Angina Pectoris


A sign of trouble

Simply stated, angina (angina pectoris) is chest discomfort or pain — but not just any chest pain. Angina is a symptom of a condition called myocardial ischemia that occurs when the heart muscle (myocardium) doesn't get as much blood (and therefore as much oxygen) as it needs. Insufficient blood supply is called ischemia.

Although the blood flow to your heart may be adequate for normal needs, when the heart demands increased oxygen, the arteries supplying blood to the heart may not be able to meet the demand because they are narrowed or blocked. When this situation occurs — typically during or after physical exertion or during periods of extreme stress — you'll feel the discomfort or pain of angina.

Angina is a warning sign of coronary artery disease and requires medical attention.

Detailed Description

Angina is often described as a squeezing, feeling of pressure, heaviness, tightening, or aching across the chest, especially behind the breastbone. It can range from a vague ache to an intense crushing sensation. You may feel short of breath. The pain can radiate to the left shoulder and down the inside of the left arm and into the fingers, and can travel to the back, throat, jaws, and teeth. Some people even feel pain in the abdomen.

Angina is typically triggered by physical activity and usually lasts for no more than a few minutes. The pain begins to subside with rest. Angina gets worse when exertion follows a meal, and cold weather is also a culprit. Walking into the wind or getting a blast of cold air when you leave a warm room can also cause angina.

Once you experience angina, subsequent attacks generally follow the same pattern. Any changes in this pattern — increased intensity, less stimulus required, longer duration, or occurrence during periods of rest — may signal that your angina has become "unstable." Unstable angina is a medical emergency that requires immediate hospital care.

Some people experience angina even when they're not stressed out or physically active. This type of angina is called variant angina pectoris, or Prinzmetal's angina. It is caused by a spasm in one of the coronary arteries, and is often seen in conjunction with plaque deposits on the inner lining of a coronary artery (coronary atherosclerosis). Variant angina pectoris occurs almost exclusively when a person is at rest — often between midnight and 8 a.m. — and it can be quite painful. With proper medical care, the condition can be often stabilized within three to six months and the symptoms tend to diminish over time.

During angina, the lack of oxygen to the heart muscle is temporary and reversible, and the chest pain disappears with rest. However, if angina is followed by a heart attack, the resulting cardiac muscle damage is permanent.

The numerous effective treatments for angina range from lifestyle modifications to drugs to surgery.

How Common Is Angina?

The American Heart Association estimates that 6,200,000 people in the United States suffer from angina, and that 350,000 new cases occur each year. The likelihood of angina increases with age. In females, angina becomes more apparent after menopause.

The estimated prevalence of angina is 3.4% for non-Hispanic white men, 2.6% for non-Hispanic black men, and 3.4% for Mexican-American men. The estimated prevalence of angina is 4.1% for non-Hispanic white women, 5.2% for non-Hispanic black women, and 4.6% for Mexican-American women.

Conventional Treatment

Treatment Goals

The specific and immediate goal of treating angina is to either the decrease oxygen demand of the heart or increase oxygen supply to the heart. The longer-term goal is to address the underlying cause and halt the progression of coronary artery disease. Minor angina can be managed effectively with rest and use of nitroglycerin and other medications, while lifestyle changes can help address the underlying coronary heart disease. In more severe cases, surgery may be necessary to clear or circumvent arterial blockages.

Treatment Overview

Angina is a no-nonsense condition that requires medical treatment and monitoring. In severe cases and in the initial stages of mild to moderate cases, medication is usually necessary. Over time, you should be able to control angina with lifestyle changes and natural approaches. However, if you have significant blockage of the coronary artery, surgery in the form of angioplasty or coronary artery bypass may be appropriate.

Drug Therapy

Angina Medications


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Angina Pectoris Prophylaxis


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Appropriate Healthcare Setting

A heart attack is a medical emergency that requires immediate hospitalization.

