Angina is a feeling of tightness, squeezing, or discomfort in your chest. It happens when your heart does not get enough oxygen-rich blood.
Men and women of any age can have angina, but it is more common among middle-aged and older adults.
What is the cause?
Angina may be caused by any condition that affects the blood flow to your heart or makes the heart work harder, such as:
Coronary artery disease: The coronary arteries are the blood vessels that bring blood and oxygen to the heart muscle. Fatty deposits called plaque build up in these blood vessels and make them narrower. The narrowing decreases the amount of blood flow to the heart. This means that less oxygen reaches the heart muscle. This is the most common cause of angina.
Coronary artery spasm: Muscles in the wall of a coronary artery can tighten or contract. This narrows the artery and causes blood to slow or stop flowing through it. When the spasm stops, the artery and blood flow return to normal.
Abnormal heart valves
Abnormal heart rhythms
Anemia: The levels of red blood cells or hemoglobin are too low. (Hemoglobin is the oxygen-carrying chemical in your blood.)
Polycythemia: The blood has too many red blood cells. This causes the blood to thicken.
A thyroid problem
Uncontrolled high blood pressure
You are more likely to have angina when your heart is working harder, for example, when:
You are exercising or doing heavy physical labor.
You are upset.
You are in cold air.
You are digesting a big meal.
However, you can also have angina when you are resting or sleeping.
What are the symptoms?
Angina symptoms may be warning signs of a heart attack. Call 911 for emergency help right away if you have symptoms of a heart attack. The most common symptoms of a heart attack include:
Chest pain or pressure, squeezing, or fullness in the center of your chest that lasts more than a few minutes, or goes away and comes back (may feel like indigestion or heartburn)
Pain or discomfort in one or both arms or shoulders, or in your back, neck, jaw, or stomach
Breaking out in a cold sweat for no known reason
Along with these symptoms, you may also feel very tired, faint, or be sick to your stomach. Women are more likely than men to have symptoms such as shortness of breath, nausea, and vomiting, with the chest pain.
Angina symptoms usually:
Last for only a few minutes (5 minutes or less)
Go away with rest or medicine such as nitroglycerin
Are similar each time they happen. You may recognize that you are having angina because it feels the same as when you have had it before.
Happen when your heart has to work harderâ€”for example, during physical activity or emotional stress
If you have been diagnosed with angina, talk to your provider so you know what to do when you have symptoms.
How is it diagnosed?
Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:
An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat. You may have an ECG while you are resting or while you exercise on a treadmill.
Nuclear heart scan, which uses a small amount of radioactive material injected into your blood to show blood flow in your heart
Stress echocardiogram, which uses sound waves (ultrasound) to show the structures of the heart and how well your heart muscle is pumping
How is it treated?
Your treatment may include diet changes and an exercise program.
Your healthcare provider may prescribe medicine to help stop chest pain, lower blood pressure, control an irregular heartbeat, help prevent blood clots, or lower blood fat (cholesterol). Your provider will determine what medicines are right for you based on your test results and any other medical problems you have.
If your coronary arteries are badly blocked, you may need balloon angioplasty or bypass surgery.
A balloon angioplasty opens blocked blood vessels and improves blood flow. A metal mesh device called a stent is usually left in the blood vessels to help keep them open.
Bypass surgery uses blood vessels from other parts of the body, or manmade material, to make a new path around a blocked area.
How can I take care of myself and help prevent angina?
Take your medicine exactly as instructed by your healthcare provider. Follow your providerâ€™s instructions about what you should do if you need to use more medicine to make symptoms better or if you have changes in your angina symptoms such as:
They are stronger or last longer.
They happen more often or at new times of the day.
You have symptoms with activities that did not cause angina or chest pain before.
In addition, follow these guidelines:
Always carry your medicine with you.
Try to keep a healthy weight. If you are overweight, lose weight.
Eat a healthy diet. Avoid foods high in cholesterol, saturated fat, and trans fat. Avoid rich foods or large meals if angina comes on after a heavy meal.
Stay fit with the right kind of exercise for you. A healthy goal for most adults is to exercise for 2 hours and 30 minutes or more each week. You don’t need to do 30 minutes of activity all at once. You can do shorter periods, at least 10 minutes each time. Exercise according to your healthcare provider’s instructions. Slow down or take rest breaks if angina comes on with exertion.
If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
Have your blood pressure checked regularly. High blood pressure increases your risk for heart disease.
Learn ways to manage stress.
Ask your provider:
How and when you will hear your test results
If there are activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.
You may learn what activities are more likely to bring on an attack of angina. Sometimes it’s hard to tell a severe attack of angina from the beginning of a true heart attack. Ask your healthcare provider when you need to call 911 for emergency help.
Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth. Last modified: 2014-07-11 Last reviewed: 2014-11-24
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Angina (Chest Pain): References
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O’Gara PT, Kushner FG, Ascheim DD, et al. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation.;127(4):e362-425.
2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Nonâ€“ST-Elevation Myocardial Infarction (Updating the 2007 Guideline). J. Am. Coll. Cardiol. 2011;57;1920-1959.
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Womenâ€”2011 Update. Circulation. 2011;Â 123:Â 1243-1262.
Fox, K, Garcia, MA, Ardissino, D, et al. Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27:1341
Fraker, TD Jr, Fihn, SD, Gibbons, RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol 2007; 50:2264.
Smith, SC, Feldman, TE, Hirshfeld, JW et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the ACC/AHA task force on practice guidelines (ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention). American College of Cardiology Web Site. Available at: http://www.acc.org/qualityandscience/clinical/statements.htm.