All About Angina

The general symptoms of angina can include:

• chest pain or discomfort that usually starts behind the breastbone or in the chest and may feel like squeezing, tightness, heaviness, pressure or burning
• pain or discomfort that can also occur in your:
  • arms
  • back
  • neck
  • jaw
  • shoulder
• feelings of weakness or fatigue
• sweating
• shortness of breath
• nausea or feeling sick to your stomach
• being light-headed or fainting

There are a few different types of angina. Each type has its own defining characteristics.

• Stable angina. This type follows a consistent pattern, often occurring after exertion or stress. Symptoms typically don’t last long and can be relieved using medication or with rest.
• Unstable angina. Unstable angina doesn’t follow a pattern and can also be more severe. It can occur at rest, last longer, and may not be relieved with medications. Since it can progress to a heart attack, it’s considered a medical emergency.
• Microvascular angina. Microvascular angina affects the very small arteries in the heart. It can occur while you’re performing your normal day-to-day activities, last a longer time, and cause severe pain. Medication may not ease symptoms. This type of angina may be more common in women.
• Variant (Prinzmetal’s) angina. This type of angina is rare and can occur while you’re resting or sleeping. It’s caused by a sudden spasm of the arteries in your heart and can cause severe pain. Symptoms can often be relieved with medication, but in some cases the spasm of the arteries can lead to potentially life-threatening arrhythmias or damage to the heart muscle.

Angina may be different in women than in men as women can experience the symptoms of classic angina differently. For some women, they may not feel the classic symptoms of chest pressure or tightness, but can sometimes can just feel fatigued as a symptom of angina.

Women may also more frequently have coronary microvascular disease. Coronary microvascular disease involves blockages in the tiny arteries in the heart, which can affect blood flow.

It’s different than coronary artery disease, where plaque buildup in restricts blood flow. In fact, up to 50 percent of women with angina symptoms don’t have a blocked epicardial (major) coronary artery, according to the American Heart Association.

Women that have coronary microvascular disease often experience microvascular angina, which can occur during normal activities as well as with physical or mental stress.

Biologically speaking, angina can be caused by a variety of things:

• Coronary artery disease. When a substance called plaque builds up on the walls of the heart’s arteries, causing them to narrow.
• Coronary microvascular disease. When the small arteries of the heart become damaged, reducing the flow of blood.
• Spasms. A sudden spasm of the arteries around the heart can cause them to narrow, limiting blood flow.
• Blood clots. In cases of unstable angina/myocardial infarction, a blood clot can form in the arteries around the heart that partially or completely blocks the blood flow in an artery, causing angina symptoms and possibly a heart attack (if there is damage to the heart).

There are also several risk factors that can trigger angina symptoms due to a mismatch between the oxygen supply to the heart and the oxygen demand of the heart.

Often these are situations where the heart requires an additional oxygen supply. They can include:

• physical exertion
• mental or emotional stress
• eating a heavy meal
• very cold or hot temperatures
• smoking

In order to diagnose angina, your doctor will do the following:

Take your medical history

Your doctor will ask about your symptoms, including what they feel like, how long you’ve had them, and when they occur. They’ll also ask if you have a family history of heart disease or any risk factors for heart disease.

Doing a physical examination

This can include things like listening to your heart, measuring your heart rate, and taking your blood pressure.

Performing diagnostic tests

There are many possible tests that your doctor may use to help diagnose angina. They can include:

• Blood tests. Blood tests can measure certain proteins that are released during a heart attack. Cholesterol and lipid levels may also be measured.
• Chest x-ray. A chest X-ray can help rule out a lung or bony condition that may be causing your symptoms.
• Electrocardiogram (ECG). ECGs measure the electrical impulses generated when your heart beats. Certain ECG patterns can indicate disrupted blood flow.
• Stress test. A stress test evaluates how your heart functions during exercise. Other tests like ECG and echocardiogram or nuclear imaging may also be used during a stress test.
• Echocardiogram. This test generates images of your heart using sound waves. It can help your doctor see if there is a problem with the squeezing or relaxing function of the heart or with the heart valves.
• Coronary angiography. This test uses x-rays and a special dye to help the doctor see if a blocked or partially blocked artery is causing your symptoms. It can also be used to treat the blockage, if appropriate.
• Coronary CT angiography. This procedure uses a CT scan to help determine if your arteries have narrowed.
• Stress MRI. This test uses an MRI scan to generate detailed images of your heart and its blood vessels when they are under stress.

