Angina pectoris is a Latin phrase that means “strangling in the chest.” Patients describe angina as a squeezing, suffocating, or burning feeling in their chest, but an episode of angina is not a heart attack. Unlike a heart attack, the heart muscle is not damaged forever, and the pain usually goes away with rest. Knowing the types of angina and how they differ is important.

What causes angina?

Angina results when a diseased vessel in your heart (a coronary artery) can no longer deliver enough blood to a part of the heart muscle to meet its need for oxygen. The heart’s lack of oxygen-rich blood is called ischemia. Angina usually happens when your heart has an extra need for oxygen-rich blood, such as during exercise. Other causes of angina can be emotional stress, extreme cold or hot temperatures, heavy meals, alcohol, and smoking.

Angina attacks in men usually happen after the age of 30 and are nearly always caused by coronary artery disease (CAD). For women, angina tends to happen later in life and can be caused by CAD or many different factors such as narrowing of the aortic valve in the heart (aortic stenosis), a low number of red blood cells in the bloodstream (anemia), or an overactive thyroid gland (hyperthyroidism). Angina can also be a symptom of coronary microvascular disease.

What are the symptoms?

Angina is usually a symptom of CAD.

Angina tends to start in the center of the chest, but the pain may spread to your left arm, neck, back, throat, or jaw. You may have numbness or a loss of feeling in your arms, shoulders, or wrists. An episode usually lasts no more than a few minutes. But if the pain lasts longer or changes or increases, you should seek immediate medical attention.

Patients with stable angina usually know the level of activity or stress that brings on an attack. You should keep track of how long attacks last, if the attacks feel different than previous ones, and whether medicine helps ease the symptoms. Sometimes patterns change—attacks happen more often, last longer, or happen without exercise.

A change in the pattern of attacks may indicate unstable angina, and you should see a doctor as soon as you can. Patients who have new, worsening, or constant chest pain have a greater risk of heart attack, an irregular heartbeat (arrhythmia), and even sudden death.

Other Types of Angina

Variant angina pectoris, or Prinzmetal’s angina, is a rare form of angina caused by coronary spasm (vasospasm). The spasm temporarily narrows the coronary artery, so the heart does not get enough blood. It may happen in patients who also have a severe buildup of fatty plaque (atherosclerosis) in at least one major vessel. Unlike typical angina, variant angina usually happens during times of rest. These attacks, which may be very painful, tend to happen regularly at certain times of the day.

Microvascular angina is a type of angina where patients have chest pain but do not seem to have a blockage in a coronary artery. The pain in the chest is because the tiny blood vessels that feed the heart, arms, and legs are not working properly. Generally, patients cope well with this type of angina and have few long-term side effects; however, this type of angina may lead to a diagnosis of coronary microvascular disease and may raise the risk of heart attack.

How is angina diagnosed?

Doctors can usually find out if you have angina by listening to you talk about your symptoms and their patterns. Some tests may include x-rays, exercise electrocardiography (ECG or EKG), a nuclear stress test, and coronary angiography. Doctors may also use blood tests to check the levels of certain proteins in your blood.

Variant angina can be diagnosed using a Holter monitor. Holter monitoring gets a non-stop reading of your heart rate and rhythm over a 24-hour period (or longer).

How is angina treated?

Lifestyle changes and medicine are the most common ways to control angina. In more severe cases, a procedure called revascularization may be necessary.

Lifestyle Changes

Although angina may be brought on by exercise, this does not mean that you should stop exercising. In fact, you should keep doing an exercise program that has been approved by your doctor. Risk factors for CAD (usually atherosclerosis) should be controlled, including high blood pressure, cigarette smoking, high cholesterol, and excess weight. By eating healthfully, not smoking, limiting how much alcohol you drink, and avoiding stress, you may live more comfortably and with fewer angina attacks.

Medicines

Certain medicines may help prevent or relieve the symptoms of angina. The most well-known medicine for angina is called nitroglycerin. It works by widening (dilating) the blood vessels, which improves blood flow and allows more oxygen-rich blood to reach the heart muscle. “Nitro” works in seconds. The moment an attack happens, patients are usually told to sit or lie down and then take their nitroglycerin. If an activity such as climbing the stairs brings on angina, you can take nitroglycerin beforehand to prevent an attack.

Other medicines used to control typical angina and microvascular angina are beta-blockers and calcium channel blockers. These medicines reduce the oxygen needs of the heart by slowing the heart rate or lowering blood pressure. They also reduce the likelihood of an irregular heartbeat, called an arrhythmia. Calcium channel blockers and nitrates may also be used to prevent the spasms that cause variant angina.

For patients with stable angina, doctors may prescribe antiplatelet therapy, such as aspirin. These medicines reduce the blood’s ability to clot, making it easier for blood to flow through narrowed arteries.

For patients with unstable angina, doctors normally prescribe bed rest and some type of blood-thinning medicine such as heparin.

Percutaneous Coronary Interventions and Surgery

If typical angina or variant angina is caused by severe CAD, then a revascularization procedure may be needed to improve the blood supply to your heart. Procedures may include either a percutaneous coronary intervention (such as balloon angioplasty or stenting) or coronary artery bypass surgery.