Medically reviewed by Dr. Ramesh Gaddam, M.D. — Written by Sumalatha, D.N.H.E
Angina is a medical term used to describe chest pain or discomfort that occurs when the heart muscle doesn’t receive enough blood flow. It is often a symptom of an underlying heart condition, typically coronary artery disease (CAD). CAD occurs when the blood vessels (coronary arteries) that supply blood to the heart muscle become narrowed or blocked due to the buildup of plaque.
Types of Angina
Angina is generally classified into several types based on the nature and characteristics of the symptoms. The main types of angina include:
Stable Angina:
This is the most common type of angina.
Stable angina is predictable and usually occurs during physical exertion or stress when the heart’s demand for oxygen increases.
The pain or discomfort is typically relieved by rest or the use of medications like nitroglycerin.
Unstable Angina:
Unstable angina is more serious and unpredictable.
It can occur at rest or with minimal exertion, and the symptoms may be more severe, prolonged, or occur more frequently.
Unstable angina is considered a medical emergency as it may indicate an increased risk of a heart attack.
Variant Angina (Prinzmetal’s Angina):
This type of angina is caused by coronary artery spasm, which leads to a temporary narrowing of the coronary arteries.
Variant angina can occur at rest and may not be related to physical exertion or stress.
It is often relieved by medications that dilate blood vessels, such as nitroglycerin.
Microvascular Angina:
Microvascular angina involves dysfunction of the small blood vessels (microvasculature) in the heart.
While the larger coronary arteries may appear normal, the microvessels do not function properly, leading to chest pain.
This type is more common in women and may not always be detected by standard diagnostic tests.
Symptoms of Angina
The symptoms of angina can vary, but they often involve chest discomfort or pain. The most common symptoms include:
- Chest Pain or Discomfort
- Shortness of Breath
- Fatigue
- Nausea or Indigestion
- Sweating
- Dizziness or Lightheadedness
Chest Pain or Discomfort:
The primary symptom of angina is usually a feeling of pressure, squeezing, burning, or heaviness in the chest.
The discomfort may also be described as tightness or aching.
It is typically located behind the breastbone (sternum) but may radiate to the arms (usually the left arm), neck, jaw, shoulder, or back.
Shortness of Breath:
Some people with angina may experience difficulty breathing or shortness of breath, especially during physical exertion.
Fatigue:
Angina can cause a feeling of fatigue or weakness, particularly if the heart is not receiving enough blood and oxygen.
Nausea or Indigestion:
Some individuals may experience nausea, indigestion, or abdominal discomfort as part of angina symptoms.
Sweating:
Profuse sweating, often described as clammy or cold sweats, can occur during an angina episode.
Dizziness or Lightheadedness:
Reduced blood flow to the heart may result in dizziness or lightheadedness.
Causes of Angina
Angina is primarily caused by a reduced blood flow to the heart muscle, typically due to coronary artery disease (CAD).
CAD is characterized by the accumulation of fatty deposits, cholesterol, and other substances (plaque) within the coronary arteries, leading to their narrowing or blockage.
The most common causes of angina include:
- Atherosclerosis
- Coronary Artery Spasm
- Coronary Microvascular Disease
- Arterial Embolism
- Aortic Stenosis
- Hypertrophic Cardiomyopathy
- Heart Failure
Atherosclerosis:
The primary cause of angina is atherosclerosis, a condition where plaque builds up on the inner walls of the coronary arteries.
This buildup narrows the arteries, restricting blood flow to the heart muscle.
Coronary Artery Spasm:
In some cases, angina may be caused by a spasm or contraction of the coronary arteries, reducing blood flow to the heart temporarily.
This variant of angina is known as Prinzmetal’s or variant angina.
Coronary Microvascular Disease:
This condition involves the dysfunction of the tiny blood vessels (microvasculature) that supply blood to the heart muscle.
Even though the larger coronary arteries may appear normal, the microvessels may not function properly, leading to angina symptoms.
Arterial Embolism:
An embolism occurs when a blood clot or other material travels through the bloodstream and blocks a coronary artery, reducing blood flow to the heart muscle.
Aortic Stenosis:
This is a condition where the aortic valve, responsible for regulating blood flow out of the heart, becomes narrowed.
It can reduce the amount of blood leaving the heart and may contribute to angina.
