What Is Angina? (an-JI-nuh or AN-juh-nuh)
Angina is chest pain or discomfort that occurs when your heart muscle
does not get enough blood. Angina may feel like pressure or a squeezing
pain in your chest. The pain may also occur in your shoulders, arms,
neck, jaw, or back. It may also feel like indigestion.
Angina is a symptom of
coronary artery disease (CAD), the most common type of heart
disease. CAD occurs when plaque builds up in the coronary arteries. This
buildup of plaque is called
atherosclerosis. As plaque builds up, the coronary arteries become
narrow and stiff. Blood flow to the heart is reduced. This decreases the
oxygen supply to the heart muscle.
Types of Angina
There are 3 types of angina-stable, unstable, and variant
(Prinzmetal's). It is very important to know the differences among the
Stable angina. Stable angina is the
most common type. It occurs when the heart is working harder than usual.
- There is a regular pattern to stable angina.
- After several episodes, you learn to recognize the pattern and can
predict when it will occur.
- The pain usually goes away in a few minutes when you rest or take
your angina medicine.
- Stable angina is not a heart attack but makes it more likely that
you will have a heart attack in the future.
Unstable angina. Unstable angina is a
very dangerous condition that requires emergency treatment. It is a sign
that a heart attack could occur soon. Unlike stable angina, it does not
follow a pattern. It can occur without physical exertion and is not
relieved by rest or medicine.
Variant angina. Variant angina is rare.
It usually occurs at rest. The pain can be severe and usually occurs
between midnight and early morning. It is relieved by medication.
Not all chest pain or discomfort is angina.
Chest pain or discomfort can be caused by a heart attack, lung problems
(such as an infection or a blood clot), heartburn, or a panic attack.
However, all chest pain should be checked
by a doctor.
What Causes Angina?
Angina is caused by reduced blood flow to an area of the heart. This is
most often due to
coronary artery disease (CAD). Sometimes, other types of heart
disease or uncontrolled high blood pressure can cause angina.
In CAD, the arteries that carry oxygen-rich blood to the heart muscle
are narrowed due to the buildup of fatty deposits called plaque. This is
atherosclerosis. Some plaque is hard and stable and leads to
narrowed and hardened arteries. Other plaque is soft and is more likely
to break open and cause blood clots. The buildup of plaque on the inner
walls of the arteries can cause angina in two ways:
- By narrowing the artery to the point where the flow of blood is
- By forming blood clots that partially or totally block the artery.
Physical exertion is the most common cause of pain and discomfort from
stable angina. Severely narrowed arteries may allow enough blood to
reach the heart when the demand for oxygen is low (such as when you are
sitting). But with exertion like walking up a hill or climbing stairs,
the heart works harder and needs more oxygen. Other causes include:
- Emotional stress
- Exposure to very hot or cold temperature
- Heavy meals
Unstable angina is caused by blood clots that partially or totally block
an artery. If plaque in an artery ruptures or breaks open, blood clots
may form. This creates a larger blockage. The clot may grow large enough
to completely block the artery and cause a heart attack. Blood clots may
form, partly dissolve, and later form again. Chest pain can occur each
time a clot blocks an artery.
Variant angina is caused by a
spasm in a coronary artery. The spasm causes the walls of the artery
to tighten. This narrows the artery, causing the blood flow to the heart
to slow or stop. Variant angina may occur in persons with and without
CAD. Other causes of spasms in the arteries that supply the heart with
What Are the Common
Signs and Symptoms of Angina?
The pain or discomfort of angina:
- Is often described as pressure, squeezing, burning, or
tightness in the chest
- Usually starts in the chest behind the breastbone
- May also occur in the arms, shoulders, neck, jaw, throat,
- May feel like indigestion.
Some people say that angina discomfort is hard to describe or
that they can't tell exactly where the pain is coming from.
Symptoms such as nausea, fatigue, shortness of breath, sweating,
light-headedness, or weakness may also occur.
Symptoms vary based on the type of angina.
The pain or discomfort:
- Occurs when the heart must work harder, usually during
- Is expected, and episodes of pain tend to be alike
- Usually lasts a short time (5 minutes or less)
- Is relieved by rest or angina medicine
- May feel like gas or indigestion
- May feel like chest pain that spreads to the arms, back,
or other areas.
The pain or discomfort:
- Often occurs at rest, while sleeping at night, or with
little physical exertion
- Is unexpected
- Is more severe and lasts longer (as long as 30 minutes)
than stable angina episodes
- Is usually not relieved with rest or angina medicine
- May get continuously worse
- May signal that a heart attack will happen soon.
The pain or discomfort:
- Usually occurs at rest and during the night or early
- Tends to be severe
- Is relieved by angina medicine.
Chest pain that lasts longer
than a few minutes and is not relieved by rest or angina
medicine may mean you are having-or are about to have-a heart
attack. Get emergency help right away.
