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Angina

Topic Overview

What is angina?

Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a symptom of heart disease. Angina happens when there is not enough blood flow to the heart muscle. This is often a result of narrowed blood vessels, usually caused by hardening of the arteries (atherosclerosis).

Angina can be dangerous. So it is important to pay attention to your symptoms, know what is typical for you, learn how to control it, and understand when you need to get treatment.

What are the symptoms?

Symptoms of angina include chest pain or pressure, or a strange feeling in the chest. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms. Other symptoms of angina include shortness of breath, nausea or vomiting, lightheadedness or sudden weakness, or a fast or irregular heartbeat.

Some people describe their angina as pressure, heaviness, weight, tightness, squeezing, discomfort, burning, or dull aching in the chest. People often put a fist to the chest when describing their pain. Some people may feel tingling or numbness in the arm, hand, or jaw when they have angina.

It might be hard for you to point to the exact location of your pain. Pressing on the chest wall does not cause the pain.

Your symptoms might begin at a low level and then increase over several minutes to reach a peak. Angina that starts with an activity usually will decrease when the activity is stopped. Chest pain that begins suddenly or lasts only a few seconds is less likely to be angina.

Women are somewhat more likely than men to have other symptoms like nausea and back or jaw pain. This feeling can be in areas other than the chest, such as in the neck or jaw.

Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.

What are the types of angina?

Stable angina

Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina.

Angina symptoms happen when your heart is working harder and needs more oxygen than can be delivered through the narrowed arteries. Angina may happen when you are:

  • Doing strenuous exercise (especially if you typically do not exercise).
  • Being exposed to cold temperatures.
  • Having sudden, intense emotions, such as anger or fear.
  • Smoking.
  • Eating a heavy meal.
  • Using cocaine or amphetamines.

The pain goes away when you rest or take nitroglycerin. It may continue without much change for years.

Unstable angina

Unstable angina is unexpected. It is a change in your usual pattern of stable angina. It happens when blood flow to the heart is suddenly slowed by narrowed vessels or small blood clots that form in the coronary arteries. Unstable angina symptoms are like heart attack symptoms. It is an emergency. It may happen at rest or with light activity. It does not go away with rest or nitroglycerin.

Angina caused by coronary artery spasms

Less common types of angina are caused by coronary artery spasms. This angina happens when a coronary artery suddenly contracts (spasms), reducing oxygen-rich blood flow to the heart muscle. If severe, a spasm can block blood flow and cause a heart attack. Most people who have these spasms have coronary artery disease, though they don't always have plaque that narrows their arteries.

The spasms can be caused by smoking, cocaine use, cold weather, an electrolyte imbalance, and other things. But in many cases, it isn't known what triggers the spasms.

Vasospastic angina, also called Prinzmetal's angina or variant angina, is one type of angina that is caused by coronary artery spasm. It has a distinctive pattern. It usually occurs when you're resting. It often happens at the same time each day. For example, it often happens at night or in the early morning. Symptoms are typically mild at first, then get worse, and then get less intense. An episode may last about 15 minutes. Nitroglycerin can relieve symptoms.

How do you manage stable angina?

Most people who have stable angina can control their symptoms by taking medicines as prescribed and nitroglycerin when needed.

For tips on managing angina see:

Quick Tips: Taking Charge of Your Angina.
Using Nitroglycerin for Angina.

What makes symptoms worse?

Other health problems, such as fever or infection, anemia, or other heart problems, can make your angina symptoms worse. They may also cause unstable angina.

Angina may get worse when another condition:

  • Forces your heart to work harder, which increases the amount of oxygen it needs.
  • Decreases the amount of oxygen the heart receives.

In either case, there is an imbalance between the amount of oxygen that your heart needs and the amount that it receives through the blood supply from your coronary arteries. If your heart can't get enough oxygen, your symptoms of stable angina may get worse.

References

Other Works Consulted

  • Beltrame JF, et al. (2017). International standardization of diagnostic criteria for vasospastic angina. European Heart Journal, 38(33): 2565-2568. DOI: 10.1093/eurheartj/ehv351. Accessed January 17, 2018.
  • Montalescot G, et al. (2013). 2013 ESC guidelines on the management of stable coronary artery disease. European Heart Journal, 34(38): 2949-3003. DOI: 10.1093/eurheartj/eht296. Accessed April 13, 2017.

Credits

ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
Steven J. Atlas, MD, MPH - Internal Medicine
Specialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology

Current as ofFebruary 26, 2018


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