Angina

What Is Angina?

Angina is a type of chest pain or discomfort that occurs when the heart does not receive enough oxygen-rich blood. It is often described as pressure, squeezing, heaviness, or tightness in the chest, but it may also be felt in the shoulders, arms, neck, jaw, or back.

Angina can be stable, meaning it occurs in a predictable pattern with physical activity or stress, or unstable, meaning it occurs suddenly, at rest, or with increasing frequency and intensity. Unstable angina is a medical emergency and requires immediate evaluation.

What Causes Angina?

The most common cause of angina is narrowing or blockage of the coronary arteries, which supply blood to the heart. This narrowing is usually due to a buildup of plaque, made up of cholesterol and other substances, along the artery walls.

Other causes may include anemia, coronary artery spasm, heart valve disease, uncontrolled high blood pressure, or conditions that increase the heart’s demand for oxygen. Risk factors for angina include smoking, diabetes, high cholesterol, high blood pressure, obesity, physical inactivity, and a family history of heart disease.

Angina Symptoms

The primary symptom of angina is chest discomfort that may feel like pressure, squeezing, burning, or tightness. The discomfort often occurs during physical exertion, emotional stress, exposure to cold, or after eating a large meal.

Angina symptoms may also include shortness of breath, nausea, sweating, dizziness, or fatigue. Some people, especially women, older adults, and individuals with diabetes, may experience atypical symptoms such as jaw pain, back pain, or indigestion-like discomfort.

Symptoms that are new, worsening, or occurring at rest should be treated as an emergency.

How is Angina Diagnosed?

Angina is diagnosed based on a combination of a patient’s symptoms, medical history, physical examination, and diagnostic testing. Because angina is a symptom of reduced blood flow to the heart, the goal of diagnosis is to identify evidence of coronary artery disease or other conditions affecting the heart’s oxygen supply.

Your healthcare provider will ask detailed questions about the nature of your chest discomfort, including when it occurs, how long it lasts, what triggers it, and what relieves it. Risk factors such as smoking, diabetes, high blood pressure, high cholesterol, and family history of heart disease are also considered.

Diagnostic tests commonly used to evaluate angina include an electrocardiogram (ECG) to assess heart rhythm and look for signs of reduced blood flow or prior heart injury.

Stress testing, which evaluates the heart during exercise or medication-induced stress, can help determine whether symptoms are related to exertion and identify areas of the heart with poor blood flow. An echocardiogram may be used to assess heart structure and function.

Angina Treatment

Treatment for angina focuses on improving blood flow to the heart, relieving symptoms, and reducing the risk of heart attack. Medications, including nitrates, beta blockers, and calcium channel blockers, may be prescribed to reduce symptoms.

Long-acting antiplatelet therapy, such as clopidogrel, may be used in patients who cannot take aspirin or who are at higher risk of clot formation.

Cardiac rehabilitation through a combination of exercise and education is commonly recommended for patients with chronic stable angina or after cardiac procedures. Cholesterol management, smoking cessation programs, weight management, and diabetes control may play a major role in long-term symptom relief and prevention of disease progression.