Healthcare Professionals Who May Be Involved in Treatment

Many health professionals and cardiac specialists participate in managing this disorder, including:

  • Family physicians
  • General internists
  • Geriatricians
  • Cardiologists
  • Radiologists
  • Cardiac surgeons
  • Thoracic surgeons


The two most commonly performed procedures to unblock the blood vessels leading to the heart are angioplasty and coronary bypass surgery, but a relatively new treatment called transmyocardial revascularization also shows promise for certain patients. The location and severity of the disease in the coronary arteries determine which procedure is chosen.

Angioplasty: A catheter with a balloon tip is inserted into the coronary arteries. When the catheter reaches a narrowed segment, the balloon is inflated to flatten the plaque and widen the artery. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque. In some cases, a wire stent may be inserted into the narrowed vessel to help keep it open and clear.

Coronary bypass surgery: This is reserved for severe cases of coronary blockage that cannot be addressed by any other means. Segments of healthy blood vessels, either from the chest or leg, are used to bypass the severely narrowed parts of the coronary arteries. The result is greatly increased blood flow to the heart muscle, reducing angina and risk of a heart attack.

Transmyocardial revascularization: In this procedure, a laser cuts a series of channels in the heart muscle to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle. This is a new and still experimental procedure.

Appropriate Healthcare Setting

If you experience characteristic mild angina (discomfort or pain brought about by physical exertion that goes away with rest), make an appointment to see your doctor for evaluation. More severe attacks and unstable angina require immediate medical attention and inpatient hospitalization.

Healthcare Professionals Who May Be Involved in Treatment

Healthcare professionals who participate in managing this disorder include:

  • Family physicians
  • Internists
  • Geriatricians
  • Critical care physicians
  • Radiologists
  • Cardiac surgeons
  • Cardiologists
  • Thoracic surgeons
  • Psychiatrists

Activity & Diet Recommendations

Because angina can be triggered by physical overexertion, avoid sudden bursts of activity and wait to exercise at least one hour after eating. Also, eat smaller meals over the course of the day. Large meals place more strain on the circulatory system. Because exposure to cold temperatures can constrict blood vessels, avoid going outside in cold, windy weather. However, exercise of moderate intensity can be very beneficial.

The importance of diet in heart disease is well established and many experts recommend a low-fat, high-fiber diet for patients with coronary artery disease. Here are some general guidelines:

  • Avoid foods high in saturated fats, such as meats, eggs, cheeses, and other dairy products
  • Eat plenty of whole grains, breads, and cereals instead of white and refined grains
  • Eat lots of fresh fruits and vegetables with meals and as snacks
  • Eat legumes such as beans, peas, and lentils in soups and salads

Quality of Life

Depending on the severity of your angina and the stage of the related coronary artery disease, available treatments range from lifestyle adjustments to major surgery. Which treatment is right for you will depend on your individual situation. Making lifestyle changes such as improving your diet, quitting smoking, gradually increasing exercise, and reducing stress can improve your overall quality of life as well as reduce your risk for a future heart attack.

Possible Complications

Angina is a symptom of coronary artery disease. The major complication of coronary artery disease is heart attack (myocardial infaction).

Considerations for Women


Other causes of chest pain besides angina should be ruled out. The additional demands of pregnancy can make symptoms worse and interfere with treatment.

Considerations for Older People

The frequency of angina increases with age. Also, older patients can be especially sensitive to the side effects of medication. For example, beta-blockers can cause depression. And stress from any emotional cause, such as loneliness, affects all illnesses.

Significant activity restrictions for older people are recommended when angina attacks begin suddenly or increase in severity or frequency. Rest at first and then resume activity slowly, gradually increasing exercise. Avoid situations that increase demands on the heart, such as anger, temperature extremes, or sudden bursts of activity.

