Chronic kidney disease and the global public health agenda: an international consensus
Angina (Ischemic Chest Pain)
Angina is chest pain that happens because there isn't enough blood going to part of your heart. It can feel like a heart attack, with pressure or squeezing in your chest. It's sometimes called angina pectoris or ischemic chest pain.
It's a symptom of heart disease, and it happens when something blocks your arteries or there's not enough blood flow in the arteries that bring oxygen-rich blood to your heart.
With angina, pain in your chest can spread to your shoulders, arms, neck, throat, jaw, or back. (Image credit: Rob3000 / Dreamstime)
Angina usually goes away quickly. Still, it can be a sign of a life-threatening heart problem. It's important to find out what's going on and what you can do to avoid a heart attack.
Usually, medicine and lifestyle changes can control angina. If it's more serious, you may need surgery. Or you may need what's called a stent, a tiny tube that props open arteries.
Angina vs. Heart attack
Heart disease can also cause a heart attack. The decrease in blood flow to your heart in a heart attack is longer than that in angina. This causes part of the heart muscle to die, which is permanent damage. The drop in blood flow to your heart in angina is short. So it doesn't cause permanent damage.
There are different types of angina:
Stable angina
This is the most common type of angina. 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 can be a sign that you're more likely to have one. Tell your doctor if this happens to you.
Unstable angina
You can have unstable angina while you're at rest or not very active. The pain can be strong and long-lasting, and it may 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.
Microvascular angina
With microvascular angina, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren't working the way they should, so your heart doesn't get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women.
Prinzmetal's angina (variant angina)
This type of angina is rare. It might happen at night while you're sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.
Chest pain is the symptom, but it affects people differently. You may have:
You might mistake an aching or burning for heartburn or gas.
You're likely to have pain behind your breastbone, which can spread to your shoulders, arms, neck, throat, jaw, or back.
Stable angina often gets better with rest. Unstable angina may not, and it could get worse. It's an emergency that needs medical help right away.
Angina symptoms by sex
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 that women were more likely to use the words "pressing" or "crushing" to describe the feeling.
You get a heart attack when blood flow to your heart muscle gets restricted or blocked, often by a clot in an artery. Without oxygen, your heart muscle gets damaged or could even die.
A 2008 study in the American Journal of Critical Care found that chest pain is the most frequently reported heart attack symptom, and 61% of 256 participants said their symptoms were constant.
Your chest pain may feel like:
"If you've not experienced it before, patients often aren't sure what it is when it first comes on," says Kristin Newby, MD, a cardiologist at the Duke Heart Center in Durham, NC.
The same study found that women were about 8 years older than men when they began to have heart trouble and were more likely to report a higher intensity of five other symptoms:
The study found that 21% of women and 10% of men had no symptoms. Less typical symptoms for both men and women are:
"Men and women may respond differently to the symptoms of a heart attack, particularly if the symptoms are vague. But if you have symptoms consistent with a heart attack, don't wait at home. Go to the hospital," says Alfred Sacchetti, MD, an emergency room doctor.
Angina usually happens because of heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to your heart muscle. This forces your heart to work with less oxygen, which causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.
Less common causes of chest pain include:
Some things about you or your lifestyle could put you at a higher risk of angina, including:
Your doctor will do a physical exam and ask about your symptoms, risk factors, and family history. They might need to do tests including:
Angina questions for your doctor
Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine and lifestyle changes can often help their blood flow better and control their symptoms.
Medicines
Your doctor might prescribe medicines including:
Cardiac procedures
If meds aren't enough, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:
Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again.
The procedure usually takes less than 2 hours. You'll probably stay overnight at the hospital.
Coronary artery bypass grafting or bypass surgery. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.
You can expect to stay in the hospital for about a week after you have this. You'll be in the intensive care unit for 1 or 2 days 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.
Enhanced external counterpulsation (EECP)
EECP may be an option to relieve your angina. Your doctor may recommend it if other treatments haven't worked or aren't right for you.
EECP uses several blood pressure cuffs on both legs to gently, but firmly, compress the blood vessels there to boost blood flow to your heart. Each wave is timed to your heartbeat. So more blood goes there when it's relaxing.
When your heart pumps again, pressure is released right away. This lets blood to be pumped more easily. It can help your blood vessels make a natural bypass around narrowed or blocked arteries that cause your chest pain. It may help some small blood vessels in your heart open. They may give more blood flow to your heart muscle to help ease your chest pain.
