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Angina

Another word for chest pain.

What is angina?

Angina is the medical term for chest pain. People with angina describe the pain as a squeezing, suffocating or burning feeling.

Key facts about angina:

  • It’s your heart telling you that it needs more oxygen.
  • You need to take a break from what you’re doing and/or take your medication.
  • It’s almost always a sign that you have blocked arteries and heart disease.
  • It’s a warning that without treatment, you are at risk for heart attack.

If you are experiencing chest pain, seek medical attention immediately.

Angina or heart attack?

The main difference between angina and a heart attack is that a heart attack causes damage to the heart muscle, and angina does not. Angina can develop into a heart attack.

When does angina happen?

  • Often during physical effort (exercise) or stress.
  • When you are in a very cold place.
  • After a large meal.

Heart attacks often happen when resting.

What does angina feel like?

Angina and heart attack feel the same. Both may cause:

  • Pain or discomfort that may spread to chest, jaw, shoulders, arms (mostly the left arm) and back.
  • Chest tightness, burning, heaviness, feeling of squeezing or not being able to breathe.
  • Angina will sometimes cause dizziness, paleness, weakness.

Heart attack symptoms often include nausea or throwing up,  weakness, tiredness or sweating.

Be aware: People with diabetes may only experience trouble breathing.

How long does angina last?

  • Three to five minutes.
  • Rarely more than 15 minutes.

Heart attacks generally last more than 30 minutes.

Is the heart damaged during angina?

  • No

A heart attack damages the heart muscle.

What brings on angina?

Angina is caused by a temporary lack of oxygen to the heart.

A heart attack is caused by a lack of oxygen to the heart for a long time.

Angina usually lasts only a few minutes.

  • If you are experiencing chest pain or pressure that is not relieved with rest or nitroglycerin after 15 minutes, you may be having a heart attack.
  • Call 9-1-1 or your local emergency response number immediately.

Read more about the differences between angina and heart attack.

Causes

Angina occurs when there’s not enough blood flow to the heart. Without enough blood, the heart doesn’t get enough oxygen. This triggers the chest pain.

Angina can stem from a number of conditions.

Coronary artery disease (CAD)

 Blocked arteries are the most frequent cause of angina.

  • When your arteries are too narrow, your heart doesn’t get enough blood.
  • When there’s less blood, there’s less oxygen.
  • Without enough blood and oxygen, your heart works too hard.
  • This triggers the angina.

Coronary artery spasm

 A contraction in the blood vessels that supply the heart.

  • If the blood vessel is constricted, blood flow to the heart can decrease or even stop.
  • This can cause angina or heart attack.

Other heart or health conditions, including:

  • Uncontrolled high blood pressure.
  • Narrowing of the valves in the heart (aortic stenosis).
  • An enlarged heart (hypertrophic cardiomyopathy).
  • Emotional or physical stress.
  • Problems with the lungs, muscles or bones.

Be aware: Over time, angina attacks may weaken the heart. This can reduce its ability to pump. Regular medical checkups are vital to living well with angina.

Types of angina

There are several types of angina. The most common are stable and unstable.

Stable angina can be managed with medication and lifestyle changes.

Unstable angina is harder to treat. It needs urgent attention.

Stable angina

  • The same each time.
  • Usually lasts 3-5 minutes. Rarely more than 15 minutes.
  • Triggered by physical activity, emotional stress, heavy meals or extreme cold or hot weather.
  • Relieved with rest or nitroglycerine.

What you can do if you have an attack:

  • Track what triggers it.
  • Time how long it lasts.
  • Note what helped ease the pain.

Unstable angina

  • Less predictable. You feel chest pain you did not have before.
  • Discomfort lasts more than 15 minutes.
  • Often happens when resting or times when you are not active at all.
  • Not relieved with rest or nitroglycerine.

Be aware: If you have chest pain that is new, worsening or constant, you are at greater risk of:

  • Heart attack
  • Irregular heartbeat (arrhythmia)
  • Sudden death
  • See your doctor as soon as possible.

Variant angina (also called Prinzmetal’s angina)

This condition is rare. It is caused by a spasm in the coronary artery. Spasms can be the result of exposure to cold weather, stress, smoking, cocaine use or certain medications.

  • Attacks may be painful.
  • Usually happen between midnight and 8 AM.
  • Unlike stable angina, it is not triggered by physical activity or stress.
  • May be treated with medication.

Most people with variant angina have a severe blockage in at least one major coronary artery and the spasm usually happens close to the blockage.

Be aware: Variant angina can be a symptom of heart disease. But it may also affect younger people and those without other risk factors.

