Angina
(Unstable Angina; Stable Angina; Angina Pectoris; Cardiac Angina; Variant Angina)
Definition TOP
Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes.
Types of angina include:
- Stable angina —Has a predictable pattern. You generally know what brings it on and what relieves it. You may also know what the intensity will be.
- Unstable angina
—Is more unpredictable and/or severe. Chest pain may occur while resting or sleeping. The discomfort may last longer and be more intense than that of stable angina.
- Unstable angina may be a sign that you are about to have a heart attack. Call for emergency medical services right away.
- Variant or Prinzmetal's angina —Caused by temporary spasm of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.
Typical Angina Pain AreasWomen are more likely to experience pain outside of these areas. Copyright © Nucleus Medical Media, Inc. |
Causes TOP
Angina is usually a sign of coronary artery disease (CAD). It occurs when the blood vessels leading to your heart are narrowed or blocked. The blockage decreases the blood and oxygen flow to your heart. When your heart is deprived of oxygen, you will feel chest pain and other symptoms.
Coronary Artery DiseaseCopyright © Nucleus Medical Media, Inc. |
Stable or Unstable Angina
Angina occurs when your heart's need for blood and oxygen is increased by:
- Exercise or exertion
- Cold weather
- A large meal
- Emotional stress
Stable angina becomes unstable when symptoms:
- Occur more often
- Last longer
- Are triggered more easily
Variant or Prinzmetal's Angina
This type of angina is usually caused by a spasm of a heart vessel. It may be a sign that you have one of the following conditions:
- CAD
- Extremely high blood pressure
- Hypertrophic cardiomyopathy
- Diseases of the heart valves
Risk Factors TOP
CAD is more common in older men.
Other factors that may increase your risk of CAD include:
- Strong family history of heart disease
- Obesity and overweight
- Smoking
- High blood pressure
- Sedentary lifestyle
- High blood cholesterol —specifically, high low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol
- Diabetes
- Stress
- Excessive alcohol intake
Symptoms TOP
Symptoms may include:
-
Pressure or squeezing chest pain
- Chest pain or discomfort is the key symptom of angina
- Some people do not experience the pain as severely
- Elderly people, women, and people with diabetes are more likely to have subtle symptoms and pain outside of the typical areas
- Some people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest pain
The likelihood of a heart attack is increased when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms, such as:
- Pain in the shoulder(s) or arm(s), or into the jaw(s)
- Weakness
- Sweating
- Nausea
- Shortness of breath
Diagnosis TOP
Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with blood tests.
Images may be taken of your heart. This can be done with an .
- Echocardiogram
- Nuclear scanning
-
Electron-beam CT scan
(coronary calcium scan, heart scan, CT
angiography)
- American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.
- Coronary angiography
Your heart activity may be tested. This can be done with:
- ECG
- Exercise stress test
- A medication is used to simulate the effects of physical exertion for those who cannot exercise.
Treatment TOP
Treatments for angina include:
Medications
-
Nitroglycerin—Usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray.
- Longer-lasting types may be used to prevent angina before an activity—May be given as pills, or applied as patches or ointments.
-
Blood thinners—A small, daily dose of
aspirin
has been shown to decrease the risk of heart attack.
- Talk to your doctor before taking aspirin daily.
- Some may benefit from the addition of blood thinners. There is an increased risk of bleeding with certain medications.
- Beta-blockers and calcium-channel blockers—May reduce the occurrence of angina.
- Cholesterol-lowering medications—May prevent the progression of CAD; may even improve existing CAD.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—Lower blood pressure and decrease the workload on your heart.
- Ranolazine—To treat chronic angina.
Surgery
Patients with severe angina or unstable, progressing angina may benefit from:
- Coronary artery bypass graft —Uses arteries from other areas of your body to bypass blocked heart arteries.
- Coronary angioplasty —Uses a balloon to open blocked arteries.
Prevention TOP
If you already have angina, you can prevent an onset by being aware of what starts it.
If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.
Steps to prevent CAD include managing risk factors:
- Maintain a healthy weight.
- Begin a safe exercise program with the advice of your doctor.
- Stop smoking.
- Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
- Manage high blood pressure and/or diabetes.
- Manage abnormal cholesterol levels or high triglycerides.
RESOURCES:
Family Doctor—American Academy of Family Physicians
https://familydoctor.org
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov
CANADIAN RESOURCES:
Canadian Cardiovascular Society
http://www.ccs.ca
College of Family Physicians of Canada
http://www.cfpc.ca
REFERENCES:
Explore angina. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/angina. Updated June 1, 2011. Accessed August 19, 2014.
Management of angina. DynaMed Plus website. Available at:
...(Click grey area to select URL)
Updated April 10, 2017. Accessed September 13, 2017.
Reenan J. Clinical Pearl: Indications for bypass surgery. Virtual Mentor. February 2004;6:2. Available at:
...(Click grey area to select URL)
Accessed August 19, 2014.
7/14/2006 DynaMed Plus Systematic Literature Surveillance. Available at: http://www.dynamed.com/topics/dmp~AN~T114649/Antiplatelet-and-anticoagulant-drugs-for-coronary-artery-disease : Andreotti F, Testa L, Biond-Zoccai GG, Crea F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J. 2006;27(5):519-526.
Last reviewed September 2018 by
EBSCO Medical Review Board
Michael J. Fucci, DO, FACC
Last Updated: 8/19/2014