Angina Pectoris (Chest Pain)

Feeling tightness or pain in your chest can be scary. You might wonder if it’s something small or a sign of serious heart problem. Angina is a common type of chest pain linked to the heart. It happens when your heart muscle doesn’t get enough oxygen-rich blood. You might feel pressure, squeezing or tightness in your chest, especially during exercise, stress or very hot or cold weather.

At Banner Health, we help you understand your symptoms and decide what to do next. Whether you need tests, treatment or ongoing heart care, our team is here to support you and keep your heart healthy.

What is angina pectoris?

Angina happens when your heart muscle (myocardium) doesn't get enough blood and oxygen. Narrowed arteries in your heart reduce blood flow to the muscle. This shortage of blood is called ischemia. The reduced blood flow to your heart muscle can cause chest pain or pressure. 

Angina is not a disease. However, it can be a warning sign of a heart problem such as coronary artery disease (CAD) in which plaque builds up in the arteries. This can cause a blockage or narrowing of one or more coronary arteries.

What does angina feel like?

Angina can feel different for everyone. Common symptoms of angina:

• Chest pain or pressure
• Squeezing or tightness in the chest
• Shortness of breath
• Very tired (fatigue)
• Nausea or dizziness
• Burning or discomfort

Pain can also spread to your arms, shoulders, neck, jaw or back. The pain might last a few minutes and then go away with rest. Some people mistake angina for indigestion or muscle strain.

Women are somewhat more likely than men to experience angina symptoms such as shortness of breath, nausea, fatigue and back or jaw pain. If something doesn’t feel right, get checked out.

Types of angina

Not all anginas are the same. Knowing the type can help guide your care. 

• Stable angina: This is the most common type. It happens in a regular pattern, often during physical activity or emotional stress. The pain usually goes away with rest or medication. Stable angina usually lasts about five minutes.
• Unstable angina: This is more serious. It can happen suddenly, even when you’re resting. The pain may last longer and feel more intense than stable angina. Unstable angina can be a warning sign of a heart attack and needs immediate attention.
• Variant (Prinzmetal) angina: Variant angina is uncommon and results from coronary artery spasms. It often happens while resting or sleeping, not after exercise or stress. An episode can last five to 15 minutes. These attacks can be very painful.
• Microvascular angina: This type affects the smallest blood vessels that lead to the heart, arms and legs. You might feel chest pain even if the larger arteries look normal. Pain can last longer than 15 minutes. Microvascular angina is more common among women. It can also serve as a symptom of a heart condition known as coronary microvascular disease (MVD). 

How is angina different from a heart attack?

While both angina and heart attacks involve the same symptom (chest pain) they have important differences. Angina pain typically improves with rest or medication but a heart attack is a medical emergency. Chest pain may come on suddenly, be more intense, last longer and not go away with rest.

A heart attack, also called a myocardial infarction, happens when blood flow to part of the heart is fully blocked. This can damage the heart muscle. Unstable angina can also raise your chance of having a heart attack. If you have severe chest pains, get emergency help right away.

What causes angina?

Angina happens when blood flow to your heart is reduced. The most common cause of angina is coronary artery disease. Other causes include coronary microvascular disease and coronary artery spasm.

Certain activities or situations can trigger angina, such as:

• Physical exertion (exercise)
• Emotional stress
• Extreme weather (extreme heat, cold temperatures or high humidity)
• Heavy meals
• Drinking alcohol or smoking

You may be at greater risk for angina and heart disease if you:

• Smoke
• Have high blood pressure
• Have high cholesterol
• Are obese or overweight
• Have diabetes
• Are inactive
• Have a family history of heart disease
• Are older age (males over 45 and females over 55)

How is angina diagnosed?

Your health care provider will begin by asking about your symptoms, medical history and risk factors. After that, you may need tests to determine what’s happening with your heart.

Common tests include:

• Electrocardiogram (EKG): Measures your heart’s electrical activity
• Stress test: Shows how your heart works during exercise
• Echocardiogram: Uses sound waves to create images of your heart
• Coronary angiography: Looks for blockages in your arteries
• CT scan: Provides detailed images of your heart and blood vessels

These tests help your care team find the cause of your symptoms and plan the best treatment.

Treatment for angina

Treatment focuses on improving blood flow to your heart and reducing the risk of a heart attack. 

Medications

Medications commonly used to treat angina include:

• Beta blockers: Reduce heart rate and workload
• Nitrates: Relax blood vessels
• Calcium channel blockers: Improve blood flow
• Antiplatelet medications: Prevent clots
• Cholesterol-lowering medications: Reduce plaque buildup

Procedures to improve blood flow

If medications aren’t enough, heart procedures may be recommended:

• Coronary angioplasty and stenting: Open blocked arteries
• Coronary artery bypass surgery: Creates a new path for blood to flow around a blockage

Long-term heart health

Maintaining a heart-healthy lifestyle is key to long-term management:

• Eat a heart-healthy diet
• Exercise regularly
• Quit smoking
• Manage stress
• Maintain a healthy weight
• Control high blood pressure and cholesterol

Living with angina

If you have angina, you can still live a full, active life. The key is learning how to manage your condition.

Pay attention to your symptoms. Know what triggers your pain and how to respond. Always take medications as prescribed. 

It can also help to:

• Track your symptoms and recognize patterns
• Avoid triggers like extreme physical activity or extreme weather
• Carry your medications with you
• Maintain a healthy lifestyle 

When to seek medical care

Call 911 if:

• You have warning signs of a heart attack
• Your symptoms continue after using medication

Do not drive yourself to the hospital if you are experiencing a heart attack. Call 911 or have someone take you to the hospital.

Call your health care provider if you have:

• Worsening or new symptoms
• Side effects from your medications
• Questions about your treatment plan

How Banner Health can help

At Banner Health, our cardiologists have experience diagnosing CAD and treating angina. We offer:

• Advanced cardiac imaging and testing
• Personalized treatment for angina and related heart conditions
• Coordinated care to reduce your risk of a heart attack

Find a Banner Health cardiologist to schedule a heart evaluation.

Frequently asked questions about angina

Is angina the same as a heart attack?

No. Angina is a chest pain caused by reduced blood flow, while a heart attack occurs when blood flow is blocked.

What triggers angina?

Physical activity, stress, extreme weather (hot or cold) or heavy meals can trigger symptoms.

Can angina occur at rest?

Yes. Variant angina and unstable angina may happen even without activity.

Can angina be treated?

Yes. Medications, procedures and lifestyle changes help manage symptoms effectively.