What is angina pectoris?

Angina pectoris is chest pain or a feeling of chest discomfort that occurs when a part of your heart doesn't get enough blood and oxygen. It is most often called angina. Angina can be a symptom of coronary artery disease (CAD), or it may be due to other causes.

What causes angina pectoris?

Angina pectoris occurs when your heart muscle (myocardium) does not get enough blood and oxygen. Not enough blood supply is called ischemia.

Angina can be a symptom of coronary artery disease (CAD). This is when arteries that carry blood to your heart become narrowed and blocked. This can happen because of:

• Hardening of arteries (atherosclerosis). This occurs when plaque builds up along the walls of the coronary arteries. As the plaque becomes larger, it can narrow or block the arteries. This reduces blood flow to the heart muscle.

• A blood clot.

• Plaque in an artery that can rupture (unstable plaque).

• Poor blood flow through a narrowed heart valve.

• The heart muscle pumping less.

• Coronary artery spasm.

There are 2 other forms of angina pectoris. They are:

• Microvascular angina. This used to be called Syndrome X. It causes chest pain with no coronary artery blockage. The pain is caused from poor function of tiny blood vessels that lead to the heart, arms, and legs. It is more common in women.

• Variant angina pectoris. This is also called Prinzmetal angina or vasospastic angina. It is rare. It occurs almost only at rest, not after exercise or stress. It usually occurs between midnight and early morning. It can be very painful. It is not related to plaque buildup in the coronary arteries (coronary atherosclerosis). It is related to a spasm of the artery. It is more common in women.

Who is at risk for angina pectoris?

Anything that causes your heart muscle to need more blood or oxygen can result in angina, especially if you already have a blockage or narrowing. Situations that may set off angina include:

• Physical activity.

• Emotional stress.

• Extreme cold or heat.

• Unhealthy diet.

• Drinking too much alcohol.

• Smoking or long-term exposure to secondhand smoke.

What are the symptoms of angina pectoris?

The most common symptoms of angina include:

• A pressing, squeezing, or crushing pain, usually in the chest under your breastbone.

• Pain that may also occur in your upper back, both arms, neck, or ear lobes. 

• Chest pain that spreads to your arms, shoulders, jaw, neck, or back.

• Shortness of breath.

• Weakness.

• Extreme tiredness (fatigue).

• Feeling faint.

Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medicine, such as nitroglycerin (nitro).

How is angina pectoris diagnosed?

Your health care provider will ask about your medical history. They will give you a physical exam. A provider can often diagnose angina from symptoms and how and when they occur. You may also have tests, such as:

• Electrocardiogram (ECG). This test records the electrical activity of the heart. It shows abnormal rhythms (arrhythmias). And it finds heart muscle damage.

• Stress test. This is done while you exercise on a treadmill or pedal a stationary bike. The test checks your heart's ability to function when under stress, such as exercise. Breathing and blood pressure rates are also watched. A stress test may be used to find coronary artery disease. Or it may be done to find safe levels of exercise after a heart attack or heart surgery. If you are unable to use a treadmill, you may have a type of stress test that uses medicine to stimulate the heart as if you were exercising. An exercise treadmill test only uses an ECG to evaluate for ischemia. A stress echocardiogram uses an ECG and ultrasound pictures of the heart. A nuclear perfusion stress test uses an ECG and radioactive tracer found by a nuclear camera.

• Cardiac catheterization. A wire is passed into the coronary arteries. Then a contrast material is injected into your artery. X-ray images are taken to see the narrowing, blockages, and other problems of certain arteries.

• Cardiac MRI. This test can look at the amount of blood flow to the heart muscle. It may not be available at all medical centers.

• Coronary CT scan. This test looks at the amount of calcium and plaque inside the blood vessels of the heart. It can also show blood flow through the coronary arteries.

How is angina pectoris treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is and the type of angina that you have.

Your health care provider may prescribe medicines if you have angina.

The most common medicine given is nitroglycerin. This helps to relieve pain by making your blood vessels wider. This lets more blood flow to your heart muscle. It decreases the workload of your heart. You may take a long-acting form of nitroglycerin daily to prevent angina. Or, you may take it as a nose spray or under the tongue when angina occurs.

Don't take erectile dysfunction (ED) medicines if you take nitroglycerin. These include sildenafil, vardenafil, and tadalafil. This can cause a dangerous drop in blood pressure that can lead to death. Tell your provider if you are taking ED medicines.

Other medicines can be used to treat angina. These include beta-blockers and calcium channel blockers.

• Beta-blockers. These block a hormone that increases the heart rate and blood pressure. This helps relax the blood vessels to improve blood flow.

• Calcium channel blockers. These can relax the muscles of your heart and blood vessels. This helps in opening of the coronary arteries.

What are possible complications of angina pectoris?

Angina means that some part of your heart is not getting enough blood. If you have angina, you have an increased risk for a heart attack.

Can angina pectoris be prevented?

Keeping up a healthy lifestyle can help to delay or prevent angina pectoris. A healthy lifestyle includes:

• A heart-healthy diet.

• Physical activity. Ask your health care provider about the activity plan that would be best for you.

• Stress management.

• Not smoking and staying away from secondhand smoke.

• Staying at a healthy weight.

• Taking medicines as prescribed.

• Treating high blood pressure, high cholesterol, diabetes, and excess weight.

Living with angina pectoris

If you have angina, note the patterns of your symptoms. Pay attention to what causes your chest pain. Note what it feels like, how long the pain lasts, and if medicine relieves your pain. Call 911 if your angina symptoms change suddenly. This is called unstable angina.

It's important to work with your health care provider to treat coronary artery disease, which causes angina. You need to control your risk factors. These include high blood pressure, cigarette smoking, high blood cholesterol levels, lack of exercise, excess weight, and a diet high in saturated fat. Take your medicines exactly as directed. This is an important part of living with angina. If you take nitroglycerin, make sure to have it with you at all times. Take it as instructed whenever you have angina.

When to contact your doctor

Call 911 if you have:

• Angina symptoms that change suddenly.

• Symptoms that happen when you are resting.

• Symptoms that continue after using nitroglycerin.

• Symptoms that last longer than usual.

• Symptoms that start to occur unpredictably or more frequently.

You may be having a heart attack. Call 911. Don't drive yourself.

Contact your health care provider or get medical care right away if:

• Your angina symptoms get worse.

• You have new symptoms.

• You have side effects from your medicines.

Key points about angina pectoris

• Angina is chest pain or discomfort that occurs when some part of your heart does not get enough blood and oxygen.

• Angina is a symptom of coronary artery disease. This occurs when arteries that carry blood to your heart become narrowed and blocked.

• Angina can feel like a pressing, squeezing, or crushing pain in the chest under your breastbone. You may have pain in your upper back, both arms, neck, or ear lobes. You may also have shortness of breath, weakness, or fatigue.

• Nitroglycerin is the most common medicine to treat angina.

• Managing angina includes treating high blood pressure and high blood cholesterol levels. It also includes healthy eating, weight loss, exercise, and not smoking.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your health care provider if you have questions, especially after office hours or on weekends.