Angina
Overview
What is angina?
Angina pectoris, or angina, is chest pain. It happens due to a painful tightening of the heart muscle. It occurs when your heart needs more oxygen-rich blood than the body can supply. Angina isn’t a condition. It’s a warning sign of heart disease.
Unstable angina is a type of angina that causes sudden, unexpected chest pain. It can indicate a heart attack and requires emergency care. Call 911 or go to the emergency room if you feel sudden chest pain.
What does angina feel like?
Most people with angina describe having chest pain and pressure. Or they may describe a squeezing sensation in the chest.
These sensations may last a few minutes and then go away. The symptoms may worsen when you climb stairs, exercise or feel stressed. Symptoms may improve when you stop exercising or take steps to manage stress. Importantly, angina can also manifest either as exertional shortness of breath, abdominal discomfort, fatigue, or in other ways in some people without the “typical” chest discomfort.
Along with angina, you may also experience:
- Abdominal pain.
- Excessive sweating.
- Gas or upset stomach (indigestion).
- Fatigue.
- Nausea and vomiting.
- Pain in the neck, jaw, shoulder or back.
- Shortness of breath (dyspnea).
How common is angina?
An estimated 10 million Americans experience angina. Close to 500,000 people will develop this symptom this year. Men older than 45 and women over 55 are more likely to have angina.
Symptoms and Causes
What causes angina?
Angina is a sign of an underlying heart problem, such as:
- Coronary artery disease (CAD): CAD is the top cause of angina in men and women. It occurs when deposits called plaques build up in the arteries that supply blood to the heart. The arteries narrow or harden (atherosclerosis), reducing blood flow to the heart. This lack of blood flow results in myocardial ischemia. It puts people at risk for a heart attack (myocardial infarction).
- Coronary microvascular disease (MVD): Women are more likely than men to have angina from MVD. This condition damages the walls and lining of tiny blood vessels that branch from coronary arteries. It decreases blood flow to the heart, causing coronary spasms.
- Coronary spasms: During a coronary spasm, the coronary arteries repeatedly constrict (tighten) and then open up. These spasms temporarily restrict blood flow to the heart. You can have coronary spasms without having coronary artery disease. Spasms can affect large or small coronary arteries.
What are the risk factors for angina?
Certain health conditions increase your risk of angina, including:
- Anemia (low red blood cells).
- Diabetes.
- Heart failure.
- High blood pressure or low blood pressure.
- High cholesterol.
- Hypertrophic cardiomyopathy (enlarged heart).
- Metabolic syndrome or obesity.
- Valve disease (narrow or leaky valves).
What are the types of angina?
Types of angina vary depending on the underlying cause. Common types include:
- Stable angina: This type is the most common. It follows a consistent pattern for at least two months. It mostly happens during moments of physical exertion or stress. You can usually predict what will trigger this type of angina. Stable angina improves when you’re resting or relaxed. The condition can progress to unstable angina, which isn’t predictable.
- Unstable angina: This type comes on without warning, often when you’re resting. A blood clot in an artery is often the cause. Unstable angina can indicate a heart attack. It is a medical emergency.
- Microvascular angina: MVD, which affects the heart’s smallest coronary artery blood vessels, often causes microvascular angina. It can come on during daily activities or times of stress. Chest pain typically lasts longer than other types of angina. You may have pain for 10 to 30 minutes.
- Variant (Prinzmetal) angina: Coronary spasms cause this rare type. It accounts for just 2 out of 100 angina incidents. The spasms and angina are more likely to occur at night and follow a pattern. Substance use disorder, smoking, cold weather, certain medications and stress can cause spasms. Younger people are more likely to develop this type of angina.
Diagnosis and Tests
How is angina diagnosed?
Unstable angina is an emergency. You should call 911 if you think you’re having a heart attack.
Report any other type of chest pain to your healthcare provider. After performing a physical exam, your provider may order one or more of these tests to find the cause of angina:
- Complete blood count (CBC).
- Chest X-rays.
- Cardiac stress test.
- Echocardiogram.
- Electrocardiogram (EKG).
- Coronary angiography and cardiac catheterization.
- Coronary computed tomography angiogram (CTA).
Management and Treatment
How is angina treated?
Your healthcare provider will treat the heart condition, which should ease angina. You may need Coronary angioplasty and stenting (also called percutaneous coronary intervention or PCI) or coronary artery bypass grafting (CABG) surgery to improve blood flow to the heart. Some patients may not require either of these and medications alone may be adequate. The final treatment is based on your symptoms as well as the findings from testing.
Even with treatment, some people still have angina. Your provider may prescribe a medication to quickly open blood vessels (vasodilators) when you have pain. Nitroglycerin is a common angina medication.
Other medications for angina include:
- Anti-clotting drugs (antiplatelets).
- Cholesterol-lowering drugs.
- High blood pressure medications.
Prevention
How can I prevent angina?
Many of the conditions that cause angina are preventable. You can take these steps for better heart health:
- Do some type of physical activity for at least 150 minutes (2.5 hours) every week.
- Eat a heart-healthy diet.
- Find healthy ways to manage stress like meditation, yoga or talking to a friend.
- Lose weight, if needed, and maintain a healthy weight.
- Manage high blood pressure, high cholesterol and diabetes.
- Quit smoking and seek help for substance use disorder. You can call the Substance Abuse and Mental Health Services Association national helpline at 1.800.662.HELP (4357).
Living With
When should I call the doctor about angina?
You should call 911 immediately anytime you think you’re having a heart attack.
Call your healthcare provider if you experience:
- Dizziness or fainting.
- Irregular heartbeat (arrhythmia).
- Nausea and vomiting.
- Rapid pulse or heart rate.
- Shortness of breath.
A note from Cleveland Clinic
If you have heart disease that causes angina, follow your healthcare provider’s recommendations for managing that condition. If you continue to have chest pain, talk to your provider. Treatments can relieve angina. Chest pain, or angina, that comes on suddenly can be a warning sign of a heart attack. Call 911.
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