Angina (Ischemic Chest Pain)

Medically Reviewed by Dr. K on 23 March 2021

What Is Angina?

Angina is a type of chest pain caused by a lack of blood flow to a portion of the heart. With pressure or squeezing of the chest, it may sound like you’re having a heart attack. It’s also known as ischemic chest pain or angina pectoris.

It happens whenever anything blocks your arteries or there isn’t enough blood flow in the arteries that carry oxygen-rich blood to your heart, and it’s a sign of heart disease.

Angina is normally short-lived. Even then, it could be a symptom of a life-threatening cardiac condition. It’s important to determine what’s going on and what you should do to prevent a heart attack.

Angina may usually be managed with medication and a change in lifestyle. You may require surgery if it’s more serious. You may even require a stent, which is a tiny tube that keeps open the arteries.

Angina may be classified into many types:

  • Stable angina

The most common type. It may be triggered by physical exercise or stress. It normally just lasts a few minutes and stops when you rest. It’s not a heart attack, so it’s a sign that you are more likely to develop one. If this happens to you, tell the doctor.

  • Unstable angina

This can happen when you are at rest or are not really active. The pain may be intense and continue for a long time, and it can recur. It may be a warning that you’re developing a heart attack, so get immediate attention right away.

  • Microvascular angina

You have chest pain but no coronary artery blockage if you have this kind. Instead, it occurs when the smallest coronary vessels aren’t functioning properly, preventing the heart from receiving the oxygen it needs. The pressure in the chest normally persists for more than 10 minutes. Women are more likely to have this kind.

  • Prinzmetal’s angina (variant angina)

This form is unusual, often in younger patients. It might happen in the middle of the night when you’re asleep or relaxing. The arteries in your core abruptly tighten or shorten. You should get it checked because it can cause a lot of discomforts.

Angina Symptoms

The symptom is chest pain, but it has varying effects on different patients. You may have:

  • Pain
  • Aching
  • Burning
  • Discomfort
  • Dizziness
  • Fatigue
  • The feeling of fullness in your chest
  • The feeling of heaviness or pressure
  • Discomfort in the stomach
  • Vomiting
  • Shortness of breath
  • Squeezing
  • Sweating

An aching or burning sensation may be mistaken for heartburn or smoke.

Pain behind the sternum is common, and it may extend to the shoulders, arms, neck, throat, jaw, or back.

Rest is also effective in the treatment of stable angina.  Unstable angina may worsen if left untreated. It’s a medical emergency that needs immediate attention.

 

Angina in Women vs. Men

Pain in the chest, neck, and shoulders is normal in males. Women can experience pain in their abdomens, necks, jaws, throats, or backs. Shortness of breath, sweating, and dizziness are also possible symptoms.

According to one study, women were more likely to describe the sensation as “pressing" or “crushing."

 

Angina Causes

Heart disease is the most common cause of angina. Plaque, a sticky film that forms in the arteries, blocks the blood supply to your heart muscle. Your heart is forced to function with less fuel as a result of this. This causes chest pain. You may even get blood clots in the heart’s arteries, which may lead to heart attacks.

The following are some of the less common causes of chest pain:

  • Pulmonary embolism: a blood clot blocking a major artery in the lungs
  • Hypertrophic cardiomyopathy: an enlarged and thickened heart
  • Aortic stenosis: narrowing of a major heart valve
  • Pericarditis: inflammation of the sac surrounding the heart
  • Aortic dissection: tearing of the wall of the largest artery of the heart

Angina Risk Factors

Some aspects of your lifestyle or behavior can increase your risk of angina, such as:

  • Family history of heart disease
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Older age
  • Stress
  • Smoking
  • Sedentary lifestyle

Angina Diagnosis

Your doctor will examine you and ask you questions regarding your conditions, risk factors, and family background. They will need to perform tests such as:

  • ECG: ECG stands for electrocardiogram. This examination tests the electrical activity and rhythm of the heart.
  • Stress test: This monitors the heart’s activity as you exercise.
  • Blood tests: Troponins are proteins that the doctor can look for. When the heart muscle is damaged, such as during a heart attack, a large level of troponins are produced. More specific tests, such as a metabolic panel or a full blood count, can be ordered by the doctor (FBC).

  • Imaging tests: This includes chest x-rays, CT scans, and MRI scans. They help visualize the organs within the body.
  • Cardiac catheterization: To monitor your blood supply and pressure, your doctor inserts a large, narrow tube into an artery in your leg and threads it up to your heart.
  • Coronary angiography: A dye is injected into the blood vessels of the heart by your doctor. An X-ray image of the blood vessels is produced with the dye showing up within the arteries of the heart. This technique can be performed during cardiac catheterization.

