Angina

Angina, also called angina pectoris, is chest pain that can feel like pressure, squeezing, or burning in the chest. Angina is caused by a lack of blood flow to the heart and is a major sign of heart disease. 

Angina can signal that you are at risk for a heart attack, so it’s essential to seek medical care if you have symptoms.

Dignity Health is proud to care for patients with angina through our expert cardiology services. Find a doctor today to get started.

Symptoms

The main symptom of angina is pain, squeezing, pressure, or fullness felt in your chest or your shoulders, neck, and jaw. It may also feel like heartburn. There are two main types of angina: stable angina occurs during or after physical activity, and unstable angina occurs while you’re at rest.

The pain or pressure associated with stable angina can be managed with medication and a gradual reintroduction to exercise with your cardiologist. Unstable angina is a medical emergency, so you should call 911. Signs of unstable angina or chest pain combined with any of the following symptoms may signal a heart attack:

• Nausea
• Dizziness
• Cold sweats
• Shortness of breath or any trouble breathing
• Severe or sudden fatigue

Causes

Reduced blood flow to your heart is the leading cause of angina. When your blood is not able to get your heart muscle the oxygen it needs, it causes ischemia.

Coronary artery disease (CAD, or heart disease) is the most common cause of reduced blood flow. CAD results from fatty build-up within the walls of the arteries, which causes them to narrow and reduce the amount of fresh, oxygenated blood that goes to the heart. This puts a strain on the heart muscle, increasing your risk of heart attack and heart failure.

When there is low energy demand from your heart, such as when you’re resting, your heart can often still function on just the reduced amount of blood flow without causing angina symptoms. Exercising increases oxygen demand and that is why some patients experience angina symptoms when active.

Types

There are two common types of angina: stable and unstable. The third type of angina, variant angina, is a very rare condition.

If you are experiencing symptoms of angina, it is important to talk to your doctor right away to evaluate the type of angina you have.

Stable angina

Stable angina is the most common type of angina. It commonly occurs during exercise or when you’re exerting yourself. It will go away when you rest. Cold weather may also bring on stable angina.

Stable angina typically:

• Comes on while your heart is working harder than usual, such as during exercise
• Lasts for five minutes or less
• Can typically be predicted
• Reoccurs, with multiple similar episodes
• Can be managed by resting or taking medication

Unstable angina

If you have new symptoms, or your existing symptoms change or worsen, you may be experiencing unstable angina. Unstable angina is a medical emergency, and you should seek medical attention immediately, as it can be an early warning sign of heart attack.

Unstable angina:

• Occurs at rest and/or unexpectedly
• Differs from your usual angina symptoms
• Causes more severe pain and lasts longer
• Does not respond to rest or medication

Variant angina

Variant angina, also called Prinzmetal’s angina, is rarer than the previous two types. Variant angina is caused by a temporary reduction in blood flow due to a spasm in your heart’s arteries.

Variant angina typically:

• Occurs at rest, typically at night
• Occurs as a series of “clustered” attacks
• Is severe
• May respond to angina medication
• May be brought on by emotional stress, smoking, cocaine use, or medications that tighten blood vessels

Risk factors

Factors that put you at risk for coronary artery disease and therefore angina include:

• Diabetes. This increases the risk of coronary artery disease, speeding up atherosclerosis, and increasing cholesterol levels.
• Family history. A family history of heart disease puts you at higher risk of angina.
• High cholesterol or triglyceride levels. High levels of low-density lipoprotein (LDL) cholesterol or triglycerides, a type of blood fat, increases your risk of angina and heart attacks.
• High blood pressure. This damages arteries over time and accelerates the hardening of arteries.
• Obesity. If you’re overweight, the heart has to work harder in order to supply your body with blood. This is connected to high cholesterol, high blood pressure, and diabetes.
• Older age. Men over 45 and women over 55 are at greater risk than young adults.
• Anger and stress can raise your blood pressure, causing a surge in hormones that can narrow your arteries.
• Using tobacco, including chewing, smoking, and long-term exposure to secondhand smoke, damages your arteries, and allows the build-up of cholesterol.

Prevention

The key to preventing angina is to make heart-healthy lifestyle changes. These changes can improve your symptoms if you already have angina, or help you avoid the onset of angina symptoms. For example, you may want to talk to your doctor about lifestyle changes, such as:

• Eating a healthy diet to maintain a healthy weight.
• Exercising once you receive permission from your doctor.
• Getting the flu shot annually.
• Limiting alcohol consumption. The recommendation is not more than two drinks a day for men or one a day for women.
• Monitoring other health conditions, such as high blood pressure or cholesterol.
• Quitting smoking.
• Reducing stress.

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.