What Is Angina? (an-JI-nuh or AN-juh-nuh)
is chest pain or
discomfort that occurs when your heart muscle does not get enough blood.
Angina may feel like pressure or a squeezing pain in your chest.
The pain may also occur in your
shoulders, arms, neck, jaw, or back. It may also feel like indigestion.
Angina is a symptom of coronary
artery disease (CAD), the most common type of heart disease. CAD occurs
when plaque builds up in the coronary arteries. This buildup of plaque is
As plaque builds up, the
coronary arteries become narrow and stiff. Blood flow to the heart is
reduced. This decreases the oxygen supply to the heart muscle.
Types of Angina
There are 3 types of angina-stable, unstable, and variant
It is very important to know the differences among the types.
Stable angina. Stable
angina is the most common type. It occurs when the heart is working harder
There is a regular pattern to stable angina.
After several episodes, you learn to recognize the pattern
and can predict when it will occur.
The pain usually goes away in a few minutes when you rest or
take your angina medicine.
Stable angina is not a heart attack but makes it more likely
that you will have a heart attack in the future.
Unstable angina is a very dangerous condition that requires
It is a sign that a heart attack could occur soon. Unlike
stable angina, it does not follow a pattern. It can occur without physical
exertion and is not relieved by rest or medicine.
Variant angina is rare.
It usually occurs at rest.
The pain can be severe and usually occurs between midnight
and early morning.
It is relieved by medication.
Not all chest pain or discomfort is angina.
Chest pain or discomfort can be caused by a heart attack,
lung problems (such as an infection or a blood clot), heartburn, or a
panic attack. However, all chest pain should be checked by a doctor.
Other Names for Angina
Stable or common angina
Coronary artery spasms
Acute coronary syndrome
What Causes Angina?
Angina is caused by reduced
blood flow to an area of the heart. This is most often due to coronary
artery disease (CAD). Sometimes, other types of heart disease or
uncontrolled high blood pressure can cause angina.
In CAD, the arteries that carry
oxygen-rich blood to the heart muscle are narrowed due to the buildup of
fatty deposits called plaque.
This is called atherosclerosis.
Some plaque is hard and stable and leads to narrowed and hardened
arteries. Other plaque is soft and is more likely to break open and cause
The buildup of plaque on the
inner walls of the arteries can cause angina in two ways: By narrowing the
artery to the point where the flow of blood is greatly reduced By forming
blood clots that partially or totally block the artery.
Physical exertion is the most
common cause of pain and discomfort from stable angina.
Severely narrowed arteries may
allow enough blood to reach the heart when the demand for oxygen is low
(such as when you are sitting). But with exertion like walking up a hill
or climbing stairs, the heart works harder and needs more oxygen.
Other causes include:
Exposure to very hot or cold temperature
Unstable angina is caused by
blood clots that partially or totally block an artery. If plaque in an
artery ruptures or breaks open, blood clots may form. This creates a
larger blockage. The clot may grow large enough to completely block the
artery and cause a heart attack.
Blood clots may form, partly
dissolve, and later form again. Chest pain can occur each time a clot
blocks an artery.
Variant angina is caused by a
spasm in a coronary artery. The spasm causes the walls of the artery to
tighten. This narrows the artery, causing the blood flow to the heart to
slow or stop. Variant angina may occur in persons with and without CAD.
Other causes of spasms in
the arteries that supply the heart with blood are:
Exposure to cold
Medications (vasoconstricting) that constrict or narrow
Who Gets Angina?
Over 6 million people in the U.
S. have angina. People with coronary artery disease (CAD) or who have had
a heart attack are more likely to have angina.
Unstable angina occurs more
often in older adults. Variant angina is rare. It accounts for only about
2 out of 100 cases of angina.
People with variant angina are
often younger than those with other forms of angina.
What Are the Common Signs
and Symptoms of Angina?
The pain or discomfort of
Is often described as pressure, squeezing, burning, or
tightness in the chest
Usually starts in the chest behind the breastbone
May also occur in the arms, shoulders, neck, jaw, throat, or
May feel like indigestion.
