Chest Pain: Angina or a Symptom of Heart Disease?

Angina, also known as angina pectoris, can be a sign of further complications with the heart. It is a type of chest pain that is usually caused by a lack of blood flow in the arteries that support the heart. Sometimes, angina can feel like a heart attack. Always consult a healthcare professional about your symptoms. Read on to learn about the types of angina, risk factors, and treatment.

What is angina?

Angina is a specific type of chest pain that is caused by not having enough blood flow to your heart. The reduced blood flow is from the major blood vessels that supply the heart with its blood. Often, it is due to plaque buildup and narrowing of the blood vessels supplying your heart.

The blood vessels that supply the heart with blood are called coronary arteries. Angina can be a symptom of another heart condition called coronary artery disease, which is when the blood vessels in the heart are narrowed by cholesterol deposits.

When the body exerts itself, like in situations where you are walking up the stairs or going to the gym, the heart requires an increased blood flow to deal with the exertion. When the heart is unable to get the blood supply it needs, it then starts to ache.

Sometimes, angina can feel like a heart attack. It may be an indicator of heart disease, and it can also be a sign that a heart attack might be coming.

Different types of angina

Angina is a condition with various causes and responses to treatment. Depending on the underlying cause, different types of angina can respond differently to treatments such as lifestyle changes or medications intended to reduce chest pain or discomfort. Understanding which type you have helps physicians develop an effective plan for symptom relief.

• Stable angina. This is chest pain that commonly occurs after physical activity, such as exercising, that goes away with rest. Stable angina can be predictable and similar to other episodes of chest pains. It usually lasts a short time prior to subsiding. Stable angina can be controlled by resting or taking certain medications.
• Unstable angina. This doesn’t necessarily need a precursor like stable angina and, therefore, is considered unpredictable. The pain with unstable angina may vary and become worsening even during rest. It usually lasts longer than stable angina and won't stop even with rest or medication. Since angina is caused by a lack of blood flow to the coronary arteries that feed the heart, a prolonged period of this can cause a heart attack. Unstable angina is a medical emergency and requires immediate treatment.
• Variant angina. Sometimes called prinzmetal angina, this is not common and is not caused by coronary artery disease but, rather is caused by a spasm in the coronary arteries that temporarily reduces blood flow. The spams cause severe chest pain and occur in cycles, usually at rest.

Symptoms of angina

Those with angina often experience uncomfortable or painful sensations in the chest, such as crushing pressure, tightness, and even sharpness. Some people describe this feeling as a heavy weight lying on their chest, similar to an “elephant on their chest.”

Chest pain may be described as:

• Pressure;
• Squeezing;
• Burning;
• Pain that radiates to the arms, neck, jaw, shoulder, or back.

Other symptoms may include:

• Shortness of breath;
• Dizziness;
• Fatigue;
• Nausea;
• Sweating.

Symptoms may vary based on the type of angina and its severity. The symptoms may also be similar to a heart attack. New or worsening angina should be evaluated by a physician immediately.

Women may feel angina differently

Women may experience angina symptoms differently than men do. The differences can cause women to not seek help when they need it.

Instead of chest pain, women may feel the following:

• Nausea;
• Shortness of breath;
• Stomach pain;
• Discomfort in neck, jaw, teeth, and back.

Risk factors of angina

Angina is a common condition that affects nine million people in the United States. However, it can be hard to distinguish from other types of chest pain that do not necessarily involve the heart.

It is caused by a reduction of blood flow in the coronary arteries in the heart. The coronary arteries supply the heart with oxygenated blood and nutrients to survive. When the heart is not getting enough blood, it causes a condition called ischemia that leads to chest pain.

The reduction of blood flow in the coronary arteries is typically caused by fatty deposits inside the vessels narrowing the artery. This condition is considered atherosclerosis.

When the body needs more oxygen, and the heart pumps harder, such as during exercise, then it places an extra demand on the heart, causing symptoms of angina when it can’t get the excess amount of blood that it needs.

Risk factors for angina include:

• High cholesterol;
• High blood pressure;
• Obesity;
• Emotional stress;
• Inactive lifestyle;
• Diabetes;
• Tobacco and illicit drug use;
• Family history of heart disease;
• 69 years or older of age.

Chest pain can be caused by non-heart-related conditions as well that will need to be ruled out by a physician.

Other non-heart-related conditions include:

• Acid reflux disease;
• Lung disease;
• Anxiety;
• Musculoskeletal conditions around the chest.

How is angina diagnosed?

Your doctor will work diligently to identify the cause of your angina symptoms, using a range of exams and assessments.

Some of these tests may include:

• Electrocardiogram (ECG);
• Blood tests for specific heart enzymes;
• Cardiac stress test;
• Echocardiogram;
• Nuclear stress test.

Treatments for angina

To manage stable angina, your doctor may recommend making some changes to how you live. These modifications could help reduce chest pain and improve overall health.

Modifiable changes include:

• Exercise regularly;
• Eat a healthy, well-balanced diet;
• Stop smoking;
• Limit alcohol use;
• Reduce stress.

If needed, your doctor may prescribe medication for you to control angina when it starts. One common medication is nitrates tablets. Nitrates help your blood vessels relax and widen to help let in more blood.

Aspirin and other prescribed blood thinners may also be used to help reduce blood clotting to lower the risk of a heart attack.

If you have unstable angina, your doctor may be more aggressive about treatment to prevent a heart attack in the future. The doctor may perform a procedure where they place stents inside the coronary arteries to help keep them open.

If severe enough, your doctor may also suggest open-heart surgery to bypass the clogged arteries.

When to seek help

If the symptoms of angina last longer than a few minutes and do not improve or go away with rest or medication, it could be a sign of a heart attack. If you notice the pain is not subsiding or is getting worse, then call 911 right away.

If angina or symptoms of chest discomfort are new, then see your healthcare provider immediately for evaluation.

If you have stable angina but your symptoms are getting worse, unable to be relieved by rest or medication, or you develop new symptoms, then seek medical care right away.