heart attack.

Angina attacks can look different in men and women. Women experience a sharper form of chest pain that may be less severe than men. Women may also experience:

• Shortness of breath
• Nausea
• Vomiting
• Abdominal pain

Though the pain often goes away with rest, an angina episode is usually the symptom of a more serious underlying heart condition, such as coronary heart disease or coronary microvascular disease (MVD).

Angina can also be caused by the narrowing of the aortic valve in the heart, which is a condition called aortic stenosis.

• Diabetes
• High blood pressure
• High cholesterol
• Smoking
• Obesity
• Older age
• Stress
• Family history of heart disease
• Lack of physical activity

• Electrocardiogram (ECG) This test records the electrical signals that travel through the heart. By examining the patterns of these electrical signals, your doctor can determine if the blood flow through your heart has slowed down or if you are having a heart attack.
• Stress Test In a stress test, your heart’s electrical activity and blood pressure are monitored while you engage in physical activity like walking on a treadmill or pedaling on a stationary bike.
• Blood Test Blood tests look for certain enzymes that leak into the blood if the heart has been damaged by a heart attack.
• Chest X-Ray Your doctor can look at an X-ray image of your chest and lungs to see if other conditions are causing your angina.
• Coronary Angiography This is part of a general group of procedures known as cardiac catheterization, in which a dye is injected into the blood vessels of the heart. X-ray imaging then offers your doctor a detailed look at the inside of your blood vessels.
• Cardiac Computerized Tomography (CT) Scan A CT scan can show if your heart’s arteries have a lot of calcium deposits, are narrowed, or if your heart is enlarged.
• Cardiac Magnetic Resonance Imaging (MRI) This type of scan allows your doctor to view detailed images of your heart’s structure and blood vessels.

Treatment for angina may involve medication or a cardiac procedure.

Medication Options

• Antiplatelet Agents and Dual Antiplatelet Therapy (DAPT) These include aspirin (Vazalore) and clopidogrel (Plavix), which prevent platelets from sticking together to form clots.
• Angiotensin-Converting Enzyme (ACE) Inhibitors ACE inhibitors relax the blood vessels to reduce blood pressure.
• Angiotensin Receptor Blockers (ARBs) ARBs prevent blood vessels from constricting, which lowers blood pressure.
• Beta-Blockers This group of drugs lowers blood pressure. Beta-blockers are used to treat a number of cardiovascular problems, including congestive heart failure and heart attack.
• Diuretics These are water pills that rid the body of extra water and lower blood pressure.
• Vasodilators These are drugs that work to open the blood vessels, allowing blood to flow more easily and reduce blood pressure.

Surgical Options

• Angioplasty In this procedure, special tubing called a catheter is threaded up to the coronary arteries along with a deflated balloon. The balloon is then inflated to open up the blocked arteries where blood flow has been decreased or cut off.
• Stent Placement A wire mesh, called a stent, is often placed during an angioplasty. It props open the artery and remains permanently.
• Atherectomy This procedure is similar to an angioplasty, but the tubing has a rotating shaver that cuts away plaque from the artery.
• Heart Valve Surgery Doctors perform surgery to replace a diseased or abnormal heart valve with a healthy one.
• Bypass Surgery During this procedure, doctors take healthy veins or arteries from other parts of the body and use them to reroute blood around the clogged artery to improve blood flow to the heart.
• Heart Transplant In this major procedure, a surgeon removes a diseased heart and replaces it with a healthy one.
• Transmyocardial Revascularization (TMR) This is a procedure in which a laser is used to drill holes from the outside of the heart into the heart’s pumping chamber. It is used to treat severe angina in very sick patients who are unable to undergo an angioplasty or bypass surgery.

Prevention of Angina

The most important ways to prevent angina include maintaining a healthy lifestyle, having frequent heart checkups, and knowing the signs and symptoms of heart disease.

• Eat a heart-healthy diet. The Mediterranean diet, which is rich in fruits and vegetables, seafood, whole grains, and healthy fats, can lower LDL (“bad”) cholesterol and reduce mortality rates from cardiovascular disease.
• Get regular heart screenings. Monitoring heart health includes getting screenings for blood pressure, cholesterol, body weight, blood glucose, smoking, physical activity, and diet. You’ll especially need to get screened if you have a family history of heart disease.

  

• Exercise. The AHA recommends getting a minimum of 150 minutes of moderate-intensity aerobic activity per week, or 75 minutes of high-intensity aerobic activity per week.

