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The Chest Pain Called Angina
Understanding the types of angina and getting the right treatment can help prevent a heart attack.

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The Chest Pain Called Angina

An estimated 7 million men and women in the United States have angina, but what is it?

Angina is chest pain or discomfort. It may signal that the heart muscle is not getting enough oxygen-rich blood.

Angina is typically a symptom of coronary heart disease. Coronary heart disease happens when plaque - a waxy substance - builds up in the arteries. Over time, the arteries may narrow or become blocked. That restricts the flow of blood to the heart. The heart gets starved for oxygen. The result is chest pain called angina.

What are the characteristics of angina?
Angina is chest pain. This pain may feel like a pressure or burning - or sharp discomfort in the chest. It is frequently felt behind the breastbone. This pain, pressure or strange feeling also can be in either or both shoulders or arms. Or it can be in the back, neck or jaw.

Other symptoms that may occur with this discomfort are shortness of breath, weakness, or feeling faint or fatigued (especially when exerting yourself). Also, lightheadedness, irregular or fast heartbeat, nausea and vomiting may occur.

For some women, angina (or a heart attack) may feel somewhat different from that experienced by men. Although studies differ in their outcomes, some show that women may have sharper chest pain rather than pressure as reported by men. Women also may be more likely to have abdominal pain, shortness of breath and nausea.

If you have chest pain, don't ignore it or feel embarrassed to call for help. Call 911 immediately. You should not drive yourself if you think you may be having a heart attack. If the pain lasts for more than a few minutes even though you rested or took your angina medicine, it may be a sign of a heart attack.

How is angina evaluated?
Your doctor will address two main issues. The first question is whether you are having a heart attack or are in danger of having one. If it appears that you are having a heart attack, or are about to have one, you will need immediate treatment. If your doctor does not suspect a heart attack, then the second issue can safely be addressed. What is the cause of your chest pain? Is this really angina? Or is it related to something else? There are many other things that can appear to be angina. It may take some time and work to find the correct diagnosis.

The doctor will ask you questions about your pain. These include when and how often it occurs, where in your body you feel pain, how severe it is and how long it lasts. You also will be asked about your family history of heart disease.

You will probably have tests to look for the cause of your chest pain. These tests may include:

  • An electrocardiogram (EKG). An EKG indicates your heart rate and rhythm, and may show evidence of a current or previous heart attack or heart damage.
  • A stress test. This test shows how well your heart works when you exercise and it is beating hard and fast. Because arteries that are narrowed with plaque won't supply your heart with enough oxygen-rich blood, this test can show symptoms of heart disease.
  • A chest X-ray to look for signs of heart failure or lung problems.
  • Cardiac catheterization with coronary angiography (frequently just called a "cardiac cath"). This procedure involves putting X-ray contrast (dye) into your heart arteries and taking special X-rays that can show narrowing or blockages in these arteries.
  • Blood tests. These can show if you are having a heart attack or have risk factors for coronary heart disease.

Types of angina
There are two types of angina: "stable angina" or "unstable angina." Although the words sound similar, there is a big difference between the two. Unstable angina requires emergency treatment. It may be a warning that you're about to have a heart attack. Even though stable angina may not need emergency treatment, it is important because it may increase your risk for a future heart attack. The initial treatment of stable angina usually involves a combination of certain medications.

Stable angina

  • Usually happens when you're exerting yourself - the heart is working harder than usual
  • Episodes of pain are similar; they don't come as a surprise
  • Lasts five minutes or less
  • May feel like chest pain spreading to the arms and back
  • May feel like indigestion or gas
  • Relieved by angina medication or rest

Unstable angina

  • New onset of angina chest pain
  • Sudden change in angina that has been stable before - something has suddenly changed
  • Doesn't follow a pattern and may be a surprise
  • Pain happens more often and may be more and more severe; each episode may also last longer
  • Can happen at rest or when you do even a little activity
  • The pain is not relieved by rest or medicine

How is angina treated?
The first priority is to be sure that the angina pain is not actually a heart attack. Once your doctor is sure that you are stable, the main goals of treatment are to reduce pain and discomfort, and decrease how often angina occurs. In addition to relieving symptoms, it is important to treat the underlying heart condition. Depending on your situation, treatment may include:

  • Nitroglycerin. This relieves pain and relaxes blood vessels. It allows more blood to reach the heart.
  • Medications for heart disease and high blood pressure.
  • Medical procedures that open or make detours around blocked coronary arteries.
  • Lifestyle changes. This includes a heart-healthy diet (whole grains, fruits, vegetables, proteins, lean meats, and low in fat and salt), quitting smoking, exercise and weight loss, if overweight.
  • Managing chronic illnesses by following your doctor's recommendations. These conditions could include heart disease, diabetes and breathing disorders.
  • Avoiding situations that bring on episodes of angina, such as emotional stress or heavy meals.
By Mary Small, Contributing Writer
Created on 07/02/2008
Updated on 08/18/2013
  • National Heart, Lung, and Blood Institute. Explore angina. What is angina?
  • National Heart, Lung, and Blood Institute. Explore angina. How is angina diagnosed?
  • American College of Cardiology. Coronary artery disease.
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