About this topic

Angina happens when the heart muscle does not get the right amount of oxygen-rich blood, most often due to blood vessels in your heart being blocked. Angina is a sign of heart disease. It does not cause long lasting damage to your heart muscle. Some types of angina are more severe and need more treatment than other types.
There are a few types of angina:

• Stable angina:
  • Most common type and often happens when your heart is working harder, like during exercise
  • May be triggered by stress, heavy meals, smoking, or being in a very hot or very cold place
  • Follows a pattern and events are similar. The signs most often happen again when you repeat the same activity.
  • May last only a short time and is eased by rest or drugs
• Unstable angina:
  • Can happen at rest, during sleep, or when your heart is working a little harder
  • Comes at any time and does not follow a pattern
  • Lasts longer and is not often eased by rest or drugs
  • May get worse over time
  • Is very dangerous and needs emergency treatment
  • May be the first sign of a heart attack
• Variant (Prinzmetal) angina:
  • Rare kind of angina and tends to happen in younger people
  • May be triggered by cold weather, stress, smoking, illegal drug use, or some drugs
  • Often happens at night or in the early morning while resting
  • Often has very bad pain that can be eased with drugs
• Microvascular angina:
  • May have very bad pain that lasts a longer time
  • Often feel short of breath, tired, and have problems sleeping with this kind of angina
  • Drugs may not help ease this type of pain

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What are the causes?

The chest pain and other signs are caused by not getting enough blood flow to the heart. The blood does not flow as well through the blood vessels that give oxygen to the heart muscle. What is limiting the blood flow to the heart may be different, based on the kind of angina.

• Stable angina − A sticky substance, called plaque, builds up inside the walls of the blood vessels of the heart
• Unstable angina − Blood clots that partly or fully block a blood vessel.
• Variant (Prinzmetal) angina − Spasms in the coronary arteries, which supply blood, flow to the heart muscle.
• Microvascular angina − Spasms in the smallest blood vessels of the heart cause low blood flow to the heart muscle.

What can make this more likely to happen?

Those who weigh too much and those who do not exercise are also more at risk. Older age and certain other health problems like diabetes, high cholesterol, or high blood pressure may give you more risk for heart disease. A family history also makes you more at risk.

What are the main signs?

• Chest pain that feels like pressure
• Chest tightness that feels like something is squeezing your chest
• Pain or pressure in your shoulders, arms, neck, jaw, or back
• Women may have more pain in the upper body
• May have no pain at all
• Upset stomach and throwing up
• Feeling tired or weak
• Short of breath
• More sweating
• Feeling weak
• Feeling dizzy
• Signs often ease with rest

How does the doctor treat this health problem?

Care is based on the type of angina you have. Your doctor will use drugs, lifestyle changes, procedures, and rehab therapy to treat your signs. Your doctor will work to help you from having a heart attack

What lifestyle changes are needed?

• Eat a healthy diet. Your doctor may want you to limit the amount of salt and cholesterol in your diet
• If you have high blood pressure, have it checked often.
• If you weigh too much, talk to your doctor or dietitian about changing your diet to lose weight.
• Talk with your doctor about an exercise program that is right for you.
• If you are a smoker, stop smoking. Talk with your doctor if you need help with this.
• Avoid stress and find ways to relax. Talk to your doctor about ways to reduce stress.

What drugs may be needed?

• Your doctor may start you on drugs, such as:
  • Nitroglycerin patches that you will apply each day
  • Nitroglycerin pills to carry with you to take when you have angina
• If you are to take nitroglycerin pills with angina, place one pill under your tongue and rest. If the pain has not eased in 5 minutes,take one more pill under your tongue and rest. If the pain does not ease after another 3 to 5 minutes, take a third pill under your tongue and call for emergency help.
• If nitroglycerin pills have been ordered, always carry them with you and make sure they are not out of date. Keep them in their original bottle and at room temperature. The pill should burn or tingle when you put it under your tongue. If it does not, it may need to be replaced.
• Talk with your doctor about taking an aspirin each day. Aspirin can help thin the blood and prevent clot from forming
• Talk with your doctor about drugs that will help control other health problems like high blood sugar, high blood pressure, or high cholesterol.
• Do not take drugs like Viagra, Cialis, Levitra, and some herbals if you are taking any form of nitroglycerin. They may cause your blood pressure to drop very low.
• Take all drugs as ordered by your doctor. If a drug makes you sick, talk with your doctor before stopping it

What problems could happen?

If not treated, some types of angina may lead to a heart attack or other serious heart problems.

What can be done to prevent this health problem?

• Eat smaller meals more often. Eat healthy meals
• Stay active. Rest often during exercise.
• Keep a healthy weight.
• Avoid stress.
• Avoid doing things that cause your angina.
• Stop smoking.

When do I need to call the doctor?

Activate the emergency medical system right away if you have signs of a heart attack. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery. Call for emergency help right away if you have:

• Signs of heart attack:
  • Chest pain
  • Trouble breathing
  • Fast heartbeat
  • Feeling dizzy
• Change in the pattern of your signs, such as pain more often, pain when at rest, pain lasts longer
• Taken nitroglycerin and still have pain

Call your doctor if you have:

• Feeling very weak
• Feelings of passing out
• Very bad headache
• Upset stomach or throwing up
• Numbness in your arm
• Swelling in your ankles that does not go away
• Problems with any of the drugs you are taking
• You are not feeling better in 2 to 3 days or you are feeling worse

Where can I learn more?

American Heart Association
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300287.pdf

NHS Choices
http://www.nhs.uk/conditions/angina/pages/introduction.aspx