What is angina?

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
• Trouble breathing
• 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 harder—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 provider’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.