You might have EECP if you:
EECP isn't invasive. If you're accepted for EECP treatment, you'll have 35 hours of therapy. It's given 1-2 hours a day, 5 days a week, for 7 weeks. Studies show its benefits include less need for angina medicine, fewer symptoms, and the ability to be more active without symptoms.
Angina raises your risk of having a heart attack. But it's treatable. Consider it a warning sign and make healthy choices.
Talk with others who have it. This may help you learn how to 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.
Lifestyle changes
You can still be active, but it's important to listen to your body. If you feel pain, stop what you're doing and rest. Know what triggers your angina, like stress or intense exercise. Try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often. If you still feel pain, talk to your doctor about having more tests or changing your medications. Because angina can be a sign of something dangerous, it's important to get checked out.
These lifestyle tips may help protect your heart:
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. Quick treatment is very important. It can protect you from more damage.
Angina is chest pain that happens when the flow of blood to your heart briefly decreases.
Angina means chest pain. It can sometimes signal a heart attack. Angina can be a sign of very serious heart issues. When you have chest pain, it's important to see a doctor right away.
Gas can get trapped in your digestive system if you can't burp it out or pass it out. Sometimes, if it's in the upper part of your digestive tract, it can make your chest hurt. You need to find out the source of any of chest pain you may have. If you're having other symptoms that might mean you're having a heart attack or angina (see above), get medical help right away.
Chest pain from gas can come after you eat or drink something that causes the gas to form. Burping or passing the gas is the fastest way to get rid of it, but if it's trapped, you might try:
What To Know About Unstable Angina
Angina happens when one of the heart's blood vessels is blocked and temporarily deprives the heart muscle of blood and oxygen, causing chest pain. If you feel like someone is squeezing your heart when you're stressed or have sudden pain in your left arm, you may be experiencing angina. Even if you have angina that only lasts for a few moments, you should speak with a doctor to determine if it might be a warning sign of coronary artery disease. Read on to learn more about unstable angina and how to manage your symptoms.
When plaque — a deposit of cholesterol, fat, and other substances — builds up inside your arteries, the artery walls narrow and become rigid, reducing blood flow to your heart. This reduced blood flow can bring on sudden chest pain.
The lack of blood flow to the heart causes angina — a symptom of coronary artery disease. The pressure and squeezing it causes can feel like a heart attack.
Stable angina is the most common type and typically occurs when you feel emotional stress or physically overexert yourself. The chest pain or discomfort caused by stable angina should subside with rest and — if necessary — medication prescribed by your doctor.
By contrast, unstable angina is sudden and can happen while you're resting. Unstable angina might also occur if symptoms of angina are new or have suddenly increased in frequency or severity. Having unstable angina typically means the blockage in your arteries has reached a critical level. As a result, chest pain and discomfort become more persistent and severe.
Unstable angina is a life-threatening emergency — rest or medicine will not help relieve your condition, and the pain will worsen over time. Call 911 if you have chest pain or discomfort while at rest, as well as:
Coronary heart disease is the principal cause of unstable angina. Left untreated, a clot can completely block an artery, leading to a heart attack or heart failure.
The risk of having unstable angina increases with age. It is more common in men ages 45 and older and in women ages 55 and older. The risk is higher if a person:
Eating a healthier diet, losing weight, lowering stress, and quitting smoking can lessen your chances of developing and experiencing unstable angina. Talk to your doctor about a treatment plan to improve your heart health.
Because unstable angina is a medical emergency, you will first be treated with painkillers and aspirin to prevent blood clots.
You will then have a procedure called a cardiac catheterization in which you will be given a nitroglycerin capsule to widen your heart's blood vessels. During the procedure, the doctor guides a catheter through an artery in your arm, groin, or leg and into the coronary arteries. The catheter is then injected with a liquid dye, and a high-speed X-ray records the course of the dye as it makes its way through your arteries, allowing the doctor to trace the flow and identify blockages.
The severity of your coronary artery blockage will determine the course of treatment. If the blockage has reached a critical stage, your doctor will likely recommend an angioplasty, a procedure in which a small tube, also known as a stent, is inserted in the artery to keep it open.
Your doctor may also recommend heart bypass surgery, a procedure that reroutes blood flow away from the blocked artery, improving overall blood flow to your heart.
Common treatments for unstable angina include blood thinners like heparin, clopidogrel, and aspirin. Medications that reduce blood pressure or cholesterol levels may also be prescribed to reduce symptoms of angina.