Hypertrophic Cardiomyopathy:
In this condition, the heart muscle becomes abnormally thick, making it harder for the heart to pump blood effectively and potentially leading to angina.
Heart Failure:
In cases of heart failure, the heart may not pump blood efficiently, causing a backup of blood in the coronary veins and reducing oxygen delivery to the heart muscle, leading to angina.
Diagnosis of Angina
Diagnosing angina typically involves a combination of medical history assessment, physical examination, and various diagnostic tests. Here are some common methods used for the diagnosis of angina:
Medical History and Physical Examination:
The healthcare provider will gather information about the patient’s symptoms, medical history, risk factors, and lifestyle.
A thorough physical examination may be conducted to check for signs of heart disease, such as elevated blood pressure, abnormal heart sounds, or evidence of other cardiovascular issues.
Electrocardiogram (ECG or EKG):
An ECG records the electrical activity of the heart.
It can help detect irregularities in the heart’s rhythm and identify any signs of reduced blood flow to the heart muscle.
Stress Testing:
Stress tests involve monitoring the heart’s response to physical activity or medication that simulates the effects of exercise.
This can be done on a treadmill or with medications that induce stress.
Stress testing helps evaluate the heart’s function and identify abnormalities, such as reduced blood flow or changes in the ECG during exertion.
Echocardiogram:
An echocardiogram uses sound waves to create a moving image of the heart.
It helps assess the heart’s structure and function, including the pumping ability of the heart muscle.
Coronary Angiography:
Coronary angiography involves injecting a contrast dye into the coronary arteries and taking X-ray images.
This procedure helps visualize any blockages or narrowed areas in the coronary arteries, providing detailed information about blood flow.
Blood Tests:
Blood tests may be conducted to measure cholesterol levels, assess for the presence of certain enzymes (such as troponin) that indicate heart damage, and evaluate other factors related to heart health.
CT Angiography:
Computed tomography (CT) angiography uses X-rays to create detailed cross-sectional images of the coronary arteries.
It can help identify blockages or narrowing in the arteries.
Risk Factors of Angina
Several risk factors can contribute to the development of angina, particularly when associated with coronary artery disease (CAD).
It’s important to recognize these risk factors as they can provide insight into an individual’s likelihood of experiencing angina or other cardiovascular issues.
Common risk factors for angina include:
- Age
- Gender
- Family History
- Tobacco Smoke and Smoking
- High Blood Pressure (Hypertension)
- High Cholesterol Levels
- Diabetes
- Obesity
- Physical Inactivity
- Unhealthy Diet
- Excessive Alcohol Consumption
- Stress
The risk of developing angina and coronary artery disease increases with age. Aging is often associated with the accumulation of plaque in the arteries.
Gender:
Men generally have a higher risk of angina than premenopausal women. However, the risk for women increases after menopause.
Family History:
A family history of heart disease, especially if a close relative had early-onset heart disease, can increase the risk of developing angina.
Tobacco Smoke and Smoking:
Smoking is a major risk factor for angina and coronary artery disease.
The chemicals in tobacco can damage blood vessels and contribute to the development of atherosclerosis.
High Blood Pressure (Hypertension):
Elevated blood pressure puts increased stress on the heart and arteries, promoting the development of atherosclerosis.
High Cholesterol Levels:
High levels of LDL (low-density lipoprotein) cholesterol, often referred to as “bad” cholesterol, can lead to the buildup of plaque in the coronary arteries.
Diabetes:
Diabetes, particularly if poorly controlled, can accelerate the development of atherosclerosis and increase the risk of angina and heart disease.
Obesity:
Being overweight or obese is associated with an increased risk of angina.
Excess weight can contribute to other risk factors such as high blood pressure and diabetes.
Physical Inactivity:
Lack of regular physical activity is a risk factor for heart disease. Exercise helps maintain cardiovascular health and can lower the risk of angina.
Unhealthy Diet:
Diets high in saturated and trans fats, cholesterol, sodium, and refined sugars contribute to the development of atherosclerosis and increase the risk of angina.
Excessive Alcohol Consumption:
Drinking alcohol excessively can contribute to high blood pressure and increase the risk of heart disease.
Stress:
Chronic stress may contribute to heart disease indirectly through behaviors like smoking, overeating, or lack of exercise.
Complications of Angina
While angina itself is not a heart attack, it is considered a warning sign of an underlying heart condition, typically coronary artery disease (CAD).
