Also known as Angina Pectoris, Acute Coronary Syndrome, Microvascular Angina, Prinzmetal Angina, Stable Angina, Unstable Angina, Variant Angina, Vasospastic Angina, Cardiac Syndrome X
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Angina is chest pain or discomfort that occurs when part of your heart muscle is not getting enough oxygenated blood. It is a common symptom of ischemic heart disease, which restricts or cuts off blood flow to the heart.
There are different types of angina pectoris, and the signs and symptoms depend on the type you have. Angina chest pain, called angina pectoris, can occur if your heart is working hard. It may go away when you stop to rest, or it may happen at rest. This pain may feel like pressure or squeezing in your chest. It can also spread to your shoulders, arms, neck, jaw, or back just like a heart attack. Angina pain can even feel like an upset stomach. Symptoms can differ in women and men.
Angina can be a warning sign that you are at increased risk for a heart attack. If you have chest pain that won't go away, call 9-1-1 immediately.
To diagnose angina pectoris, your doctor will ask you about your signs and symptoms and may run blood tests, an X-ray, or order tests, such as an electrocardiogram (EKG), an exercise test, or cardiac catheterization, to determine how well your heart is working . With some types of angina pectoris, you may need emergency medical treatment to prevent a heart attack. To control your condition, your doctor may recommend changes to your heart-healthy lifestyle, medications, medical procedures, and cardiac rehabilitation.
Symptoms
Signs and symptoms vary depending on the type of angina you have and whether you are male or female. Angina symptoms can vary in severity, location in the body, timing, and how much relief you can feel with rest or medications. Since the symptoms of angina pectoris and heart attack can be the same, call 9-1-1 if you feel chest discomfort that doesn't go away with rest or medications. Angina can also lead to heart attack and other complications that can be life-threatening.
Pain and discomfort are the main symptoms of angina pectoris. Angina is often described as pressure, squeezing, burning, indigestion, or chest tightness. The pain or discomfort usually starts behind the sternum. Some people say that angina pectoris is difficult to describe or that they cannot say exactly where the pain is coming from.
Other symptoms include:
- Fatigue
- Feeling light-headed or fainting
- Nausea or nausea in the stomach
- Shortness of breath
- To sweat
- Weakness
Symptoms of angina can be different in women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of heart disease. As a result, treatment for women may be delayed.
Because angina has so many possible symptoms and causes, all chest pain should be monitored by a doctor.
Each type of angina has certain typical symptoms. Learn about the symptoms typical of each type.
Stable angina
- Discomfort that feels like gas or indigestion
- Pain during physical exertion or mental stress
- Pain spreading from your sternum to your arms or back
- Pain relieved by medicines
- Pattern of symptoms that has not changed in the past 2 months
- Symptoms that disappear within 5 minutes
Unstable angina
- Changes in your stable angina symptoms
- Pain that gets worse
- Pain that is not relieved by rest or medication
- Pain that lasts longer than 20 minutes or goes away and then returns
- Pain while resting or sleeping
- Severe pain
- Shortness of breath
Microvascular angina
- Pain after physical or emotional stress
- Pain that is not directly relieved by medication
- Pain that lasts a long time
- Pain you feel while performing normal daily activities
- Severe pain
- Shortness of breath
Variant angina
- K.old sweat
- Pass out
- Numbness or weakness of the left shoulder and upper arm
- Pain relieved by medicines
- Pain that occurs while resting or while sleeping
- Pain that starts in the early morning hours
- Severe pain
- Faint pain with a feeling of pressure in the lower chest, which may extend to the neck, jaw, or left shoulder
Therapy
Your doctor will decide a treatment approach based on the type of angina you have, your symptoms, test results, and the risk of complications. Unstable angina is a medical emergency that requires immediate hospital treatment. If your angina is stable and your symptoms aren't getting worse, you may be able to get your angina pectoris under control with heart-healthy lifestyle changes and medications. If your lifestyle changes and medications can't control your angina, you may need a medical procedure to improve blood flow and relieve your angina.
Medicines
If you are diagnosed with angina, your doctor will prescribe fast-acting medicines that you can use to control angina and relieve pain. Often other drugs are also prescribed to control angina pectoris in the long term. The choice of medications may depend on the type of angina pectoris you have.
- Anticoagulants or blood thinners, such as heparin, to prevent dangerous blood clots and future complications, such as a heart attack or another angina pectoris.
- Antiplatelet medicines to prevent blood clots from forming. If you have stable or unstable angina pectoris, your doctor may recommend aspirin to treat angina and reduce the risk of complications from ischemic heart disease. Other platelet inhibitors, such as clopidogrel, can also be prescribed.
- Beta blockers to make your heart beat more slowly and with less force. These medications are often prescribed to help relieve angina pectoris. If for some reason you cannot use beta blockers, long-acting nitrates are preferred.
- Calcium channel blockers to prevent calcium from entering the muscle cells of your heart and blood vessels. This allows the blood vessels to relax. Calcium channel blockers can be an alternative medicine if you cannot use beta blockers or nitrates. For variant angina, your doctor will likely order calcium channel blockers and will not give you beta blockers.
- Nitrates to dilate and relax blood vessels, allowing more blood to flow to the heart while reducing the workload on the heart. Nitrate pills or sprays, including nitroglycerin, work quickly and can relieve pain during an event. Long-acting nitrates are available as pills or skin patches. If you're hospitalized for chest pain, your doctor may order intravenous (IV) nitrates to relieve your angina pectoris.
- Statins to prevent plaque buildup and relieve blood vessel spasms or inflammation, reducing the risk of heart attack or other complications after emergency treatment.
If you still have symptoms or experience side effects, your doctor may prescribe other drugs, including:
- Morphine to relieve pain and help blood vessels to relax. Your doctor may suggest it if other medicines have not helped.
- Ranolazine to help you get angina symptoms less often. When given with other angina pectoris medicines, ranolazine can also increase the amount of time you can be physically active without pain. This medicine may work in microvascular coronary disease causing microvascular angina pectoris. Ranolazine can be a nitrate substitute for men with stable angina pectoris who are taking drugs for erectile dysfunction.
Procedures
If lifestyle changes and medications don't control angina, you may need a medical procedure to treat the underlying heart condition.
- Coronary bypass graft (CABG) to treat ischemic heart disease and relieve angina pectoris. CABG can improve blood flow to your heart, relieve chest pain and possibly prevent heart attack
