Angina Pectoris

What is angina pectoris?

Angina pectoris—or simply angina—is chest pain or discomfort that keeps coming back. It happens when some part of your heart doesn’t get enough blood and oxygen. Angina can be a symptom of coronary artery disease (CAD). This occurs when arteries that carry blood to your heart become narrowed and blocked because of atherosclerosis or a blood clot. It can also occur because of unstable plaques, poor blood flow through a narrowed heart valve, a decreased pumping function of the heart muscle, as well as a coronary artery spasm.

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There are 2 other forms of angina pectoris. They are:

Variant angina pectoris
(or Prinzmetal’s angina)

Microvascular angina

  • Is rare
  • Occurs almost only when you are at rest
  • Often doesn’t follow a period of physical exertion or emotional stress
  • Can be very painful and usually occurs between midnight and 8 a.m.
  • Is related to spasm of the artery
  • Is more common in women
  • Can be helped by medicines such as calcium channel blockers. These medicines help dilate the coronary arteries and prevent spasm.
  • A recently discovered type of angina
  • People with this condition have chest pain but have no apparent coronary artery blockages
  • Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart, as well as the arms and legs
  • Can be treated with some of the same medicines used for angina pectoris
  • Was once called Syndrome X
  • Is more common in women

What causes angina pectoris?

Angina pectoris occurs when your heart muscle (myocardium) does not get enough blood and oxygen for a given level of work. Insufficient blood supply is called ischemia.

Who is at risk for angina pectoris?

Anything that causes your heart muscle to need more blood or oxygen supply can result in angina. Risk factors include physical activity, emotional stress, extreme cold and heat, heavy meals, drinking excessive alcohol, and cigarette smoking.

What are the symptoms of angina pectoris?

These are the most common symptoms of angina:

  • A pressing, squeezing, or crushing pain, usually in the chest under your breastbone
  • Pain may also occur in your upper back, both arms, neck, or ear lobes 
  • Pain radiating in your arms, shoulders, jaw, neck, or back
  • Shortness of breath
  • Weakness and fatigue
  • Feeling faint

Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medicine, such as nitroglycerin.

An episode of angina means some part of the heart is not getting enough blood supply. If you have angina, you have an increased risk for a heart attack. Note the pattern of your symptoms—what causes the chest pain, what it feels like, how long it lasts, and whether medicine relieves the pain. If angina symptoms change sharply, or if they happen when you are resting or they start to occur unpredictably, call 911. You may be having a heart attack. Do not drive yourself to the emergency department.

The symptoms of angina pectoris may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

How is angina pectoris diagnosed?

In addition to a complete medical history and medical exam, your healthcare provider can often diagnose angina from your symptoms and how and when they occur. Other tests may include:

  • Electrocardiogram (ECG). Records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and detects heart muscle damage.
  • Stress test (usually with ECG; also called treadmill or exercise ECG). Given while you walk on a treadmill or pedal a stationary bike, to monitor your heart’s ability to function when placed under stress such as during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, or to determine safe levels of exercise after a heart attack or heart surgery. A special type of stress test uses medicine to stimulate the heart as if you were exercising.
  • Cardiac catheterization. With this procedure, a wire is passed into the coronary arteries. Next a contrast agent is injected into your artery. X-ray images are taken to locate the narrowing, blockages, and other abnormalities of specific arteries.
  • Cardiac MRI. This test can find the amount of blood flow to the heart muscle. It may not be available at all medical centers.
  • Coronary CT scan. This test looks at the amount of calcium and plaque inside of the blood vessels of the heart.