If left untreated or unmanaged, angina can lead to various complications, including:
- Heart Attack (Myocardial Infarction)
- Unstable Angina
- Arrhythmias
- Heart Failure
- Cardiogenic Shock
- Recurrent Angina
- Sudden Cardiac Death
Heart Attack (Myocardial Infarction):
One of the most serious complications of angina is the progression to a heart attack.
A heart attack occurs when the blood flow to a part of the heart muscle is blocked completely, leading to damage or death of the heart tissue.
Unstable Angina:
Angina is classified into stable and unstable forms. Unstable angina is more severe and unpredictable, occurring even at rest.
It may signal a higher risk of a heart attack and requires immediate medical attention.
Arrhythmias:
Reduced blood flow to the heart can disrupt the normal electrical impulses that regulate the heart’s rhythm, leading to abnormal heart rhythms or arrhythmias.
Heart Failure:
Chronic inadequate blood supply to the heart muscle can weaken the heart over time, leading to heart failure.
Heart failure occurs when the heart is unable to pump blood effectively to meet the body’s needs.
Cardiogenic Shock:
In severe cases, particularly during a heart attack, the heart may become so damaged that it is unable to pump enough blood to meet the body’s requirements.
This can lead to a life-threatening condition called cardiogenic shock.
Recurrent Angina:
Without proper management, angina episodes can become more frequent and severe, reducing the individual’s quality of life and increasing the risk of complications.
Sudden Cardiac Death:
In rare cases, severe coronary artery disease can lead to sudden cardiac death, which is an abrupt loss of heart function.
This is a medical emergency and requires immediate intervention, typically with cardiopulmonary resuscitation (CPR) and defibrillation.
Treatment of Angina
The treatment of angina aims to relieve symptoms, improve the quality of life, and reduce the risk of complications, such as heart attack and heart failure.
The specific approach to treatment may vary based on the type of angina, its severity, and the underlying causes. Here are common treatment strategies for angina:
Lifestyle Modifications:
Healthy Diet:
Adopting a heart-healthy diet that is low in saturated and trans fats, cholesterol, and sodium can help manage angina. Focus on fruits, vegetables, whole grains, and lean proteins.
Regular Exercise:
Engaging in regular physical activity, under the guidance of a healthcare professional, helps improve cardiovascular health and may reduce angina symptoms.
Smoking Cessation:
Quitting smoking is crucial, as tobacco smoke contributes to the progression of coronary artery disease.
Medications:
Nitroglycerin:
Nitroglycerin is commonly used to relieve acute episodes of angina by dilating the coronary arteries and improving blood flow to the heart.
Beta-blockers:
These medications reduce the workload on the heart by slowing the heart rate and decreasing blood pressure, helping to manage angina symptoms.
Calcium Channel Blockers:
These medications relax blood vessels, improve blood flow, and reduce the heart’s workload.
Antiplatelet Drugs:
Aspirin and other antiplatelet medications may be prescribed to prevent blood clots and reduce the risk of heart attack.
Statins:
Statin medications help lower cholesterol levels and may be prescribed to reduce the progression of atherosclerosis.
Angioplasty and Stenting:
Percutaneous Coronary Intervention (PCI):
Angioplasty involves using a catheter with a balloon to widen narrowed or blocked coronary arteries. Stents may be placed to keep the arteries open.
Coronary Artery Bypass Grafting (CABG):
In cases of severe coronary artery disease, CABG surgery may be recommended.
This procedure involves bypassing blocked arteries by grafting a blood vessel from another part of the body.
Cardiac Rehabilitation:
Cardiac rehabilitation programs include supervised exercise, education on heart-healthy living, and support for making lifestyle changes.
These programs can improve cardiovascular health and reduce the risk of angina recurrence.
Oxygen Therapy:
In certain situations, supplemental oxygen may be provided to increase oxygen levels in the blood and alleviate angina symptoms.
Prevention of Angina & Self-Care
Preventing angina involves addressing modifiable risk factors and adopting a heart-healthy lifestyle. Here are key preventive measures:
Quit Smoking:
Smoking is a significant risk factor for angina and cardiovascular disease. Quitting smoking can have immediate and long-term benefits for heart health.
Adopt a Healthy Diet:
Consume a diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Limit intake of saturated and trans fats, cholesterol, and sodium. Following a heart-healthy diet helps manage cholesterol levels and maintain overall cardiovascular health.