How is Angina
Treatment for angina includes lifestyle changes,
medication, surgery, and rehabilitation. The main goals
of treatment are to:
- Reduce the frequency and severity of symptoms
- Prevent or lower the risk of heart attack and
Lifestyle changes and medication may be the only
treatments needed if your symptoms are mild and are not
getting worse. Unstable angina is an emergency condition
that requires treatment in the hospital.
The first thing that you need to do is change your
living habits to avoid bringing on an episode of angina.
If angina comes on
- With exertion, slow down or take rest breaks.
- After a heavy meal, avoid large meals and rich
foods that leave you feeling stuffed.
- With stress, try to avoid situations that make you
upset or stressed. Learn techniques to handle stress
that can't be avoided.
Other changes that you need to make include:
Nitrates are the most commonly used medicines to
treat angina. Fast-acting preparations are taken when
angina occurs or is expected to occur. Nitrates relax
and widen blood vessels, allowing more blood to flow to
the heart while reducing its workload.
You can use nitrates in different forms to:
- Relieve an episode that is occurring by using the
medicine when the pain begins
- Prevent episodes from occurring by using the
medicine just before pain or discomfort is expected to
- Reduce the number of episodes that occur by using
the medicine regularly on a long-term basis.
Nitroglycerin is the
most commonly used nitrate for angina.
Nitroglycerin that dissolves under your tongue or
between your cheeks and gum is used to relieve an
angina episode. Nitroglycerin in the form of
skin patches is used to prevent attacks of angina.
(Nitroglycerin in these forms acts too slowly to relieve
pain during an angina attack.)
Other medicines used to treat angina include:
Beta blockers, which slow heart rate and lower
blood pressure. They can delay or prevent the onset of
Calcium channel blockers, which relax blood
vessels so that more blood flows to the heart,
reducing pain from angina. Calcium channel blockers
also lower blood pressure.
ACE inhibitors lower blood pressure and reduce
the strain on the heart. They also reduce the risk of
a future heart attack and heart failure.
Medicines that may also be used by people with angina
Medicines to lower cholesterol levels
Medicines to lower high blood pressure
Oral antiplatelet (an-ty-PLAYT-lit) medicines
clopidigrel) taken daily to stop platelets from
clumping together to form blood clots. Platelets are
small blood cell fragments that circulate through your
blood vessels and help stop bleeding by sticking
together to seal small cuts or breaks in tiny blood
vessels. Antiplatelet medicines may not be appropriate
for some people because they increase the risk of
bleeding. Discuss the benefits and risks with your
doctor before starting therapy with aspirin or the
other antiplatelet medicines.
Glycoprotein IIb-IIIa inhibitors are potent
antiplatelet medicines that prevent clots from forming
in your arteries. They are given intravenously in
hospitalized patients in the treatment of angina or
during and after angioplasty.
Anticoagulants (an-ty-ko-AG-u-lants) to
prevent clots from forming in your arteries and
blocking blood flow.
When medicines and other treatments do not control
angina, special procedures may be needed. Two commonly
used procedures are:
to open blocked or narrowed coronary arteries. It can
improve blood flow to your heart, relieve chest pain,
and possibly prevent a heart attack. Sometimes a stent
is placed in the artery to keep it propped open after
- Coronary artery
bypass surgery, which uses arteries or veins
from other areas in your body to bypass your blocked
coronary arteries. Bypass surgery improves blood flow
to your heart, relieves chest pain, and can prevent a
Your doctor may prescribe cardiac rehab for angina or
after bypass surgery, angioplasty, or a heart attack.
The cardiac rehab team may include:
- Your family doctor
- A heart specialist
- A surgeon
- Exercise specialists
- Physical therapists and occupational therapists
- Psychologists or other behavior therapists.
Rehab has two parts:
- Exercise training
to help you learn how to exercise safely, strengthen
your muscles, and improve your stamina. Your exercise
plan will be based on your individual ability, needs,
counseling, and training to help you understand
your heart condition and find ways to reduce your risk
of future heart problems. The cardiac rehab team will
help you learn how to cope with the stress of
adjusting to a new lifestyle and to deal with your
fears about the future.
Select the link below for more information on cardiac
"Recovering from Heart Problems Through Cardiac
Rehabilitation: Patient Guide," from the U.S. Agency
for Healthcare Quality and Research.
National Institutes of Health
Nutritional Therapy for Angina
best to avoid saturated fats (meat and full-fat dairy
products), caffeine, processed foods, and alcohol. Consume a
variety of fresh vegetables, whole grains, and essential
fatty acids (cold-water fish, nuts, and seeds).
The following supplements may help reduce
symptoms of angina by tonifying the cardiovascular system.
- Coenzyme Q10 (50 to 100 mg one to two
times per day)
- L-carnitine (330 mg two to three times
- Vitamin E (400 to 800 IU per day)
- Essential fatty acids (1,000 to 1,500
mg one to two times a day)
- L-taurine (100 mg twice a day) and
magnesium (200 mg two to three times per day)
- Vitamin C (250 to 500 mg two times per
- Bromelain (400 to 1,000 mg per day)