Angina (Angina Pectoris)

Angina (angina pectoris) is pain or discomfort that occurs when your heart isn’t receiving enough blood. The chest pain can range in severity, from a vague ache to crushing pressure. Angina pectoris is a symptom of heart disease — most commonly, plaque buildup or a blockage in your heart’s arteries.

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

There are four main types of angina pectoris:

• Stable angina: This comes and goes in ways you can predict, often with a predictable amount of activity. Each episode usually lasts five minutes or fewer. The pain feels the same each time. It doesn’t grow more severe or start happening more often. Rest or medicine can make it go away.
• Unstable angina: This happens without warning, often with no clear triggers, including while at rest. An episode may last 15 minutes or more. The pain feels different, more severe or more frequent than what’s typical for you. Rest and medicine usually don’t make it go away.
• Microvascular angina: Like with stable angina, this type usually occurs when you’re moving around or stressed. But an episode can last longer — often 15 minutes or more. 
• Prinzmetal (variant) angina: This type happens when you’re sleeping or resting. An episode typically lasts five to 15 minutes.

The main treatments for angina include medications to stop episodes as they’re happening, plus medications or procedures to address the underlying cause of angina pectoris. You’ll need lifelong follow-up with a cardiologist to check on your heart and adjust your treatment plan as needed.

What angina feels like

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

• Squeezing
• Tightness
• Heaviness
• Crushing
• Burning
• Heartburn or indigestion

This pain or discomfort from angina pectoris may spread to your jaw, teeth, shoulders, arm or back.

Symptoms that may occur along with angina

You may also have:

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

Symptom severity scale

Healthcare providers sometimes use a scale of 1 to 4 to describe the severity of angina symptoms, with 4 being the most severe:

1: You have angina only when you’re pushing yourself with physical activity. Your usual activities don’t cause it.

2: Fast walking or climbing stairs 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 it. You may even have it while resting.

What are the most common causes of this symptom?

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 the main arteries that supply blood to your heart and limits blood flow.
• Coronary microvascular disease: This means tiny arteries in your heart are damaged or don’t function correctly.
• Coronary artery spasm: This is when your heart’s 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, tobacco use, biological 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. These conditions force your heart to work harder.
• Are exposed to harmful substances: Smoking, vaping, secondhand smoke and recreational drugs make you more likely to get 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 angina. This means you may need a combination of medications, procedures and lifestyle changes. The goals of treatment are to improve blood flow to your heart and lower your risk of a heart attack or cardiac arrest.

Your provider may recommend:

• Medications: Nitroglycerin can stop an angina episode in its tracks. Over the long term, you may need to take beta-blockers, extended-release nitroglycerin or calcium channel blockers. These relax your blood vessels and help blood reach your heart.
• Procedures: If your coronary arteries are narrow or blocked, you may need a procedure. 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, called a bypass, which requires open heart surgery.
• 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 types of exercise are safe for you and if you should avoid certain activities.

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

When should angina be treated by a healthcare provider?

You can’t always know what type of angina you’re having in the moment. That’s why it’s crucial to contact a healthcare provider if you have chest pain of any sort. They’ll figure out the cause and distinguish between stable and unstable angina. You may need emergency care right away to prevent or treat a heart attack.

Call 911 or your local emergency number if:

• You have heart attack symptoms, including chest pain/discomfort, profuse sweating, nausea and shortness of breath
• Stable angina suddenly becomes worse, happens without a usual trigger or doesn’t go away (this can be a sign of unstable angina)