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Angina




Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw or back.

Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina: stable, unstable and variant. Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It is does not go away with rest or medicine. It is a sign that you could have a heart attack soon.

Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider.

What is Angina?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.
  • Stable angina - Stable angina is the most common type. It occurs when the heart is working harder than usual.
    • There is a regular pattern to stable angina. After several episodes, you learn to recognize the pattern and can predict when it will occur.
    • The pain usually goes away in a few minutes after you rest or take your angina medicine.
    • Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.
  • Unstable angina - Unstable angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.
  • Variant angina Variant - angina is rare. It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medicine.
Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

Other Names for Angina
  • Angina pectoris
  • Stable or common angina
  • Unstable angina
  • Variant angina
  • Prinzmetal's angina
  • Coronary artery spasms
  • Acute coronary syndrome
What Causes Angina?

Angina is caused by reduced blood flow to an area of the heart. This is most often due to coronary artery disease (CAD). Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

In CAD, the coronary arteries that carry oxygen-rich blood to the heart muscle are narrowed due to the buildup of fatty deposits called plaque. This is called atherosclerosis. Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. The buildup of plaque on the inner walls of the arteries can cause angina in two ways:
  • By narrowing the artery to the point where the flow of blood is greatly reduced.
  • By forming blood clots that partially or totally block the artery.


The illustration shows a normal artery with normal blood flow (Figure A) and an artery containing plaque buildup (Figure B).

Stable Angina

Physical exertion is the most common cause of pain and discomfort from stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you are sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. Other causes include:
  • Emotional stress
  • Exposure to very hot or cold temperature
  • Heavy meals
  • Smoking
Unstable Angina

Unstable angina is caused by blood clots that partially or totally block an artery. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. The clot may grow large enough to completely block the artery and cause a heart attack. Blood clots may form, partly dissolve, and later form again. Chest pain can occur each time a clot blocks an artery.

Variant Angina

Variant angina is caused by a spasm in a coronary artery. The spasm causes the walls of the artery to tighten. This narrows the artery, causing the blood flow to the heart to slow or stop. Variant angina may occur in people with and without CAD. Other causes of spasms in the arteries that supply the heart with blood are:
  • Exposure to cold
  • Emotional stress
  • Medications (vasoconstricting) that constrict or narrow blood vessels
  • Cigarette smoking
  • Cocaine use
What Are the Signs and Symptoms of Angina?

Pain and discomfort are the main symptoms of angina. These symptoms
  • Are often described as pressure, squeezing, burning, or tightness in the chest
  • Usually start in the chest behind the breastbone
  • May also occur in the arms, shoulders, neck, jaw, throat, or back
  • May feel like indigestion
Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

Symptoms vary based on the type of angina.

Stable Angina

The pain or discomfort:
  • Occurs when the heart must work harder, usually during physical exertion
  • Is expected, and episodes of pain tend to be alike
  • Usually lasts a short time (5 minutes or less)
  • Is relieved by rest or angina medicine
  • May feel like gas or indigestion
  • May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina

The pain or discomfort:
  • Often occurs at rest, while sleeping at night, or with little physical exertion
  • Is unexpected
  • Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
  • Is usually not relieved with rest or angina medicine
  • May get continuously worse
  • May signal that a heart attack will happen soon
Variant Angina

The pain or discomfort:
  • Usually occurs at rest and during the night or early morning hours
  • Tends to be severe
  • Is relieved by angina medicine
Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having—or are about to have—a heart attack.

How Can Angina Be Prevented?

You can prevent or lower your risk for heart disease and angina by making lifestyle changes and getting treatment for related conditions.

Make Lifestyle Changes

You can prevent or lower your risk for angina and heart disease by making healthy lifestyle choices:
  • Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity.
  • Quit smoking, if you smoke
  • Be physically active, as directed by your doctor
  • Lose weight, if you are overweight or obese
Treat Related Conditions

In addition to making lifestyle changes, you can help prevent angina and heart disease by treating related conditions, such as:
  • High blood cholesterol. If you have high cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed.
  • High blood pressure. If you have high blood pressure, follow your doctor's advice about keeping your blood pressure under control. Take blood pressure medications as directed.
  • Diabetes (high blood sugar). If you have diabetes, follow your doctor's advice about keeping your blood sugar levels under control. Take medicines as directed.
  • Overweight or obesity. If you are overweight or obese, talk to your doctor about how to lose weight safely.


Information obtained from National Institute of Health
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