Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or
Types of angina include: Stable angina
—Has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be.
—Is more unpredictable and/or severe. Chest pain may occur while resting or even sleeping (nocturnal angina). The discomfort may last longer and be more intense than that of stable angina.
Unstable angina may be a sign that you are about to have a
. It should be treated as an emergency.
Variant or Prinzmetal's angina
—Caused by temporary spasm (contraction) of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.
Typical Angina Pain Areas
Women are more likely to experience atypical pain, outside of these areas.
Copyright © Nucleus Medical Media, Inc.
Angina is usually a sign of
coronary artery disease
(CAD). It occurs when the blood vessels leading to your heart are narrowed or blocked. The blockage decreases the blood and oxygen flow to your heart. When your heart is deprived of oxygen, you will feel chest pain and other symptoms.
Coronary Artery Disease
Copyright © Nucleus Medical Media, Inc.
Angina occurs when your heart's need for blood and oxygen is increased by: Exercise or exertionCold weatherA large mealEmotional stress
Stable angina becomes unstable when symptoms: Occur more oftenLast longerAre triggered more easily
This type of angina is usually caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions: CAD
high blood pressureHypertrophic cardiomyopathyDiseases of the heart valves
Major risk factors for CAD include the following: Gender: maleIncreased ageStrong family history of heart diseaseObesity
SmokingHigh blood pressureSedentary lifestyleHigh blood cholesterol
(specifically, high low-density lipoprotein [LDL] cholesterol and low high-density lipoprotein [HDL] cholesterol)
Other risk factors for CAD: StressExcessive alcohol intake
Pressure or squeezing chest pain
Chest pain or discomfort is the key symptom of anginaSome people do not experience the pain as severelyElderly people, women, and people with diabetes are more likely to have atypical or subtle symptomsSome people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest painChest pain of any kind requires a medical evaluation to determine the cause
The likelihood of a
when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms, such as:
Pain in the shoulder(s) or arm(s), or into the jaw(s)WeaknessSweatingNauseaShortness of breath
Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include: Blood testsElectrocardiogram (EKG)EchocardiogramExercise stress test A medication is used to simulate the effects of physical exertion for those who cannot exercise.Nuclear scanning
Electron-beam CT scan
(coronary calcium scan, heart scan, CT
American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.Coronary angiography
Treatments for angina include:
Nitroglycerin—Usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray.
Longer-lasting types may be used to prevent angina before an activity—May be given as pills, or applied as patches or ointments.
Blood thinners—A small, daily dose of
has been shown to decrease the risk of heart attack.
Some may benefit from the addition of
. There is an increased risk of bleeding with this drug.
Talk to your doctor before taking aspirin daily or warfarin.Beta-blockers and calcium-channel blockers—May reduce the occurrence of anginaCholesterol-lowering medications—May prevent the progression of CAD; may even improve existing CADAngiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—Lower blood pressure and decrease the workload on your heartRanolazine—To treat angina
Patients with severe angina or unstable, progressing angina may benefit from: Coronary artery bypass graft
—Uses arteries from other areas of your body to bypass blocked heart arteries
—Uses a balloon to open blocked arteries
If you already have angina, you can
prevent an onset
by being aware of what starts it.
If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.
Steps to prevent CAD include managing risk factors: Maintain a healthy weight.Begin a safe exercise program with the advice of your doctor.Stop smoking.Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.Appropriately treat high blood pressure and/or diabetes.
Appropriately treat abnormal cholesterol levels or
Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial.
Lopez-Sendon J, Swedberg K, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE-inhibitors of the European Society of Cardiology.
Eur Heart J
7/14/2006 DynaMed's Systematic Literature Surveillance. Available at:
: Andreotti F, Testa L, et al. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients.
Eur Heart J
Last reviewed September 2013 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.