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Definition

Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes.

Types of angina include:

  • Stable angina —Has a predictable pattern. You generally know what brings it on and what relieves it. You may also know what the intensity will be.
  • Unstable angina —Is more unpredictable and/or severe. Chest pain may occur while resting or sleeping. The discomfort may last longer and be more intense than that of stable angina.
    • Unstable angina may be a sign that you are about to have a heart attack . It should be treated as an emergency.
  • Variant or Prinzmetal's angina —Caused by temporary spasm of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.
Typical Angina Pain Areas
IMAGE
Women are more likely to experience pain outside of these areas.
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Causes

Angina is usually a sign of coronary artery disease (CAD). It occurs when the blood vessels leading to your heart are narrowed or blocked. The blockage decreases the blood and oxygen flow to your heart. When your heart is deprived of oxygen, you will feel chest pain and other symptoms.

Coronary Artery Disease
Coronary Artery plaque
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Stable or Unstable Angina

Angina occurs when your heart's need for blood and oxygen is increased by:

  • Exercise or exertion
  • Cold weather
  • A large meal
  • Emotional stress

Stable angina becomes unstable when symptoms:

  • Occur more often
  • Last longer
  • Are triggered more easily

Variant or Prinzmetal's Angina

This type of angina is usually caused by a spasm of a heart vessel. It may be a sign that you have one of the following conditions:

This type of angina is usually caused by a spasm of a heart vessel. It may be a sign that you have one of the following conditions:

Risk Factors

CAD is more common in older men.

Other factors that may increase your risk of CAD include:

Symptoms

Symptoms may include:

  • Pressure or squeezing chest pain
    • Chest pain or discomfort is the key symptom of angina
    • Some people do not experience the pain as severely
    • Elderly people, women, and people with diabetes are more likely to have subtle symptoms and pain outside of the typical areas
    • Some people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest pain

The likelihood of a heart attack is increased when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms, such as:

  • Pain in the shoulder(s) or arm(s), or into the jaw(s)
  • Weakness
  • Sweating
  • Nausea
  • Shortness of breath

Diagnosis

Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with blood tests.

Images may be taken of your heart. This can be done with an .

  • Echocardiogram
  • Nuclear scanning
  • Electron-beam CT scan (coronary calcium scan, heart scan, CT angiography )
    • American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.
  • Coronary angiography

Your heart activity may be tested. This can be done with:

Treatment

Treatments for angina include:

Medications

  • Nitroglycerin—Usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray.
    • Longer-lasting types may be used to prevent angina before an activity—May be given as pills, or applied as patches or ointments.
  • Blood thinners—A small, daily dose of aspirin has been shown to decrease the risk of heart attack.
    • Talk to your doctor before taking aspirin daily.
    • Some may benefit from the addition of blood thinners. There is an increased risk of bleeding with certain medications.
  • Beta-blockers and calcium-channel blockers—May reduce the occurrence of angina
  • Cholesterol-lowering medications—May prevent the progression of CAD; may even improve existing CAD
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—Lower blood pressure and decrease the workload on your heart
  • Ranolazine—To treat chronic angina

Surgery

Patients with severe angina or unstable, progressing angina may benefit from:

Prevention

If you already have angina, you can prevent an onset by being aware of what starts it.

If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.

Steps to prevent CAD include managing risk factors:

  • Maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • Stop smoking.
  • Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
  • Manage high blood pressure and/or diabetes.
  • Manage abnormal cholesterol levels or high triglycerides .

Revision Information

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • National Heart, Lung, and Blood Institute

    http://www.nhlbi.nih.gov

  • Canadian Cardiovascular Society

    http://www.ccs.ca

  • College of Family Physicians of Canada

    http://www.cfpc.ca

  • Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet. 2002;360:752.

  • Lopez-Sendon J, Swedberg K, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE-inhibitors of the European Society of Cardiology. Eur Heart J. 2004;25:1454.

  • Reenan J. Clinical Pearl: Indications for bypass surgery. Virtual Mentor. February 2004;6:2. Available at: http://virtualmentor.ama-assn.org/2004/02/cprl1-0402.html. Accessed August 19, 2014.

  • What is angina? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/angina. Updated June 1, 2011. Accessed August 19, 2014.

  • 7/14/2006 DynaMed's Systematic Literature Surveillance. Available at: http://www.ebscohost.com/dynamed: Andreotti F, Testa L, et al. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J. 2006;27:519-26.