Angina

What is angina?

Angina (commonly pronounced an-JY-nuh) is chest pain or discomfort that happens when your heart isn’t receiving enough blood. Angina is a symptom of heart disease — most commonly plaque buildup or a blockage in your coronary arteries. Without treatment, dangerous complications like a heart attack or cardiac arrest could occur.

About 11 million people in the U.S. experience angina. It’s common and generally treatable. The most important thing you can do is tell your provider about any chest discomfort you feel. This is true even if you think it’s minor. Don’t ignore any new or changing symptoms. Angina can range in severity from a vague ache in your chest to crushing pressure.

Angina can be a warning sign of a heart attack — sometimes days or weeks in advance. If you have unexpected, severe or worsening chest pain, call 911 (or your local emergency services number).

Angina pectoris is another name for this same symptom. But providers usually just call it angina.

What does angina feel like?

Most people with angina describe having chest pressure or pain. It can be mild or more severe. It’s common to feel vague discomfort, rather than actual pain. Angina might feel like:

• Squeezing
• Tightness
• Heaviness
• Crushing
• Burning, like heartburn or indigestion

This discomfort may spread to your jaw, teeth, shoulders, arm or back.

Angina can happen alongside other symptoms, like:

• Sweating
• Dizziness
• Weakness
• Gas or bloating
• Upset stomach or nausea
• Feeling clammy
• Skin that’s paler than usual
• Feeling of impending doom

Types of angina

There are four main types of angina:

• Stable angina: This is chest discomfort that comes and goes in predictable patterns. Physical activity is a common trigger. Each episode is usually short (about five minutes or less). The discomfort feels the same each time. It doesn’t grow more severe or start happening more often. Rest or medicine makes it go away.
• Unstable angina: This is chest discomfort that’s different, more severe or more frequent than usual. It happens without warning and may have no clear triggers. An episode may last longer (15 minutes or more). Rest and medicine usually don’t make it go away. THIS IS A MEDICAL EMERGENCY.
• Microvascular angina: Problems with small blood vessels in your heart cause this type of angina. The tightness or pressure can last 15 minutes or more. Treatment can prevent damage to your heart from a lack of oxygen.
• Prinzmetal (variant) angina: Coronary artery spasms cause this type of angina. It usually occurs when you’re sleeping or resting. This makes it different from other types. An episode typically lasts five to 15 minutes.

Healthcare providers consider your triggers when describing the severity of your angina. They may use a scale of 1 to 4. The higher the number, the more severe the angina:

• 1: You have angina only when you’re pushing yourself with physical activity. Your usual activities don’t cause it.
• 2: Walking or climbing stairs quickly can trigger angina. You may also notice it if you move around after a heavy meal. Cold weather, wind or strong emotions may also cause it.
• 3: Walking a shorter distance at a normal pace can trigger angina.
• 4: Any physical activity can trigger angina. You may even have it while resting.

What causes angina?

Reduced blood flow to your heart causes angina. Your heart may not get enough blood due to:

• Coronary artery disease (CAD): This is the most common cause of angina. It happens when plaque builds up in your coronary arteries.
• Coronary microvascular disease: This means tiny arteries in your heart are damaged.
• Coronary artery spasm: Your coronary arteries quickly tighten and then open up. You can have this condition without having coronary artery disease.

Risk factors

You’re more likely to develop angina if you:

• Are older: Males over 45 and females over 55 have a greater risk of angina than younger adults.
• Have risk factors for coronary artery disease: These include high blood pressure, high cholesterol, family history of heart disease, overweight/obesity and diabetes.
• Have severe anemia: This means you don’t have enough healthy red blood cells to carry oxygen to different parts of your body — including your heart.
• Have certain heart conditions: Heart valve disease, heart failure and hypertrophic cardiomyopathy raise your risk for having angina. These conditions force your heart to work harder.
• Are exposed to harmful substances: Smoking, vaping, secondhand smoke, recreational drugs and exposure to particles in the air raise your risk for angina.

How is angina treated?

Medications can stop angina episodes and reduce how often you have them. But your provider will also treat the condition that’s causing your angina. This means you may need a combination of medicines, procedures and changes to your daily habits. The goals of treatment are to improve blood flow to your heart and lower your risk of a heart attack.

Your provider may recommend:

• Medicines: Nitroglycerin can stop an angina episode in its tracks. You may also need beta-blockers, extended-release nitroglycerin or calcium channel blockers to manage angina long-term. They relax your blood vessels and help blood reach your heart.
• Procedures: If your coronary arteries are narrow or blocked, you may need a procedure or surgery. Your provider can use a small balloon and tube (stent) to reopen your artery so blood can flow through. Or they can create a new path around blockages.
• Changes to your daily habits: Eating heart-healthy foods, moving around more, quitting smoking and limiting alcohol are just a few ways to help your heart. Your provider will explain which exercises are safe for you.

Does angina go away on its own?

No. You usually need treatment for angina. An episode of stable angina attack may go away within five minutes of rest. But it will likely reoccur without medical evaluation and treatment.

Unstable angina is a warning sign of a heart attack. Don’t wait to seek medical care.

How can angina be prevented?

Your provider may prescribe medicines that prevent angina episodes. Follow your provider’s guidance on how to take these medicines.

You can lower your risk of developing conditions that cause angina by:

• Eating in heart-healthy ways
• Getting enough physical activity
• Not smoking or vaping
• Limiting alcohol

When should angina be treated by a healthcare provider?

Call 911 or your local emergency number if:

• You have early warning signs of a heart attack, including chest pressure, cold sweats, fatigue and nausea
• Your stable angina suddenly becomes worse, happens without a usual trigger or doesn’t go away

Call your healthcare provider if you have:

• Questions or concerns about your treatment plan
• Side effects from your medicines
• Symptoms that are new or getting worse

Your provider will help you learn how to manage angina in your daily life. For example, they may ask you to keep a log of your angina episodes. Include the date and time, what it felt like, what you were doing and possible triggers. Your provider will also tell you if there are any limits on what you should do from day to day.

If your provider prescribes nitroglycerin, be sure to keep it with you at all times.