Angina (Chest Pain)

What Is Angina?

If you have a feeling of pressure or a squeezing in your chest, it may be angina. It can feel like a heart attack, but often it's a warning sign from your heart.

There's a lot you can do to stop it from happening. Usually, medicine along with lifestyle changes can control angina. If it's more severe, you may need surgery, too. Or you may need a stent, a tiny tube that props open arteries.

The chest pain you feel with angina happens because there isn't enough blood flowing to part of your heart. It's a symptom of heart disease, and it's caused when something blocks the arteries that bring oxygen-rich blood to your heart.

Angina usually goes away quickly, but it can be a symptom of a life-threatening heart problem. Call your doctor if you have angina. It's important to find out what's going on and to talk about what you can do to avoid a heart attack in the future.

There are different types of angina:

Stable angina is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn't a heart attack, but it's a sign that you're more likely to have one in the future. Tell your doctor if this happens to you.

Unstable angina. It happens while you're at rest or not very active. The pain can be strong and long lasting, and can come back again and again. It can be a signal that you're about to have a heart attack, so see a doctor right away.

Prinzmetal's angina (also called variant angina) is rare. It might happen at night during sleep or while at rest. The heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.

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Causes

Angina is usually caused by heart disease. A fatty substance called plaque builds up in the arteries, blocking blood flow to the heart muscle. This forces the heart to work with less oxygen, and that causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.

Other less common causes of chest pain include:

  • A blockage in a major artery of the lungs (pulmonary embolism)
  • An enlarged or thickened heart (hypertrophic cardiomyopathy)
  • Narrowing of the valve in the main part of the heart (aortic stenosis)
  • Swelling of the sac around the heart (pericarditis)
  • Tearing in the wall of the aorta, the largest artery in your body (aortic dissection)

 

Symptoms

Chest pain is the symptom, but it affects people differently. You may feel:

  • Aching
  • Burning
  • Discomfort
  • Feeling of fullness in the chest
  • Heaviness
  • Pressure
  • Squeezing

You are likely to have pain behind your breastbone, but it can spread to your shoulders, arms, neck, throat, jaw, or back.

It's possible to mistake an aching or burning for heartburn or gas.

Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat or back. You may also have shortness of breath, sweating, or dizziness.

One study found women were more likely to use the words "pressing" or "crushing" to describe the feeling.

Stable angina often gets better with rest. Unstable angina may not -- and could get worse.

Getting a Diagnosis

Questions for Your Doctor

  • Do I need any more tests?
  • What type of angina do I have?
  • Do I have heart damage?
  • What treatment do you recommend?
  • How will it make me feel?
  • What can I do to try to prevent a heart attack?
  • Are there activities I shouldn't do?
  • Will changing my diet help?

Treatment

Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine along with lifestyle changes can often help blood flow better and control symptoms.

Your doctor might prescribe medicines to:

  • Widen blood vessels, allowing more blood to flow to the heart
  • Slow the heart down so it doesn't have to work as hard
  • Relax blood vessels to let more blood flow to the heart
  • Prevent blood clots from forming

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If medicines aren't enough to treat your angina, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:

  • Angioplasty/stenting. During this procedure, the doctor threads a tiny tube with a balloon inside through a blood vessel and up to your heart. Then he inserts and inflates the balloon inside the narrowed artery to widen it and restore blood flow. A small tube called a stent may be left inside the artery to help keep it open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again.The procedure usually takes less than 2 hours. You will most likely stay overnight at the hospital.
  • Coronary artery bypass grafting (CABG), or bypass surgery. The surgeon takes healthy arteries or veins from another part of your body and uses them to bypass the blocked or narrowed blood vessels. You can expect to stay in the hospital about a week after this procedure. You'll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. You'll then move to a regular room to recover.

 

Taking Care of Yourself

You can continue to lead an active life, but it's important that you listen to your body. If you feel pain, stop what you are doing and rest. Know what triggers your angina, like stress or intense exercise. And try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often.

These lifestyle changes can help protect your heart:

  • Stop smoking. It can damage your blood vessels and increase your heart disease risk.
  • Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. If those are out of normal range, it can raise your chance for heart disease. Eat mainly fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.
  • Use stress-relieving measures like meditation, deep breathing, or yoga to relax.
  • Exercise most days of the week.
  • See your doctor regularly.

If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Don't wait. Quick treatment is very important. It can protect you from more damage.

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What to Expect

Angina raises your risk of having a heart attack. But it is treatable. Consider it a warning sign and make smart choices for yourself.

Talking with others who also have it may help you gain insights and tips to help you feel better.

Your family, too, may need support to help them understand your angina. They'll want to know what they can do to help.

Getting Support

For more information, go to the web site of the American Heart Association.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on August 27, 2014

Sources

SOURCES:

American Heart Association: "Angina (Chest Pain)," "Angina in Women Can Be Different Than Men," "Cardiac Catheterization and Angiogram."

Kreatsoulas, K. JAMA Internal Medicine, published online May 13, 2013.

NHLBI: "What is Angina?" "What Is an Electrocardiogram?"

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