Angina Pectoris

Last updated 26 March 2012


  • Angina pectoris
  • Unstable angina
  • Prinzmetal's angina/variant angina pectoris (angina that occurs almost exclusively when a person is at rest)
  • Chest pain




Established Causes

The most common cause of angina is coronary artery disease. Coronary arteries supply oxygen to the heart muscle. Coronary artery disease develops when cholesterol is deposited on the artery wall. The accumulation of cholesterol over time causes narrowing of the coronary arteries, a process called atherosclerosis. The prognosis for angina depends on the stage of this narrowing process. If caught at a relatively early stage, medical treatments should be able to halt and, in some cases, even reverse the narrowing of the coronary arteries. In advanced stages, surgery has proven successful.

The following conditions can also decrease oxygenation of the heart or prevent it from pumping blood effectively:

  • Severe anemia
  • Heart valve disease
  • Fast heartbeat (tachycardia)
  • Spasms of the coronary arteries

Risk Factors

Risk factors for angina include:

  • Smoking
  • Family history of coronary artery disease and/or cholesterol disorder
  • High cholesterol
  • High blood pressure
  • Sustained psychological stress
  • Obesity
  • Sedentary lifestyle
  • Increasing age
  • Male gender
  • Postmenopause
  • Diabetes mellitus

Symptoms & Diagnosis

Signs and symptoms of angina include:

  • Paleness
  • Perspiration
  • Pain between shoulder blades
  • Difficulty breathing
  • Aching due to feeling of chest constriction, brought on by exertion or stress
  • Choking feeling in throat
  • Chest pain similar to indigestion
  • Heaviness or tingling sensation in neck, arm, shoulder, elbow (typically on left side)

Conditions That May Be Mistaken for Angina

Conditions that may confuse the diagnosis of angina include:

  • Gastrointestinal disorders such as peptic ulcer, indigestion, hiatus hernia, gallbladder disease, and spasms or inflammation of the esophagus
  • Aortic aneurysm: injury of the tissue in the wall of aorta (the major artery carrying blood out of the heart)
  • Chronic shortness of breath (dyspnea)
  • Blood clot in the lung, pneumonia, or pleurisy
  • Inflammation of the membrane around the heart (pericarditis)
  • Inflammation of or damage to the ribs
  • Disease of the spinal nerve roots (radiculopathy)
  • Psychological disorders due to panic or anxiety
  • Cervical or thoracic spine disease

How Is Angina Diagnosed?

Specific Tests

Your doctor will likely order an exercise stress test that will show your heart activity via electrocardiogram (ECG) and monitor your symptoms as you exercise to a predetermined level.

Although not usually used for diagnosis, continuous ECG monitoring with a Holter monitor (a portable, battery-powered ECG recorder) shows abnormalities indicating silent ischemia in some patients. The American Heart Association estimates that as many as 3 to 4 million Americans may have ischemic episodes without knowing it because they experience no pain or discomfort (silent ischemia). Continuous ECG monitoring also helps diagnose variant angina by detecting certain changes that occur when angina develops during rest.


If your doctor wants to determine the condition of your coronary arteries, you may undergo some type of imaging procedure:

  • Coronary arteriography: A doctor guides a thin plastic tube through an artery in your arm or leg and into the coronary arteries, and then injects a liquid dye visible in X-rays through the catheter. High-speed X-ray movies show the liquid as it flows through the arteries. Doctors can identify blockages in the arteries by tracing the liquid's flow.
  • Stress echocardiography: A diagnostic procedure that studies the structure and motion of the heart.
  • Stress thalium: An imaging test to measure cardiac function and blood flow.

Laboratory work to determine risk factors includes a blood test to determine your cholesterol levels.

Self care & Prevention

Preventing Angina Pectoris

The following strategies will specifically help prevent angina:

  • Eat four or five smaller meals spread evenly throughout the day. Eating heavy meals diverts blood to the digestive system, reducing oxygen flow to the heart.
  • Avoid exercise for at least one hour after eating.
  • Avoid excessive alcohol — it can damage heart muscle.
  • Don't go out on cold, windy days. Cold weather constricts blood vessels.