Everything You Need To Know About Angina
Angina occurs when part of the heart does not receive enough oxygen. It may feel like pain, squeezing, or pressure in the chest. Angina is not a disease but a symptom of another underlying condition.
In this article, learn about the types of angina, which doctors classify, at least in part, according to their pattern of occurrence.
We also describe symptoms specific to females, when anyone should contact a doctor, signs of an emergency, and the range of treatments.
Angina is tightness, squeezing, pressure, or pain in the chest. It occurs when an area of the heart muscle receives less blood oxygen than usual.
Angina is not a disease but a symptom. It usually happens due to ischemia, when one or more of the coronary arteries becomes narrow or blocked. It is often a symptom of coronary heart disease (CHD).
Alone, angina is not life threatening, but it can resemble the symptoms of a heart attack, and it is a sign of heart disease.
Receive medical attention if angina occurs unexpectedly, does not go away, or does not respond to rest or medication.
There are several types of angina, including:
Stable angina
Stable angina occurs when the heart is working harder than usual — for instance, during exercise. It usually lasts around 5 minutes.
It has a regular pattern, and a person may experience it for months or years. Rest or medication often relieves the symptoms.
Unstable angina
Unstable angina does not follow a regular pattern and usually occurs during rest. It mostly results from atherosclerosis, which involves a blockage preventing blood from reaching the heart.
The pain lasts longer than 5 minutes and may worsen over time. Rest and medication alone maynot improve the symptoms.
Unstable angina can indicate the risk of a heart attack. Anyone with unexpected angina should receive emergency care.
Microvascular angina
Microvascular angina can occur with coronary microvascular disease (MVD). This affects the smallest coronary arteries.
As well as chest pain, a person may experience:
Microvascular angina tends to be more persistent than stable angina. It often lasts longer than 10 minutes and sometimes longer than 30 minutes.
Variant angina
Variant angina is rare. Doctors sometimes call it Prinzmetal angina, and it can develop when the body is at rest, often around midnight or the early morning.
It happens when a spasm occurs in the coronary arteries. Possible triggers include exposure to cold, stress, medicines, smoking, or cocaine use.
It is a chronic condition, but medication can help manage it.
Angina involves any of the following sensations in the chest:
The pain often spreads to the neck, jaw, arms, shoulders, throat, back, or teeth.
Other possible symptoms include:
The duration of these symptoms depends on the type of angina.
Anyone who experiences severe or persistent chest pain should call 911 or otherwise seek emergency care.
In anyone, angina may stem from CHD or MVD.
MVD affects females more often than males, and as a result, the American Heart Association (AHA) explain, females may experience different symptoms that accompany angina.
As well as chest pain, which may be sharp, a female with angina may experience:
The AHA urge females to seek help for symptoms of heart disease. They emphasize that cardiovascular disease is the main cause of death among females in the United States and that it occurs in almost half of Black American females.
Treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of a heart attack. A doctor may recommend medication, lifestyle changes, a surgical procedure, or a combination.
Lifestyle changes
The following strategies can help:
Medications
Doctors often prescribe nitrates, such as nitroglycerin, for angina. Nitrates prevent or reduce the intensity of angina by relaxing and widening the blood vessels.
Other drug options include:
Medications to manage high blood pressure may help manage angina. These aim to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming.
Alternatives other than surgery
Surgical procedures
In some cases, a procedure is necessary. A heart specialist may recommend an angioplasty, possibly with a stent placement.
Alternately, the cardiologist may recommend coronary artery bypass grafting, in which a surgeon uses a healthy artery or vein from another part of the body to bypass narrowed arteries in the heart.
Angina usually results from underlying coronary artery disease.
The coronary arteries supply the heart with oxygen-rich blood. When cholesterol collects on the wall of an artery and forms hard plaques, this effectively narrows the arteries.
Other factors, including damage to the arteries and smoking, increase the risk of plaque buildup.
When the arteries narrow, it becomes harder for oxygen-rich blood to reach the heart. Also, plaques may break off and form clots that block the arteries.
If blood cannot carry oxygen to the heart, the heart muscle cannot work properly. This causes angina.
Angina involves sensations of pain, squeezing, or pressure in the chest, and it results from too little oxygen reaching the heart muscle. It is not necessarily dangerous, but it can be a sign of heart disease.
Effective medical treatments and lifestyle changes can manage angina or prevent it from returning.
Anyone who experiences sudden, unexplained, or worsening or chest pain should receive medical attention right away.
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