Patient education: Angina (The Basics)

What is angina? — Angina means chest pain or discomfort that is caused by a condition called "coronary artery disease." This condition is often just called "heart disease."

In people who have coronary artery disease, the arteries that supply blood to the heart get clogged with fatty deposits. When this happens, the arteries narrow, and the heart muscle does not get enough blood. This can cause chest pain or discomfort, especially during physical activity.

Coronary artery disease increases a person's risk of heart attack and other forms of heart disease. A heart attack happens when an artery becomes mostly or completely blocked and part of the heart is damaged.

There are 2 main types of angina:

●Stable angina – This is when the chest pain or discomfort follows a pattern. For example, you might notice it when you exercise, are stressed, or eat a big meal. These are all times when your heart needs more blood.

●Unstable angina – This is when chest pain or discomfort does not follow a pattern. It can happen at any time. It is often more severe and lasts longer than stable angina, even when you rest. Unstable angina is an emergency because it can be a sign of a heart attack.

What are the symptoms of angina? — People often describe a feeling of chest discomfort or pressure, rather than pain. It can feel similar to heartburn. It might extend to other parts of the body, such as the lower jaw, shoulders, arms, neck, or upper belly.

An episode of angina usually starts slowly and goes away slowly. With stable angina, the discomfort usually improves once you stop the activity that triggered it.

Sometimes, people also have other symptoms with angina, such as shortness of breath. Certain symptoms seem to be more common in females than in males. These include:

●Burping

●Nausea or indigestion

●Feeling dizzy or lightheaded

●Sweating

●Feeling very tired

Like chest pain, these symptoms can also be signs of a heart attack. This is why it's important to see a doctor if you have any type of chest pain or discomfort.

When should I call an ambulance for chest pain? — Call for an ambulance (in the US and Canada, call 9-1-1) if:

●Your chest pain is new or severe, or keeps getting worse.

●You have chest pain along with shortness of breath.

●Your chest pain does not get better with rest.

●Your chest pain does not get better after you take your angina medicine.

●You feel lightheaded or dizzy.

●Your symptoms scare or worry you.

If you are having a heart attack, it's very important to get treatment as soon as possible.

Will I need tests? — Yes. Your doctor or nurse will ask about your symptoms and do an exam. They will also do tests to check for other causes of chest pain, including heart attack.

Tests might include:

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart (figure 1).

●Blood tests – Blood tests can check for chemicals that are increased in people with heart damage.

●Stress test – During a stress test, you might be asked to run or walk on a treadmill while you also have an ECG. Physical activity increases the heart's need for blood. This test helps doctors see if the heart is getting enough blood. If you cannot walk or run, your doctor can give you a medicine to make your heart pump faster.

●Cardiac catheterization (also called "cardiac cath") – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then, they move the tube up to your heart. Next, the doctor puts a dye that shows up on an X-ray into the tube. This part of the test is called "coronary angiography." It can show whether any of the arteries in your heart are clogged.

●CT scan – This is a special kind of X-ray. Your doctor might use this to look at the blood vessels going to your heart.

How is angina treated? — Treatment options include:

●Medicines – This includes different types of medicine, such as "nitrates" and "beta blockers." Some work by relaxing blood vessels going to the heart muscle. Some work by reducing the amount of work the heart has to do (figure 2). If you have heart disease, you will need to take other medicines, too.

●Procedures – These restore blood flow to the part of the heart that is not getting enough blood. They include:

•Stenting – A stent is a tiny metal tube that can hold open a clogged artery (figure 3).

•Surgery – Some people get surgery called "coronary artery bypass grafting." It is sometimes just called "bypass surgery." For this, the doctor takes a healthy blood vessel from another part your body. Then, they use it to re-route blood around the clogged artery (figure 4).

Is there anything I can do on my own to feel better? — Yes. You can make healthy lifestyle changes, such as:

●Quit smoking, if you smoke – If you are having trouble quitting, your doctor or nurse can help.

●Follow a healthy diet – Eat lots of fruits and vegetables, and limit foods with saturated fat (such as meat and fried foods). Limit processed foods.

●Move your body – Try to walk or do some form of physical activity on most days of the week. Even gentle exercise is good for your health.

●Lose weight, if you have excess body weight – Your doctor or nurse can help you do this in a healthy way.

More on this topic

Patient education: Treatment choices for angina (chest pain) (The Basics)
Patient education: Chest pain (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Medicines after a heart attack (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Coronary artery disease in women (The Basics)
Patient education: ECG and stress test (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Nuclear heart testing (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Stenting for the heart (The Basics)
Patient education: Stress cardiomyopathy (The Basics)

Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)
Patient education: Medications for angina (Beyond the Basics)
Patient education: Chest pain (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: Stenting for the heart (Beyond the Basics)