  

• Don’t smoke. You can find a wealth of free resources, like tools and tips, support groups, and news updates for smoking addicts and family, at SmokeFree, the American Cancer Society, and the Centers for Disease Control and Prevention (CDC).
• Monitor your blood pressure. High blood pressure can sneak up on you because it generally doesn’t have symptoms and is not detected unless measured. If your blood pressure is below 120/80 millimeters of mercury (mm Hg), the AHA recommends getting it checked every two years, starting at 20 years old. If your blood pressure is higher, you may need to get it checked more often.

  

• Maintain healthy cholesterol levels. When you turn 20, the AHA also recommends getting your fasting lipoprotein profile (cholesterol) checked every six months. Your total cholesterol should be less than 200 milligrams per deciliter (mg/dL), although if you’re at risk for cardiovascular disease, your low-density lipoprotein (LDL) cholesterol should be less than 100 mg/dL. Your triglycerides should be no more than 150 mg/dL.

  

• Take steps to prevent diabetes. High blood glucose levels may also put you at risk for developing diabetes, and untreated diabetes can increase your risk of heart disease.

  

  The American Diabetes Association recommends screening for type 2 diabetes annually in patients age 45 and older, or in patients younger than 45 with major risk factors.

  

• Maintain a healthy weight. Waist circumference and body mass index (BMI) should be measured at every annual healthcare visit.

Angina can make some day-to-day activities, such as walking, difficult or uncomfortable.

The most dangerous complication of angina is a heart attack. Common warning signs of a heart attack include:

• Pain in the center of the chest that can feel like pressure, fullness, or squeezing that lasts more than a few minutes
• Pain moving from the chest to shoulders, arms, back, or jaw
• Shortness of breath
• Nausea and vomiting
• Sweating
• Feeling faint

Unstable angina may also lead to:

• Arrhythmias This includes heartbeats that are too fast, too slow, or irregular.
• Cardiomyopathy In this rare condition, the heart muscle becomes enlarged, thick, or rigid. This can lead to a weakening of the heart muscle, making it more difficult to pump blood to the rest of the body.
• Sudden Cardiac Arrest This is a very serious condition in which the heart suddenly and unexpectedly stops beating, causing blood to stop flowing to the brain and other organs.

  

As with other heart conditions, Black Americans are disproportionately affected by angina.

Angina and heartburn are often confused for each other, as the chest pain can feel very similar.

Still, everyone is different, so if you have chest pain and you’re not sure what the cause is, seek medical help right away.

Favorite Orgs for Essential Info About Angina

American Heart Association (AHA)

The AHA is the nation’s oldest and largest nonprofit organization dedicated to fighting heart disease and improving the lives of patients with heart issues. The AHA funds life-saving research, advocates for people affected by all heart-related problems, and provides education for people with heart issues, including angina.

American College of Cardiology (ACC)

The ACC is a nonprofit medical association made up of cardiovascular specialists. The ACC partners with the AHA to develop clinical practice guidelines for cardiologists. The ACC also holds annual meetings that focus on the latest research and innovation around heart health.

Favorite Online Support Networks

WomenHeart

Women experience angina differently than men. This organization helps women who are dealing with heart-related health issues like angina connect with one another. The website offers an interactive map of the United States that you can scroll over to see if there are local support networks in your community. WomenHeart also offers one-on-one support by text, phone, or email, virtual live meetings, and an online community.

Support Network

AHA’s support network offers the chance to connect with others on a number of heart-related topics, including general heart health, caregiving, and rehab and recovery. Share your story and engage with others who have shared theirs.

Favorite Apps for Angina

My Therapy

My Therapy generates reminders to take your angina medication and has a built-in health diary to help you monitor symptoms, triggers, and medication side effects. You can also record your blood pressure and cholesterol readings and set daily health goals. My Therapy is free on Android and iOS.

Angina Control

This easy-to-use app allows patients to log their angina symptoms and fill in conditions associated with their onset (like if it occurred during exertion or at rest) and whether or not medication was needed to alleviate pain. The app then produces weekly, monthly, or yearly reports tracking your angina attacks over time, as well as medication consumption, that you can share with your doctor.

Favorite Resource for a Heart-Healthy Diet

EatRight.org

The Academy of Nutrition and Dietetics offers advice and actionable cooking tips on how to make changes to your diet to make it more heart-healthy.

Favorite Resource for Becoming an Advocate

Go Red for Women

The AHA’s signature women’s initiative is designed to increase awareness around women’s heart health. Participate in the annual National Wear Red Day every February and start conversations about women’s heart health with the people you love in your life.

Additional reporting by Nicol Natale.