Angina (Ischemic Chest Pain)
What Is Angina?
Angina is chest pain that happens because there isn’t enough blood going to part of your heart. It can feel like a heart attack, with pressure or squeezing in your chest. It’s sometimes called angina pectoris or ischemic chest pain.
It’s a symptom of heart disease, and it happens when something blocks your arteries or there’s not enough blood flow in the arteries that bring oxygen-rich blood to your heart.
Angina usually goes away quickly. Still, it can be a sign of a life-threatening heart problem. It’s important to find out what’s going on and what you can do to avoid a heart attack.
Usually, medicine and lifestyle changes can control angina. If it’s more severe, you may need surgery, too. Or you may need what’s called a stent, a tiny tube that props open arteries.
There are different types of angina:
Stable angina. This is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn’t a heart attack, but it can be a sign that you’re more likely to have one. Tell your doctor if this happens to you.
Unstable angina. You can have this while you’re at rest or not very active. The pain can be strong and long-lasting, and it may come back again and again. It can be a signal that you’re about to have a heart attack, so see a doctor right away.
Microvascular angina. With this type, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women.
Prinzmetal’s angina (variant angina). This type is rare. It might happen at night while you’re sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.
Chest pain is the symptom, but it affects people differently. You may have:
- Feeling of fullness in your chest
- Feeling of heaviness or pressure
- Upset stomach or vomiting
- Shortness of breath
You might mistake an aching or burning for heartburn or gas.
You’re likely to have pain behind your breastbone, which can spread to your shoulders, arms, neck, throat, jaw, or back.
Stable angina often gets better with rest. Unstable angina may not, and it could get worse. It’s an emergency that needs medical help right away.
Angina in Women vs. Men
Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat, or back. You may also have shortness of breath, sweating, or dizziness.
One study found that women were more likely to use the words “pressing” or “crushing” to describe the feeling.
Angina usually happens because of heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to your heart muscle. This forces your heart to work with less oxygen. That causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.
- A blockage in a major artery of your lungs (pulmonary embolism)
- An enlarged or thickened heart (hypertrophic cardiomyopathy)
- Narrowing of a valve in the main part of your heart (aortic stenosis)
- Swelling of the sac around your heart (pericarditis)
- Tearing in the wall of your aorta, the largest artery in your body (aortic dissection)
Angina Risk Factors
Some things about you or your lifestyle could put you at higher risk of angina, including:
- Older age
- Family history of heart disease
- High blood pressure
- High cholesterol
- Using tobacco
- Not getting enough exercise
Your doctor will do a physical exam and ask about your symptoms, risk factors, and family history. They might need to do tests including:
- EKG. This test measures your heart’s electrical activity and rhythm.
- Stress test. This checks how your heart is working while you exercise.
- Blood tests. Your doctor will check for proteins called troponins. Lots of them are released when your heart muscle is damaged, as in a heart attack. Your doctor may also do more general tests like a metabolic panel or complete blood count (CBC).
- Imaging tests. Chest X-rays can rule out other things that might be causing your chest pain, like lung conditions. Echocardiograms and CT and MRI scans can create images of your heart to help your doctor spot problems.
- Cardiac catheterization. Your doctor inserts a long, thin tube into an artery in your leg and threads it up to your heart to check your blood flow and pressure.
- Coronary angiography. Your doctor injects dye into the blood vessels of your heart. The dye shows up on an X-ray, creating an image of your blood vessels. They may do this procedure during cardiac catheterization.
- Do I need any more tests?
- What type of angina do I have?
- Do I have heart damage?
- What treatment do you recommend?
- How will it make me feel?
- What can I do to try to prevent a heart attack?
- Are there activities I shouldn’t do?
- Will changing my diet help?
Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine and lifestyle changes can often help their blood flow better and control their symptoms.
Your doctor might prescribe medicines including:
- Nitrates or calcium channel blockers to relax and widen blood vessels, letting more blood flow to your heart
- Beta-blockers to slow your heart down so it doesn’t have to work as hard
- Blood thinners or antiplatelet medications to prevent blood clots
- Statins to lower your cholesterol levels and stabilize plaque
If meds aren’t enough, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:
Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again.
The procedure usually takes less than 2 hours. You’ll probably stay overnight at the hospital.
Coronary artery bypass grafting (CABG), or bypass surgery. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.
You can expect to stay in the hospital about a week after you have this. You’ll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. You’ll then move to a regular room to recover.
Enhanced external counterpulsation
Enhanced external counterpulsation (EECP) may be an option to relieve your angina. Your doctor may recommend it if other treatments haven’t worked or aren’t right for you.
EECP uses several blood pressure cuffs on both legs to gently, but firmly, compress the blood vessels there to boost blood flow to your heart. Each wave is timed to your heartbeat. So more blood goes there when it’s relaxing.
When your heart pumps again, pressure is released right away. This lets blood be pumped more easily. It can help your blood vessels make a natural bypass around narrowed or blocked arteries that cause your chest pain. It may help some small blood vessels in your heart open. They may give more blood flow to your heart muscle to help ease your chest pain.
You might have EECP if you:
- Have chronic stable chest pain
- Aren’t helped by nitrates, calcium channel blockers, and beta-blockers
- Invasive procedures like bypass surgery, angioplasty, or stenting aren’t right for you
EECP isn’t invasive. If you’re accepted for EECP treatment, you’ll have 35 hours of therapy. It’s given 1 to 2 hours a day, 5 days a week, for 7 weeks. Studies have shown its benefits include less need for anti-anginal medicine, fewer symptoms, and the ability to be more active without symptoms
You can still be active, but it’s important to listen to your body. If you feel pain, stop what you’re doing and rest. Know what triggers your angina, like stress or intense exercise. Try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often. If you still feel pain, talk to your doctor about having more tests or changing your medications. Because angina can be a sign of something dangerous, it’s important to get checked out.
These lifestyle tips may help protect your heart:
If you smoke, stop. It can damage your blood vessels and increase your heart disease risk.
Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. When those are out of normal range, your chance for heart disease can rise. Eat mainly fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.
Use stress-relieving measures like meditation, deep breathing, or yoga to relax.
Exercise most days of the week.
See your doctor regularly.
If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Quick treatment is very important. It can protect you from more damage.
Angina raises your risk of having a heart attack. But it’s treatable. Consider it a warning sign and make healthy choices.
Talk with others who have it. That may help you learn how to feel better.
Your family, too, may need support to help them understand your angina. They’ll want to know what they can do to help.