Angina: Symptoms, Causes, and Treatments

Angina: Symptoms, Causes, and Treatments


Angina, also known as ischemic chest pain, occurs when the heart muscle does not receive enough oxygen-rich blood to function properly. As a result, you may feel pressure, squeezing, tightness, or burning in the center of your chest, which may spread to the neck, arms, jaw, or back.

Angina is typically a symptom of an underlying heart problem (such as coronary artery disease), which develops when one or more of the heart’s arteries become narrowed or blocked. 

Eleven million people in the United States live with angina, making this condition quite common. However, symptoms can vary from person to person. Depending on the type of angina you have, you may experience chest pain during physical activity, at certain times of the day (or night), or discomfort that occurs suddenly and without warning.

Early diagnosis can help improve symptoms and lower your risk of complications.

Angina can cause varying levels of chest pain and discomfort that may feel like pressure, squeezing, burning, tightness, and heaviness. The pain typically starts in the middle of the chest and may radiate to the arms, neck, jaw, shoulders, or back. It may begin mildly and worsen over a few minutes.

While chest pain is the most common sign of angina, some people may experience additional symptoms, such as:

People of different sexes tend to experience angina differently. Research shows that assigned females are more likely to experience more pain in the jaw, back, arms, and neck, whereas assigned males tend to experience more severe pain in the chest. However, the severity, onset, and triggers for angina pain can vary depending on the type of angina you have, regardless of sex.

There are several types of angina, which healthcare providers classify based on the cause and pattern of symptoms.

Stable Angina

Stable angina causes symptoms that develop during physical exertion, such as during exercise or when climbing the stairs. Emotional stress can also trigger symptoms, and some people may experience symptoms after eating a heavy meal or when smoking. Most stable angina symptoms go away within five minutes, usually with rest or medication. 

Unstable Angina

Unstable angina is a more unpredictable form of angina that can occur at rest or with minimal exertion. This type also tends to last longer than 20 minutes and worsens over time. An unstable angina may sometimes progress to a heart attack and often requires immediate medical attention.

Variant Angina

Variant angina (also known as vasospastic angina) occurs when the muscles within the heart’s arteries spasm (suddenly tighten), causing the arteries to narrow. Symptoms of this type of angina typically occur when you’re resting or sleeping at night or in the early morning. Chest pain with variant angina can be severe and generally lasts about 15 minutes, but medications can often relieve the pain.

Microvascular Angina

Microvascular angina affects the heart’s tiny arteries, causing dull chest pain that may occur during physical activity or at rest. Symptoms of microvascular angina tend to be more severe than other types and can last more than 15-20 minutes. Routine daily activities and mental stress can trigger symptoms, and many people also experience shortness of breath. 

Your heart needs oxygen to function correctly. The harder your heart works, like when you’re exercising, the more oxygen it needs. Angina occurs when the coronary arteries—the blood vessels that carry oxygen-rich blood to the heart—become narrowed or blocked, reducing blood flow to the heart muscle. 

Angina is not a condition on its own but a symptom of heart disease or a sign of a problem with the arteries that supply blood to the heart, such as the common causes listed below.

Coronary Artery Disease 

Coronary artery disease (CAD) is the leading cause of angina. CAD occurs when plaque builds up in the main arteries that supply blood to the heart muscle. The plaque buildup (known as atherosclerosis) causes the arteries to narrow, reducing blood flow and oxygen delivery to the heart. 

CAD can develop over time, with the coronary arteries gradually narrowing and limiting blood supply to part of the heart muscle. The condition can sometimes develop suddenly when pieces of plaque break away from the artery wall and cause blood clots that partially or completely block the coronary arteries.

For many people, plaque builds up in the arteries beginning in childhood and worsens with age. Risk factors for CAD include:

  • High low-density lipoprotein (LDL) cholesterol (“bad” cholesterol)
  • Low high-density lipoprotein (HDL) cholesterol (“good” cholesterol) 
  • Hypertension (high blood pressure)
  • Diabetes 
  • Smoking 
  • Obesity
  • Family history of heart disease

Coronary Microvascular Disease 

Coronary microvascular disease (MVD), or small artery disease, affects the walls of the tiny blood vessels within the heart. These small blood vessels typically expand to accommodate the heart’s increased need for oxygen-rich blood during activities like exercise. Damage to or abnormalities in these blood vessels means they cannot expand, limiting blood flow to the heart and causing angina. 

People assigned female at birth develop MVD more frequently than their male counterparts. Other common risk factors for MVD include: 

Coronary Artery Spasms

Coronary artery spasms (CAS) happen when the muscles within the heart’s arteries suddenly tighten, temporarily narrowing the arteries. This narrowing can block or slow blood flow to the heart, causing vasospastic (variant) angina when the large or small coronary arteries tighten and narrow.

Damage to the arteries can sometimes trigger a variant angina episode. In other cases, prolonged stress, cold exposure, cocaine use, and magnesium deficiency may trigger the spasms.

Angina is a warning sign that your heart isn’t receiving enough blood. If you experience any angina episodes, schedule an appointment with your primary care provider or a cardiologist, a doctor with special training in diagnosing, treating, and preventing heart diseases. Early diagnosis and treatment can help manage angina, protect your heart health, and reduce the risk of complications. 