Some people say that angina discomfort is hard to describe
or that they can't tell exactly where the pain is coming from.
Symptoms such as nausea,
fatigue, shortness of breath, sweating, light- headedness, or weakness may
Symptoms vary based on the
type of angina:
The pain or discomfort:
Occurs when the heart must work harder, usually during
Is expected, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or angina medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or
The pain or discomfort:
Often occurs at rest, while sleeping at night, or with
little physical exertion
Is more severe and lasts longer (as long as 30 minutes) than
stable angina episodes
Is usually not relieved with rest or angina medicine
May get continuously worse
May signal that a heart attack will happen soon.
The pain or discomfort:
Usually occurs at rest and during the night or early morning
Tends to be severe
Is relieved by angina medicine.
Chest pain that lasts longer than a few minutes and is not
relieved by rest or angina medicine may mean you are having-or are about
to have-a heart attack. Get emergency help right away.
How is Angina Diagnosed?
To find out if you have
angina, your doctor will:
Do a physical exam
Ask about your symptoms
Ask about your risk factors and your family history of
coronary artery disease (CAD) or other r heart disease.
Sometimes, your doctor can diagnose angina by noting your
symptoms and how they occur.
Your doctor may order one or more tests to help make a
diagnosis of angina.
The tests your doctor may
EKG or ECG (electrocardiogram). This test measures the rate
and regularity of your heartbeat. Some people with angina have a normal
Exercise stress test. This test shows how well your heart
pumps at higher workloads when it needs more oxygen. EKG and blood
pressure readings are taken before, during, and after exercise to see how
your heart responds to exercise.
The first EKG and blood pressure reading are done to get a
baseline. Readings are then taken while you walk on an exercise treadmill,
pedal a stationary bicycle, or receive medicine to make your heart beat
The test continues until you reach a heart rate set by your
doctor. The exercise part is stopped if chest pain or a very sharp rise in
blood pressure occurs. Monitoring continues for 10 to 15 minutes after
exercise or until your heart rate returns to baseline.
Chest x-ray. A chest x-ray takes a picture of the organs and
structures inside your chest. These include your heart, lungs, and blood
Nuclear heart scan. This test shows blood flow to the heart
and any damage to the heart muscle. A radioactive dye (technetium or
thallium) is injected into your bloodstream.
A special camera can then see the dye and find areas where
there is less blood flow. Nuclear heart scans are often taken while you
are at rest and again after exercise. If you cannot exercise, a medication
is given to increase the workload of the heart.
exercise scans are compared.
Echocardiogram. This test uses sound waves to create a
picture of the heart. The picture is more detailed than an x-ray image.
The test shows how well your heart chambers fill with blood and pump it to
the rest of the body.
An echocardiogram also can help identify areas of poor blood
flow to the heart, areas of heart muscle that are not contracting
normally, and previous injury to the heart muscle caused by poor blood
flow. An echocardiogram can also be used with a stress test.
Cardiac catheterization. A thin flexible tube (catheter) is
passed through an artery in the groin or arm to reach the coronary
arteries. Your doctor can determine pressure and blood flow in the heart's
chambers, collect blood samples from the heart, and examine the arteries
of the heart by x-ray.
Coronary angiography. This test is done during cardiac
catheterization. A dye that can be seen by x-ray is injected through the
catheter into the coronary arteries. Your doctor can see the flow of blood
through the heart and see where there are blockages.
Your doctor may also order
blood tests, such as:
A fasting lipoprotein profile to check your cholesterol
Fasting glucose test to check your blood sugar level.
C-reactive protein (CRP) test. This blood test measures CRP,
a protein in the blood that shows the presence of inflammation.
Inflammation is the body's response to injury. High levels of CRP may be a
risk factor for CAD.
A test to check for low hemoglobin in your blood. Hemoglobin
is the part of red blood cells that carries oxygen to all parts of your
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