There are many treatment options available for angina. Your doctor will work with you to develop a treatment plan that’s appropriate for your condition.

Medications

Several different medications can be given for angina. Which one you’re prescribed can depend on the type of angina that you have.

Angina medications can help to relieve symptoms of a flare-up or help to prevent a flare-up from occurring. Possible angina medications include:

• nitrates, such as nitroglycerin, that can help blood vessels to relax and widen
• beta-blockers, which cause the heart to beat more slowly and less forcefully, reducing oxygen demand.
• calcium channel blockers, which help to relax blood vessels
• ACE inhibitors that can help to lower blood pressure
• clot-preventing drugs to prevent the formation of blood clots, such as aspirin
• statins to help lower cholesterol levels
• ranolazine, which can help you experience symptoms less frequently

Lifestyle changes

Adopting lifestyle changes can also help limit your angina symptoms. Examples include:

• eating a heart-healthy diet and avoiding large or heavy meals
• exercising regularly, but being sure to pace yourself and take breaks if necessary
• maintaining a healthy weight
• finding effective ways to relieve stress
• quitting smoking, vaping or marijuana use
• limiting alcohol intake
• avoiding exposure to very hot or cold temperatures
• making sure other health conditions like high blood pressure or diabetes are properly treated

Surgery

In cases where medications and lifestyle changes can’t manage your angina, you may require surgery. Additionally, medical emergencies like unstable angina may also require surgical treatment.

The type of procedure used will depend on your individual condition. Options include:

• Percutaneous coronary intervention (PCI). PCI uses a small balloon to help open or widen an artery. A stent is then put in place to help keep the artery open. This is done during a coronary angiogram.
• Coronary bypass. This procedure uses a blood vessel from somewhere else in the body (usually a vein in your leg or artery in your chest) to help bypass an artery in the heart that’s been blocked.

Angina can be an indicator of other underlying heart conditions. It can mean that you’re at an increased risk of experiencing a potentially life-threatening event like a heart attack or problems with other blood vessels, such as those going to the brain (stroke) or those going to the legs (peripheral arterial disease).

If you have angina, it’s very important that you get treatment. If your angina is properly managed through things like medications and lifestyle changes, you can lead a very normal life.

After being diagnosed with angina, you may have to follow up with your doctor several times a year. This is very important to make sure that the treatment you’re receiving is effectively managing your condition.

Outlook can vary by individual. It may depend on several factors, including your overall health, your lifestyle, and if you have any other underlying health conditions.

It’s always important to see your doctor if you experience chest pain. They can help you figure out what may be causing it and determine an appropriate treatment.

If chest pain comes on suddenly, is severe, or lasts longer than a few minutes, you should seek emergency medical attention. These could be signs of a heart attack.

If you have angina and notice your symptoms have changed, occur at rest, or don’t respond to medications, you should also seek emergency treatment. Unstable angina can progress to a heart attack.

Angina is chest pain that happens when your heart isn’t getting sufficient blood. It’s often caused by conditions like coronary artery disease or coronary microvascular disease.

Things like physical exertion and stress can trigger symptoms and risk factors include smoking, family history, high cholesterol, high blood pressure or diabetes.

Experiencing angina is a warning sign that you could be at an increased risk of having a heart attack or stroke. Additionally, unstable angina can develop into a heart attack if you don’t receive prompt treatment.

If you experience new chest pain, be sure to make an immediate appointment with your doctor to discuss it. Any chest pain that’s severe, sudden, or lasts more than a few minutes should be treated as a medical emergency.