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Angina Pectoris: Knowing When Your Chest Pain Is (and Isn’t) a Heart Attack

Do you ever feel chest pain while playing your favorite sport or while waiting nervously to present at a big meeting? Or do you ever feel chest pain while just sitting on the couch watching TV? Although your first thought may be “am I having a heart attack?”, that pain in your chest may actually be what the medical world calls “angina.” If you or someone you look after is experiencing chest pain or discomfort, then it’s important to know what causes that pain, and what steps to take.

Generally, angina is what happens when the heart isn’t getting enough blood. Angina symptoms can feel like pressure or a squeezing pain in the chest, and may also be felt in the arms, back, jaw, neck or shoulders. (It sometimes feels like indigestion.) When the pain is specific to your chest, it’s called angina pectoris or angina pectus.

“Your chest pain could be the result of a supply-demand mismatch in what the heart needs for blood flow and what it is actually getting,” explained Tushar Acharya, MD, a cardiologist with Banner - University Medicine. Dr. Acharya talked to us all about angina, and what people need to know.

Types of angina and warning signs

There are two types of angina — stable and unstable. The Centers for Disease Control and Prevention (CDC) describes them this way:

  • Stable: Happens during physical activity or under mental or emotional stress and goes away with rest.
  • Unstable: Occurs even while at rest, without apparent reason. This type of angina is a medical emergency.

For those with stable angina, Dr. Acharya said the pain is pretty predictable with a certain level of exertion, and is relieved with medication or rest.

Unstable angina, by contrast, can show up without exertion, even when the person is resting. It may last longer than stable angina and isn’t relieved with rest or medication. “In this scenario, patients are at a high risk for a heart attack, and are often having an active heart attack,” Dr. Acharya warned. In this instance, it’s important to call 911 and get medical help immediately.

Causes of angina

Stable and unstable angina are the most common symptoms of coronary artery disease (CAD), and can happen when plaque builds up inside your arteries. This buildup narrows the artery’s space for blood flow. And that can be quite painful.

Unstable angina is caused by blood clots that block an artery, either partially or completely. These blood clots can form, partially dissolve, then form again later.

Coronary artery disease is almost always the culprit. If you have other conditions that raise your risk for CAD — like diabetes, high blood pressure or high cholesterol — angina is certainly possible. Dr. Acharya also pointed out some behaviors that put you at greater risk, like eating lots of fatty/processed foods, smoking and not exercising. When someone has angina from coronary disease, it’s crucial they talk to a cardiologist.

Angina treatment

Dr. Acharya said that to treat stable angina, the first line of treatment is medication. These medications include blood thinners, antiplatelet medicines, beta blockers, calcium channel blockers, nitrates and statins. In many cases, patients' angina disappears when on the right medication. If symptoms continue to be lifestyle-limiting despite medications, patients may need more thorough diagnostic testing or a procedure to assess blood flow to the heart.

When a procedure is needed, your health care provider will perform a cardiac catheterization to find where your arteries are blocked. The catheter enters through either the wrist or groin area and is directed toward the coronary arteries in the heart. Liquid dye is injected through the catheter, and high-speed x-rays record the dye as it passes through your coronary arteries, tracking/looking for blockages.

From here, there are three main options:

  1. Medicines are used to treat angina. 
  2. Percutaneous coronary intervention (PCI): Also known as angioplasty. This involves a small wire being guided into a coronary artery, across a blockage, and a balloon and/or stent being placed in the blockage to relieve the obstruction.
  3. Coronary artery bypass graft surgery: Uses a blood vessel to reroute blood around the blocked part of the artery.

According to Dr. Acharya , blocked artery procedures are getting pretty sophisticated. “We are treating more advanced and severe disease than ever before, and we are doing it more safely without the need for surgery, We even have small cameras that can take pictures of the heart arteries from the inside—a technology called intravascular ultrasound," he said. "However, even with all the latest technology at our fingertips, in some situations having open heart bypass surgery instead of angioplasty will give patients the best long-term results."

In all cases, patients should try to do what they can to prevent coronary artery disease in the first place. Healthy eating, regular cardio exercise and stress reduction strategies can all go a long way. Additionally, it’s recommended to continue regular visits with your primary care physician, and when necessary, a specialist. To find a health care provider near you, visit bannerhealth.com.

Interested in learning more about heart disease? Try our free heart health risk assessment tool and check out these similar articles written with help from Banner Health experts.

Updates were made to this article content on February 1, 2024. 

Heart Health