Microvascular angina, sometimes called Cardiac Syndrome X (or CSX)

  • Chest pain without any apparent blockage in a coronary artery. It’s caused when the tiny blood vessels that feed your heart don’t function properly.
  • Pain is more severe and can last longer than stable angina, sometimes 30 minutes or more.  
  • Pain is unpredictable. It can happen during exercise or while resting.
  • Nitroglycerine may not relieve the pain.
  • Treatment includes medication and lifestyle changes.
  • Is more common in women than men. About 70% of patients are women who are approaching - or have already gone through menopause.   

The Persistent Cardiac Pain Resource Centre has detailed information about cardiac syndrome X and its treatment.

Be aware: Cardiac syndrome X is not the same as Syndrome X, also known as metabolic syndrome. This refers to a group of risk factors that can lead to diabetes or heart disease.

Atypical angina

Symptoms can differ from typical angina and may include:

  • Vague chest discomfort
  • Shortness of breath
  • Fatigue
  • Indigestion or nausea
  • Back or neck pain

Women are more likely to experience atypical symptoms such as vague chest discomfort.

Refractory angina

This is chronic heart pain due to heart disease.

Be aware: Women can experience angina symptoms differently than men. It may not include chest pain. See your doctor if you have:

  • Vague pain.
  • Difficulty breathing.
  • The feeling of being tired all the time for no obvious reason.
  • Fatigue or trouble getting through normal, everyday activities.
  • Ache or discomfort in areas other than the chest: neck, jaw, throat, shoulder, arms or back.
Symptoms

Angina pain can be triggered by a number of factors:

  • Physical activity
  • Exercise
  • Emotional stress
  • Extreme temperatures (either hot or cold)
  • Heavy meals
  • Drinking alcohol or smoking.

Angina symptoms vary from person to person. And they can differ between women and men.

Be aware: Angina is usually a symptom of heart disease. It means you are at risk of having a heart attack. See your healthcare provider as soon as possible you experience one or more of these symptoms. Or if your pattern of angina symptoms changes.

Shortness of breath or difficulty breathing

Pain

  • Tightness, pressure or discomfort in the chest.
  • Ache or discomfort in areas other than the chest: neck, jaw, throat, shoulder, arms or back.
  • Indigestion or heartburn.
  • Sharp, burning or cramping pain.
  • Vague pain. Note this is more common in women.

Fatigue

  • Being tired all the time for no obvious reason.
  • Trouble getting through normal, everyday activities.
  • Weakness.
Diagnosis

Your healthcare provider will review your medical history and give you a complete physical exam. He or she may also run some tests. These could include:

  • Angiography
  • Electrocardiogram (ECG/ EKG)
  • Echocardiogram
  • Exercise electrocardiogram (Stress test)
  • Thallium or cardiolite scan
  • Transesophageal echocardiogram (TEE)
Treatment

Angina is often controlled with a combination of medication and lifestyle changes. In some cases, surgery may be necessary.

Take your medication
These medications may help prevent or relieve the symptoms of angina. If they are prescribed for you, take them exactly as directed.

  • Nitroglycerin (or nitro)
    • Nitro is widely prescribed for angina.
    • It widens or opens up the coronary arteries.
    • This gets more blood and more oxygen to your heart.
    • If you take nitro, always carry it with you.
  • Anti-platelets
  • Beta-blocker
  • Calcium channel blockers

An ounce of prevention
You may be able to prevent or reduce angina by avoiding the four E’s:

  • Exertion or too much physical activity
  • Eating a large meal
  • Emotional stress
  • Environment that’s too hot or too cold

Make lifestyle changes

  •  Moderate exercise. Yes, exercise can trigger angina. But you still need to stay physically active, as long as your healthcare provider approves.
  • Eat a healthy, balanced diet.
  • Avoid smoking.
  • Limit alcohol use.

Talk to your doctor about the most beneficial lifestyle changes for you.

Control other medical conditions or risk factors
Angina can be worsened by other conditions such as high blood pressure, diabetes and high blood cholesterol.

  • Maintaining a healthy lifestyle.
  • Take your other medications as prescribed.

Surgery and other procedures
Angina caused by blocked arteries can be treated surgically.

By widening or bypassing the affected arteries, more blood can flow to your heart. Procedures might include:

  • Percutaneous coronary intervention (PCI) also known as angioplasty with stent
  • Coronary artery bypass surgery
Related information

Heart pain is disruptive and frightening. These guides can help you learn more about your specific angina and manage your pain.

Angina
Living Well With Heart Disease

How is angina different from a heart attack?

Refractory angina
A fact sheet on refractory angina

Cardiac syndrome X
A fact sheet on cardiac syndrome X

To find useful services to help you on your journey with heart disease, see our services and resources listing.

Join the Heart and Stroke Community of Survivors