Angina questions for your doctor

  • What tests do I need to have?
  • What type of angina do I have?
  • Do I have a heart attack?
  • What treatments do I need?
  • How can I prevent a heart attack?
  • What diet or lifestyle changes do I have to do?

Angina Treatment

Your treatment will be decided by the degree of your heart’s injury. Medication and lifestyle changes will also help patients with mild angina improve their blood flow and manage their symptoms.

Medications

Medications that your doctor can recommend include:

  • Nitrates or calcium channel blockers relax and expand blood vessels, enabling more blood to flow to your heart.
  • Beta-blockers help the heart function less intensely by slowing it down.
  • Blood thinners or antiplatelet medications thin the blood to prevent blood clots.
  • Statins help to lower cholesterol levels and stabilize any plaques within the arteries.

Cardiac procedures

If medications aren’t working, you may need a medical procedure or surgery to open blocked arteries. This may be:

Angioplasty/stenting is a procedure that involves the placement of a balloon into the arteries.  A small tube with a bubble within is threaded into a blood artery and up to the heart by the specialist. The bubble is then inflated within the compressed artery, widening it and restoring blood supply. A thin tube called a stent can be inserted into your artery to help hold it intact. The stent is normally constructed of metal and is permanent. It may also be composed of a polymer that is absorbed into the body over time. Some stents provide medication to prevent the artery from being blocked again.

It normally takes less than two hours to complete the operation. You’ll most likely spend the night in the hospital.

Bypass procedure, also known as coronary artery bypass grafting (CABG). Healthy arteries or veins from another section of the body are used to bypass the damaged or shortened blood vessels by the surgeon.

After this, you can expect to spend approximately a week in the hospital. You’ll spend a day or two in the intensive care unit, where nurses and doctors monitor the pulse rate, blood pressure, and oxygen levels. After that, you’ll be moved to a normal ward to recover.

Lifestyle changes

You can still be active, but you should pay attention to your body. Stop what you’re doing and rest if you’re in pain. Know what causes angina, such as stress or intensive activity. Try to stay away from situations that seem to aggravate it. If big meals trigger problems, for example, consume smaller meals more regularly. If the discomfort persists, speak with the doctor about getting further tests or adjusting the medications. It’s important to get checked out if you have angina because it could be a symptom of something dangerous.

These lifestyle suggestions can help you keep your heart healthy:

  • Stop smoking. It can damage your blood vessels and raise your risk of heart disease.
  • Reduce your blood pressure and cholesterol levels by eating a heart-healthy diet. When certain values fall outside of the standard range, the risk of heart attack increases.
    Fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy should make up the majority of the diet.
    Limit the intake of salt, fat, and sugar.
  • Relax by using stress-relieving techniques such as meditation, deep relaxation, or yoga.
  • Aim for exercise for 30 minutes, 5 days a week.
  • See a doctor on a regular basis.

If you are feeling chest pain that is new or unusual for you and suspects you are having a heart attack, dial 999 immediately. It is important to get care as soon as possible. It has the potential to prevent you from even more harm.

 

Angina Outlook

Angina makes you more likely to have a heart attack. It is, however, treatable. Take that as a warning sign to make healthy decisions.

Talk to those people who have it. That could assist you with learning how to feel better.

Your families may also require help in order to understand your angina. They’ll be curious as to what they might do to assist.

Sources

Referenced on 2.3.2021:

  1. American Heart Association: “Angina (Chest Pain)," “Angina in Women Can Be Different Than Men," “Cardiac Catheterization and Angiogram," “Microvascular Angina,” “Unstable Angina,” Angina in Women Can Be Different Than Men.”
  2. JAMA Internal Medicine: “Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men."
  3. National Heart, Lung, and Blood Institute: “Angina,” “What is Angina?" “What Is an Electrocardiogram?"
  4. Stanford Health Care: “Angina.”
  5. Mayo Clinic: “Angina.”
  6. American Association for Clinical Chemistry: “Angina,” “Troponin.”
  7. Johns Hopkins Medicine: “Microvascular Angina: Why Women Shouldn’t Ignore Chest Pain and Fatigue.”
  8. UpToDate: “Patient education: Chest pain (Beyond the Basics).”
  9. HeartHealthyWomen.org: “EECP: What is enhanced external counterpulsation (EECP)?"
  10. Cleveland Clinic: “Enhanced external counterpulsation."
  11. https://www.webmd.com/heart-disease/heart-disease-angina#1

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