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Angina (Chest Pain)

What is angina?

Angina pectoris is a feeling of tightness, squeezing, or pain in the chest. It happens when the heart does not get enough oxygen-rich blood.

Angina can occur in men and women of any age, but it is more common among the middle-aged and older adults.

How does it occur?

Angina may be caused by any condition that affects the blood flow to your heart, such as:

  • Coronary artery disease: The walls of the arteries that carry blood to the heart can develop atherosclerosis (fatty deposits). This restricts the flow of blood so that less oxygen reaches the heart muscle. This is by far the most common cause of angina.
  • Coronary artery spasm: Muscles in the wall of the coronary artery can go into spasm. This narrows the artery and causes blood to slow or stop flowing through it. When the spasm stops, the artery and blood flow return to normal.
  • Abnormal heart valves that cause the heart muscle to get too thick.
  • Abnormal heart rhythms.
  • Anemia: The levels of red blood cells or hemoglobin (the oxygen-carrying chemical in the blood) are too low.
  • Polycythemia: The blood has too many red blood cells. This causes the blood to thicken.
  • A thyroid problem.
  • Uncontrolled high blood pressure.

You are more likely to have angina when your heart is working harder, for example, when:

  • You are exercising or doing heavy physical labor.
  • You are upset.
  • You are in cold air.
  • You are digesting a big meal.

However, you can also have angina when you are resting or sleeping.

What are the symptoms?

The symptoms of angina may vary from person to person. Symptoms may include:

  • Discomfort in the chest that lasts for more than 2 minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other parts of the upper body, such as in one or both arms, the upper back, neck, jaw, or stomach.
  • Shortness of breath.
  • Sweating.
  • Lightheadedness.
  • Nausea.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. You will have a physical exam. You may have one or more of the following tests:

  • Electrocardiogram (ECG) and exercise treadmill test (ETT): These tests show electrical changes in the heart muscle if it is getting too little oxygen.
  • Nuclear heart scan: This scan measures blood flow in the heart.
  • Stress echocardiogram: This test shows how a lack of blood oxygen affects the heart's ability to squeeze (contract).

How is it treated?

Lifestyle:
When angina is caused by coronary artery disease, treatment often involves changes in your lifestyle. This may include:

  • quitting smoking
  • losing weight
  • reducing stress
  • getting more regular exercise, as prescribed by your healthcare provider
  • lowering your blood pressure (if high)
  • lowering your blood cholesterol (if high)
  • lowering your blood sugar (if high).

Medicine:
Often the symptoms of angina can be controlled with medicine.

  • Nitrates such as nitroglycerin increase the blood flow to the heart. They reduce the workload on the heart by dilating (expanding) the coronary blood vessels and lowering blood pressure slightly.
  • Drugs called beta blockers and calcium channel blockers are also effective.
  • Other medicines your healthcare provider may prescribe are ACE (angiotensin-converting enzyme) inhibitors, aspirin, and cholesterol-lowering medicines.

Your provider will determine which type of medicine is right for you based on your test results and any other medical problems you have.

Surgery and other procedures:
Angina caused by blocked arteries can be treated with:

  • percutaneous coronary intervention
  • coronary artery bypass surgery.

Percutaneous coronary intervention (PCI) is a simpler procedure than coronary bypass surgery. Your healthcare provider inserts a balloon catheter (a flexible tube) into a blocked artery in your heart to unblock it. The balloon at the tip of the catheter is inflated. The balloon opens the artery enough to let blood flow normally. The catheter is removed, but a metal mesh device called a stent is usually left in the artery. The stent helps keep the blood vessel open. You may need to stay at the hospital a day or two after the procedure. The procedure may also be called angioplasty.

In coronary artery bypass graft surgery, blood vessels are taken from other parts of your body and attached to the blocked coronary arteries on either side of the blockage. The blood is then able to flow around, or bypass, the blockages. You will likely stay in the hospital about 1 week and then recover at home for several weeks.

How long do the effects last?

With treatment, the outlook for people with angina is quite good. With treatment, most people can lead a normal or near normal life.

How can I take care of myself and prevent angina?

Follow the treatment prescribed by your healthcare provider. In addition, follow these guidelines:

  • Begin a regular exercise program under your healthcare provider's supervision.
  • If you are overweight, begin a weight-loss program under the supervision of your healthcare provider or a dietitian.
  • Eat a healthy, well-balanced diet. Avoid foods high in cholesterol, saturated fat, and trans fat.
  • Have your blood pressure checked regularly. High blood pressure increases your risk for heart disease.
  • Try to avoid emotional upset and stressful situations.
  • Always carry your medicine with you.

If your provider has prescribed nitroglycerin, take it if:

  • stopping an activity doesn't help your pain, or
  • the pain happens when you are resting.

It may be more comfortable to sit in a chair when you take the medicine. Some people help prevent symptoms by taking nitroglycerin before any activity that usually causes angina.

When should I call my healthcare provider?

See your healthcare provider if the angina gets worse or happens more often.

Sometimes it's hard to tell a severe attack of angina from the beginning of a true heart attack. You need to call 911 for emergency help right away if:

  • You have chest discomfort (pressure, fullness, squeezing, or pain) that lasts more than 5 minutes or goes away and comes back.
  • You have chest discomfort with lightheadedness.
  • Your chest pain goes beyond your chest to one or both arms or to your neck or jaw.
  • You have chest discomfort and are sweating a lot or having trouble breathing or are sick to your stomach.
  • You still have pain after taking your nitroglycerin tablets as directed.

If you are having these symptoms, do not drive yourself to the hospital. You could pass out if the angina is severe.

Developed by RelayHealth.
Published by RelayHealth.
Last modified: 2011-06-29
Last reviewed: 2010-11-04
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2011 RelayHealth and/or its affiliates. All rights reserved.
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