- By sahlhealth
- May 18, 2021
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Angina is a type of chest pain caused by reduced blood flow to the heart. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease.
Angina, which may also be called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. Angina may be a new pain that needs evaluation by a doctor, or recurring pain that goes away with treatment.
Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.
Angina symptoms include:
Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness
Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
Shortness of breath
These symptoms need to be evaluated immediately by a doctor who can determine whether you have stable angina, or unstable angina that may indicate a possible heart attack.
Stable angina is the most common form of angina. It usually happens when you exert yourself and goes away with rest. For example, pain that comes on when you're walking uphill or in the cold weather is often angina.
Characteristics of stable angina
Develops when your heart works harder, such as when you exercise or climb stairs
Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
Lasts a short time, perhaps five minutes or less
Disappears sooner if you rest or use your angina medication
The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.
Characteristics of unstable angina (a medical emergency)
Occurs even at rest
Is a change in your usual pattern of angina
Is usually more severe and lasts longer than stable angina, maybe 30 minutes or longer
May not disappear with rest or use of angina medication
Might signal a heart attack
There's another type of angina, called variant angina or Prinzmetal's angina. This type of angina is rarer. It's caused by a spasm in your heart's arteries that temporarily reduces blood flow.
Characteristics of variant angina (Prinzmetal's angina)
Usually happens when you're resting
Is often severe
May be relieved by angina medication
Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also experience symptoms such as:
Shortness of breath
Discomfort in the neck, jaw or back
Stabbing pain instead of chest pressure
When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.
If chest discomfort is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If stable angina gets worse or changes, seek medical attention immediately.
There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of a heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.
If your angina is mild, lifestyle changes may be all you need. Even if your angina is severe, making lifestyle changes can still help. Changes include:
If you smoke, stop smoking. Avoid exposure to secondhand smoke.
If you're overweight, talk to your doctor about weight-loss options.
Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
Talk to your doctor about starting a safe exercise plan.
Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
Avoid large meals that make you feel overly full.
Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:
Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle.
You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.
Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.
Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can't take aspirin.
Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol.
They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
Blood pressure-lowering medications. If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to bring your blood pressure down. There are two main classes of drugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).
Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.
Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.
This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.
Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.