What is Angina?
Angina, also known as angina pectoris, is a symptom of coronary artery disease that occurs when insufficient oxygen-rich blood flows to the heart, causing pain and tightness in the chest. This reduction in blood flow is usually caused by a condition known as ischemia, where one or more arteries are blocked.
Angina causes the heart to work harder, pumping blood and resulting in chest pain. Angina is not a disease--rather, it’s a symptom of possible heart disease.
Types of Angina
There are different types of angina depending on the cause. Some types of angina persist even when a person is resting, while others may respond well to medication.
- Stable angina - Considered the most common type of angina, it is typically brought on by exertion, like exercise or walking up the stairs, or can come from exposure to cold weather or emotional stress. It is usually relieved by rest or nitroglycerin (an antianginal medication).
- Unstable angina – a medical emergency. Unstable angina is a serious condition that requires immediate medical attention. This type of angina can occur at rest, with the pain worsening in severity and frequency. Severe pain from unstable angina can last up to 20 minutes and cannot be alleviated with angina medication.
- Variant angina (Prinzmetal angina) – This type of angina is not caused by coronary artery disease. The episodes occur when a spasm in the heart’s artery disrupts the blood flow causing severe pain. It usually happens while resting or overnight. Antianginal medications are usually prescribed as treatment.
- Refractory angina - A chronic angina condition lasting up to three months, which has not responded well to previous medications, angioplasty, or bypass surgery. It’s caused by myocardial ischemia (blocked coronary artery).
Signs & Symptoms of Angina
The most common symptom of angina is a feeling of pressure or tightness in the chest. Some describe angina as having a ton of weight on their chest. The severity of pain and the length of time the symptoms last depend on the type of angina a person is experiencing.
Symptoms of angina can include:
- Chest pain or pressure
- Burning sensation
- Feeling full and uncomfortable
- A squeezing feeling in your chest
- Pain may radiate to the shoulder, back, neck, and arms
- Faint or dizzy
- Increased sweating with exertion
Call your doctor immediately if you experience new or worsening angina symptoms lasting up to 20 minutes or no improvement even with antianginal medication and rest.
Call 911 for immediate medical attention. This could be a warning sign of a heart attack stemming from unstable angina.
If you have been experiencing signs of angina, contact NewYork-Presbyterian for a consultation and examination.
Angina symptoms in women
Men are more prone to develop blockages of the coronary arteries called obstructive coronary artery disease (CAD). At the same time, women more often experience a condition called microvascular disease (MVD), which affects the tiny arteries that extend out of the coronary arteries. Cardiovascular disease is the leading cause of death for women in the United States.
Another way angina affects women differently from men is that women may experience it. Typical symptoms of angina in women include:
- Chest pain or discomfort (most times)
- Pain in the lower chest and abdomen
- Pressure in the chest
- Pain that radiates to the jaw, neck, and shoulders
- Nausea and vomiting
- Difficulty breathing
- Dizziness or fainting
What Causes Angina?
Most causes of angina are related to heart disease, where the arteries leading to the heart become blocked or narrowed with a build-up of plaque or other fatty substances. This blockage, called atherosclerosis, reduces the oxygen-rich blood supply to the heart, which causes the heart to pump harder, thus creating an episode of angina. Over time, this increased demand for the heart to pump blood harder damages the heart muscle and tissue and can cause a heart attack.
The two types of coronary heart disease that can cause angina are:
- Coronary artery disease (CAD) - Plaque accumulates in the coronary artery, which supplies the heart with blood. This condition is called atherosclerosis. The plaque can narrow the artery, putting strain on the heart to pump blood. Also, if the plaque breaks off, it can cause a blood clot which could partially or block the artery.
- Coronary microvascular disease (CVD) – The tiny arteries that branch off from the main coronary artery (arterioles) are affected. Here, these tiny arteries become blocked, causing a strain on the heart, resulting in angina. CVD is more common in women.
Risk Factors for Cardiac Arrest
Many of the risk factors for developing angina are directly affected by lifestyle choices. Yet, other angina risk factors result from unavoidable circumstances, such as age.
Risk factors that are common for angina are:
- Age - Angina is more common in people over 60 years old
- Family history - If there is a known history of heart disease in a family member, particularly at a young age, your doctor should be advised; additional tests may be ordered if concern is warranted
- Smoking - Even exposure to secondhand smoke can cause heart health issues like damaging artery linings
- High blood pressure - Can eventually damage the arteries, leading to angina
- High cholesterol & triglycerides – High cholesterol causes arteries to narrow, increasing the risk for angina or a heart attack. In addition, high triglycerides can also lead to heart disease.
- Lack of Exercise
- Medications – Drugs that constrict blood vessels, such as migraine medications, could trigger Prinzmetal angina (not connected to heart disease)
- Stimulant drugs.
- Cold temperatures
Medications to treat angina are usually well-tolerated by most people and have proven effective in controlling angina.
If you are still bothered by bouts of angina, contact your doctor. Angina can be a warning sign for a more serious heart condition. If angina is left untreated, possible complications include a heart attack, sudden death caused by irregular heart rhythms, or unstable angina.
Angina can sometimes be a warning sign of an impending heart attack. If you are experiencing unexplained or severe chest pain, call 911 for immediate medical attention.
Preventing angina follows the same rules as preventing heart disease. Embrace a healthier lifestyle, and a healthier you will follow. Some suggestions to avoid angina and heart disease include:
- Stop smoking
- Eat healthier, such as a Mediterranean diet—low in fat, salt, and sugar and high in protein and fiber.
- Lose weight
- Reduce stress
- Monitor existing health issues
Trust NewYork-Presbyterian for Angina Care
NewYork-Presbyterian’s cardiologists, heart surgeons, and the entire team of interventional cardiologists and critical care experts are here to customize your heart health care, prevent further heart damage, and improve our patient’s quality of life.
Call today to learn more about the options NewYork-Presbyterian has for angina treatment as well as other cardiovascular care services.