When you visit your healthcare provider, they will ask about your symptoms and review your medical and family history. If they suspect a heart condition could be causing your angina, they may order diagnostic tests, such as: 

  • Electrocardiogram (EKG): Measures the heart’s electrical activity to identify abnormal rhythms that suggest damage to parts of the heart or other abnormalities 
  • Stress test: Evaluates how well your heart functions under stress, usually by asking you to perform an exercise like walking on a treadmill to increase your heart rate and determine if there is a reduction in blood supply in the arteries
  • Blood test: Offers insights into your heart health, including cholesterol, cardiac troponin (a type of protein found in the heart), and red and white blood cell count
  • Chest X-ray: Provides pictures of the heart and blood vessels to show their size and location 
  • Coronary angiography: Uses X-rays and contrast dye that your provider injects into a vein to help visualize the coronary arteries and identify any narrowing or blockages 
  • Cardiac catheterization: Requires your provider to insert a thin tube into the artery to directly measure blood pressure in your heart’s chambers and visualize the coronary arteries 
  • Computed tomography angiography (CTA): Utilizes X-rays and computer technology to create detailed 3D images of the heart and coronary arteries, helping detect blockages and other abnormalities

If you have a personal family history of angina, it’s a good idea to talk to your provider if you: 

  • Have symptoms more often
  • Experience pain that lasts longer or is more intense
  • Have angina when sitting, quieting, or resting
  • Notice that your heartbeat is too slow (60 beats a minute or less) or too fast (120 beats a minute or more) 
  • Feel additional symptoms like fatigue, lightheadedness, or fainting

The goal of angina treatment is to relieve your pain and prevent complications like a heart attack. Treatments for angina vary depending on the severity of your condition and the type of angina you’re experiencing. Your healthcare team may recommend lifestyle changes and medications to keep your symptoms at bay.

Lifestyle Changes

Adopting heart-healthy lifestyle habits can reduce angina episodes and lower the risk of complications. This may include the following:

  • Eat a heart-healthy diet: Consume a nutritious, balanced diet with plenty of fruits, vegetables, lean proteins, and whole grains. Limit sodium (salt), saturated fats, added sugars, and alcohol to lower or prevent high cholesterol and blood pressure.
  • Prioritize sleep: Sleep allows your heart and blood vessels to heal. Aim for seven to nine hours of sleep each night. 
  • Get regular exercise: Moving your body can improve your heart health, so it’s important to talk to your healthcare provider about exercises that are safe for you if you experience angina during physical activity. 
  • Manage stress: Meditation, leaning on family and friends, speaking with a therapist, and carving out time to engage in hobbies can all help manage stress and lower the risk of stress-induced angina episodes.
  • Avoid smoking: Smoking can weaken and damage your blood vessels, worsen angina, and increase the risk of complications. 

Medications 

Some medications for angina are fast-acting and can quickly relieve pain during angina episodes. Others help manage angina and its underlying causes in the long term. Depending on the type of angina you have, your healthcare provider may prescribe: 

  • Nitrates: These medications widen and relax blood vessels and improve blood flow to the heart. Nitrate pills and sprays rapidly relieve pain during an angina episode. Long-acting nitrates are pills or skin patches that may help delay or avoid angina episodes. 
  • Beta-blockers: These medications slow your heart rate and reduce its workload, which may help relieve angina. 
  • Calcium channel blockers: These medications relax your heart’s blood vessels and muscle cells. If you cannot take nitrates or beta-blockers, calcium channel blockers may help relieve angina pain. 

If the above medications are ineffective for managing angina episodes, your healthcare provider may prescribe:

  • Ranexa (ranolazine): Your healthcare provider may prescribe long-acting medication in combination with other angina medications to reduce the frequency of angina episodes. This medicine may prolong the amount of physical activity you can engage in without triggering angina. 
  • Morphine: Your healthcare provider may prescribe this opioid medication when your angina causes severe pain if other medicines are ineffective.

The good news is that you can prevent angina by following a heart-healthy lifestyle. Consider the following tips:  

  • Manage existing conditions: Follow your treatment plan if you have conditions that increase the risk of heart disease, such as diabetes, high blood pressure, or high cholesterol. 
  • Quit or avoid smoking: If you smoke, quitting is one of the best ways to protect your heart and overall health. Talk to your healthcare provider about smoking cessation options to help you quit. 
  • Exercise: Regular physical activity is essential for your heart health. Aim for 30 minutes of exercise at least five times a week, such as swimming, biking, or brisk walking. 
  • Eat nutritious foods: Consume a well-balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins. Limit your intake of processed foods, red meats, refined grains, and sugary snacks and beverages. 
  • Reduce stress: Chronic stress is associated with a higher risk of angina and heart disease. Finding ways to manage your stress, whether through exercise, spending time with friends and family, or engaging in hobbies, is essential for your mental and physical well-being.

Angina episodes, sometimes called “angina events,” do not permanently damage the heart. However, poorly controlled or severe angina can lead to serious complications, such as: 

  • Heart attack: Angina is often a precursor to a heart attack. When there is too little blood flow to your heart for too long, the cells that make up your heart muscle can begin to die, leading to a heart attack. Damage your heart sustains during a heart attack is permanent.
  • Arrhythmia: Reduced blood flow to the heart can lead to an arrhythmia (irregular heartbeat).
  • Heart failure: Heart diseases that cause angina or a heart attack can weaken the heart’s muscles and lead to heart failure when the heart cannot pump enough blood to meet your body’s needs.

Angina is a type of chest pain that occurs when the heart does not receive enough oxygen-rich blood. This pain is often a symptom of heart disease, which causes symptoms like pressure, tightness, or burning pain in the chest that can radiate to the jaw, arms, shoulders, or back.

While angina is not life-threatening, it is a warning sign of underlying heart problems. Therefore, getting an early diagnosis and starting timely treatment can improve your symptoms and overall heart health.

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