Angina is a condition marked by a crushing pain in your chest. You may also feel pain in your:
The pain is due to inadequate blood supply to your heart muscle, which deprives your heart of oxygen.
There are several types of angina. Stable angina occurs when you exert yourself physically or feel considerable stress. Stable angina doesn’t typically occur more frequently or worsen over time.
Unstable angina is chest pain that happens suddenly and becomes worse over time. It occurs seemingly without cause. It can happen when you’re at rest or even asleep. An attack of unstable angina may lead to a heart attack. For this reason, an attack of unstable angina is an emergency and you should seek immediate medical treatment.
Unstable angina is a signal that your arteries are becoming very narrow and that you could experience a heart attack. If left untreated, unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heart rhythm). These can be life-threatening conditions.
Coronary heart disease caused by a buildup of plaque along the walls of your arteries is the principal cause of unstable angina. The plaque causes your arteries to narrow and become rigid. This constricts blood flow to your heart muscle. When the heart muscle doesn’t have enough blood and oxygen, you feel chest pain.
Risk factors for coronary heart disease include:
- a family history of heart disease
- high blood pressure
- high low-density lipoprotein (LDL) cholesterol
- low high-density lipoprotein (HDL) cholesterol
- being male
- using any form of tobacco
- leading a sedentary life
Men 45 and older and women 55 and older are more likely to experience unstable angina.
The main symptom of angina is chest discomfort or pain, but this sensation can vary depending on the person. Unstable angina sometimes causes sensations that feel as if you’re having a heart attack.
Angina symptoms include:
- squeezing or sharp chest pains
- pain that radiates to your extremities or back
- shortness of breath
- unexplained fatigue
If you have stable angina, it’s possible your angina can progress to unstable angina. Be aware of any chest pains you feel even when at rest, chest pains that last longer than yours typically do, or chest pains that simply feel different to you.
If you take nitroglycerin, a medication that enhances blood flow, during a stable angina attack, you may find the medicine doesn’t work during an unstable angina attack.
You doctor will perform a physical exam that includes checking your blood pressure. They may use other tests to confirm unstable angina.
Some tests they may perform include:
- blood tests to check for cardiac biomarkers (troponin) and enzymes creatine kinase (CK) that leak from your heart muscle if it has been damaged.
- electrocardiogram to see patterns in your heartbeats that indicate reduced blood flow
- echocardiography to produce images of your heart that your doctor can check for angina-related problems
- stress tests to cause your heart to work harder and make angina easier to detect
- computed tomography angiography
- coronary angiography and heart catheterization to study the health and caliber of your arteries
Because coronary angiography helps your doctor visualize any artery narrowing and blockages, it’s one of the most common tests to diagnose unstable angina.
Treatment for unstable angina depends on the severity of your condition. One of the first treatments your doctor may recommend is a blood thinner such as heparin or clopidogrel. When your blood isn’t as thick, it can flow more freely through your arteries.
Your doctor may use other medications to reduce angina symptoms, including those that reduce:
- blood pressure
If you have a blockage or severe narrowing in an artery, your doctor may recommend more invasive procedures. These include angioplasty, where they open up an artery that was previously blocked. Your doctor also may insert a small tube known as a stent to keep your artery open.
In severe instances, you may need heart bypass surgery, which reroutes blood flow away from a blocked artery to help improve blood flow to your heart.
Over the long term, you may need to take appropriate actions to change your lifestyle, no matter the severity of your condition. Lifestyle changes such as eating a healthier diet, lowering your stress, exercising more, losing weight if you are overweight, and quitting smoking if you currently smoke can lessen your chances of an angina attack and reduce your risk of heart attack. Talk to your doctor about appropriate changes to your lifestyle, specifically about a healthy diet and exercise regime.
Some nonmedical self-care options are often recommended. These include taking steps to lose weight, giving up tobacco use, and exercising more regularly. Taking steps toward a healthier lifestyle can improve your heart health and reduce the risk for future unstable angina episodes.