Maintain a Healthy Weight:
Achieving and maintaining a healthy weight reduces the risk of developing conditions such as hypertension, diabetes, and high cholesterol, which contribute to angina.
Exercise Regularly:
Engage in regular physical activity, following guidelines provided by healthcare professionals. Exercise improves cardiovascular fitness, helps control weight, and promotes overall heart health.
Manage Stress:
Chronic stress can contribute to heart disease. Adopt stress-reducing techniques such as deep breathing, meditation, yoga, or other relaxation methods.
Control Blood Pressure:
Keep blood pressure within a healthy range through lifestyle modifications, medications if prescribed, and regular monitoring.
Manage Diabetes:
If you have diabetes, work with healthcare professionals to manage blood sugar levels through diet, exercise, and medications as needed.
Limit Alcohol Intake:
Moderation in alcohol consumption is advised. Excessive alcohol intake can contribute to high blood pressure and other heart-related issues.
Take Medications as Prescribed:
If prescribed medications for conditions such as high blood pressure, high cholesterol, or diabetes, take them as directed by healthcare professionals.
Regular Medical Check-ups:
Schedule regular check-ups with healthcare providers for monitoring and managing cardiovascular risk factors. Early detection and intervention can help prevent the progression of heart disease.
Undergo Cardiac Rehabilitation:
If diagnosed with angina or a heart-related condition, participating in a cardiac rehabilitation program can provide structured exercise, education, and support for lifestyle changes.
Follow a Treatment Plan:
Adhere to any prescribed medications, lifestyle modifications, and treatment plans recommended by healthcare professionals.
Things to Avoid with Angina
Individuals with angina should be mindful of their lifestyle choices to manage the condition and reduce the risk of triggering angina episodes.
Here are things to avoid with angina:
Smoking:
Smoking is a major risk factor for cardiovascular disease, including angina.
It can constrict blood vessels and reduce oxygen supply to the heart.
Quitting smoking is crucial for heart health.
Excessive Alcohol Consumption:
While moderate alcohol consumption may have some cardiovascular benefits, excessive drinking can lead to high blood pressure, irregular heartbeats, and increased risk of heart disease.
Limit alcohol intake.
High-Fat and High-Sodium Foods:
A diet high in saturated and trans fats, cholesterol, and sodium can contribute to the development and progression of coronary artery disease.
Opt for a heart-healthy diet with fruits, vegetables, whole grains, and lean proteins.
Stress and Anxiety:
Chronic stress and anxiety can trigger angina episodes.
Employ stress-reducing techniques such as deep breathing, meditation, or yoga to manage stress levels.
Cold Weather or Extreme Temperatures:
Exposure to very cold weather or extreme temperatures can cause blood vessels to constrict, potentially triggering angina.
Dress appropriately and avoid prolonged exposure to extreme conditions.
Strenuous Physical Activity Without Consultation:
While regular exercise is beneficial for heart health, engaging in strenuous physical activity without consulting a healthcare professional can trigger angina in some cases.
Develop an exercise plan with guidance from your doctor.
Overeating or Large Meals:
Large, heavy meals can increase the demand on the heart and lead to indigestion, potentially triggering angina.
Opt for smaller, more frequent meals throughout the day.
Dehydration:
Dehydration can strain the cardiovascular system and contribute to angina.
Stay well-hydrated, especially during physical activity or in hot weather.
Skipping Medications:
Adherence to prescribed medications is crucial for managing angina.
Skipping medications can lead to uncontrolled symptoms and an increased risk of complications.
Ignoring Symptoms:
Ignoring or downplaying symptoms of angina can lead to delayed medical intervention.
Report any changes in symptoms promptly to your healthcare provider.
Uncontrolled Blood Pressure and Diabetes:
Poorly managed blood pressure and diabetes can worsen angina and increase the risk of complications. Regular monitoring and effective management are essential.
Diet for Angina
A heart-healthy diet is crucial for managing angina and reducing the risk of complications associated with coronary artery disease (CAD).
Here are dietary recommendations for individuals with angina:
Low-Fat, Low-Cholesterol Diet:
Reduce saturated and trans fats, as they can contribute to the buildup of plaque in the arteries.
Choose lean sources of protein such as poultry, fish, legumes, and low-fat dairy products.
Heart-Healthy Fats:
Include sources of monounsaturated and polyunsaturated fats in the diet, such as olive oil, avocados, nuts, and seeds.
These fats have cardiovascular benefits.
Omega-3 Fatty Acids:
Incorporate fatty fish, such as salmon, mackerel, and trout, into the diet.
Omega-3 fatty acids found in these fish can help lower cholesterol levels and reduce inflammation.
Whole Grains:
Choose whole grains over refined grains.
Whole grains, such as brown rice, whole wheat, quinoa, and oats, provide fiber and essential nutrients.
Fruits and Vegetables:
Aim for a variety of colorful fruits and vegetables, as they are rich in antioxidants, vitamins, and minerals. These nutrients contribute to overall heart health.
Low-Sodium Diet:
Limit salt intake to help control blood pressure.
Avoid processed foods and restaurant meals high in sodium. Use herbs and spices to add flavor to dishes instead of salt.
Limit Added Sugars:
Reduce the consumption of sugary foods and beverages.
Opt for natural sources of sweetness, such as fruits, and be mindful of hidden sugars in processed foods.
Portion Control:
Pay attention to portion sizes to avoid overeating.
Eating smaller, more frequent meals throughout the day can help maintain steady energy levels and prevent excessive demands on the heart.
Hydration:
Stay well-hydrated by drinking plenty of water.
Adequate hydration is essential for overall health and can help prevent dehydration, which may strain the cardiovascular system.
Limit Caffeine Intake:
Some individuals may be sensitive to caffeine, which can potentially trigger angina in certain cases.
Monitor your response to caffeine-containing beverages and consider reducing intake if necessary.
Alcohol in Moderation:
If you consume alcohol, do so in moderation.
Moderate alcohol consumption may have some cardiovascular benefits, but excessive drinking can contribute to heart-related issues.
Consult with a Registered Dietitian:
Work with a registered dietitian to create an individualized meal plan.
They can help tailor dietary recommendations based on specific health needs, preferences, and lifestyle.
Frequently Asked Questions
What is Angina?
Angina is a medical condition characterized by chest pain or discomfort that occurs when the heart muscle doesn’t receive enough blood, typically due to coronary artery disease (CAD).
What Does Angina Feel Like?
The sensation of angina is often described as pressure, squeezing, burning, tightness, or heaviness in the chest.
It may also be felt in the arms, neck, jaw, shoulder, or back.
What Causes Angina?
Angina is primarily caused by reduced blood flow to the heart muscle, usually due to the buildup of plaque in the coronary arteries, a condition known as atherosclerosis.
How is Angina Diagnosed?
Diagnosis involves a combination of medical history assessment, physical examination, and diagnostic tests such as electrocardiogram (ECG), stress testing, echocardiogram, coronary angiography, and blood tests.
Angina Pectoris Occurs When
Angina pectoris occurs when there is insufficient blood flow to meet the heart’s demand for oxygen, leading to temporary chest pain or discomfort.
What is Angina Pain?
Angina pain is characterized by discomfort in the chest, often described as pressure, squeezing, burning, tightness, or heaviness.
It can radiate to other areas such as the arms, neck, jaw, shoulder, or back.
How Long Does Angina Last?
The duration of angina episodes varies but typically lasts for a few minutes.
Pain that lasts longer or is more severe may indicate a more serious condition.
How to Treat Angina?
Treatment may involve lifestyle changes, medications (such as nitroglycerin, beta-blockers, or calcium channel blockers), angioplasty, stenting, coronary artery bypass grafting (CABG), and cardiac rehabilitation.
What is Unstable Angina?
Unstable angina is a more severe and unpredictable form of angina that can occur at rest or with minimal exertion.
It may signal an increased risk of a heart attack and requires immediate medical attention.
How to Pronounce Angina?
Angina is pronounced as “an-JY-nuh.”
Angina Attack: What to Do
If experiencing symptoms of an angina attack, it is crucial to seek immediate medical attention.
Use prescribed medications such as nitroglycerin as directed, and have an emergency action plan in place.
If symptoms persist or worsen, call emergency services.
What are the Factors Influencing Life Expectancy with Angina
- Severity of Coronary Artery Disease (CAD)
- Effectiveness of Treatment
- Overall Health Status
- Lifestyle Factors
- Presence of Other Medical Conditions
Medically reviewed by Dr. Ramesh Gaddam, M.D.
General Physician, Diabetologist, and Critical Care Specialist.
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