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Angina (Chest Pain) Symptoms, Diagnosis, and Treatment

Angina is chest pain caused by an area of your heart not getting enough blood flow. It isn't a disease but a symptom of an underlying heart problem.

People with chest pain can get complete care at the UPMC Heart and Vascular Institute. Our doctors are experts in finding and treating underlying heart conditions that cause angina.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

What Is Angina?

Angina is chest pain that happens when an area of your heart doesn't get enough blood flow.

It feels like a squeezing in your chest. It can also cause pain in your shoulders, neck, back, arms, or jaw.

Angina isn't a disease. Instead, it's a symptom of an underlying heart problem, most often coronary artery disease (CAD) or coronary microvascular disease.

CAD happens when plaque builds up in your arteries, reducing blood flow to your heart. That lack of blood flow causes angina.

As many as 7 million people in the U.S. may have angina. It affects men and women equally.

The UPMC Heart and Vascular Institute provides complete angina care — from screening to diagnosis to treatment and recovery. Our experts work as a team to care for you and empower you to live a heart-healthy life.

Types of angina

There are four main types of angina:

  • Stable (angina pectoris). This is the most common type of angina. It happens when your heart muscle is working harder than normal. The pain and severity occur in a regular pattern.>
  • Unstable. This type of angina needs emergency treatment. The pain may become severe, and it's unpredictable. It's a signal you may have a heart attack soon.
  • Variant. This rare type, caused by a spasm in your coronary artery, often happens when you're resting.
  • Microvascular. This is another rare type that may cause severe pain and last longer than other types of angina.

Angina causes

Angina occurs when the heart doesn't receive enough blood flow. This often happens because of CAD. When arteries narrow from plaque buildup, blood can't flow through them as easily.

Certain factors can damage the arteries, causing plaque to build up. This means less blood can flow to the heart.

Angina risk factors

Certain factors can put you at a higher risk of angina, such as:

  • Older age. People older than 60 are more likely to get angina.
  • A family history of heart disease. If you have parents or siblings who have had heart disease or a heart attack, there's a chance you're at higher risk.
  • Smoking or tobacco use. Tobacco use or long-term secondhand smoke exposure can damage arteries, reducing blood flow.
  • Certain medications. Some drugs can cause blood vessels to tighten. Ask your doctor about the ones you take.
  • Diabetes. People with diabetes are at an increased risk of CAD.
  • High blood pressure. High blood pressure can cause damage to arteries and speed up hardening over time.
  • High cholesterol. High levels of bad cholesterol or triglycerides can lead to arteries narrowing.
  • Chronic kidney disease. This can put you at an increased risk of angina.
  • Sedentary lifestyle. Being idle increases your risk for heart disease and puts you at a higher risk of chest pain.
  • Obesity. Excess weight means your heart works harder to send blood to the body and increases your risk of heart disease.
  • Weather. Cold weather can cause a type of chest pain called Prinzmetal angina.
  • Stress. Too much stress can increase blood pressure and cause arteries to narrow.

Symptoms of angina

Angina often feels like a squeezing, tightening, or burning in the chest behind the breastbone.

You may also have pain in the:

  • Shoulder.
  • Arms.
  • Neck or throat.
  • Jaw.
  • Back.

The pain may feel like indigestion.

Other symptoms of angina include:

  • Nausea.
  • Fatigue.
  • Shortness of breath.
  • Sweating.
  • Lightheadedness.
  • Weakness.

Symptoms may happen during physical exertion or at rest.

Angina symptoms in women

Women's angina symptoms may differ from those of men.

Although women have chest pain with angina, they're more likely to have other symptoms such as:

  • Pain in the neck, jaw, teeth, or back.
  • Shortness of breath.
  • Nausea.
  • Stabbing pain in the chest rather than a feeling of pressure.
  • Stomach pain.
  • Fatigue.
  • Palpitations.

With stable angina, symptoms occur in a predictable pattern — mostly during exertion. Rest and medicine can relieve stable angina symptoms.

Other types of angina may cause symptoms even at rest, and medicine may or may not ease symptoms.

When to see a doctor for chest pain

You should make an appointment with a doctor if you have:

  • Chest pain or discomfort.
  • Chest pressure.
  • Shortness of breath.
  • Dizziness.

See a doctor if your wearable (an Apple Watch, for example) shows signs of heart rhythm changes.

Find a doctor at UPMC.

Diagnosing angina

First, your doctor will give you a physical exam and ask about your symptoms and health history.

Before confirming an angina diagnosis, your doctor will decide the cause of your chest pain and rule out a heart attack. Because angina is a symptom of heart disease, your doctor will look for signs of heart damage.

Your doctor will also diagnose what type of angina you have, either stable or unstable.

They may give you certain tests or order imaging scans such as:

  • An EKG. This test measures your heartbeat and your heart's electrical activity (rhythm). Your doctor will look for signs of heart damage from heart disease or prior heart attack.
  • Stress test. This test measures your heart's response to physical activity that requires your heart to pump harder and faster. The test looks for shortness of breath and abnormal changes in your heart rate, rhythm, or electrical activity.
  • Chest x-ray. This test looks for signs of heart damage, lung disorders, or other health problems. A chest x-ray doesn't diagnose angina but may rule out other causes of chest pain.
  • Blood tests. Blood tests look for risk factors for heart disease.
  • CT scans. A CT scan is a type of x-ray that looks for narrowing of the arteries.
  • Electrophysiology testing. These tests check heart rhythms and the heart's electrical activity.

Your doctor will base your treatment on what type of angina you have.

The main goals of treatment for all types of angina are to lessen your chest pain and prevent a heart attack.

Lifestyle changes for treating angina

Adjust your lifestyle to avoid triggers, such as:

  • Slowing down or taking more breaks during exertion.
  • Eating smaller meals.
  • Limiting stress.

Making heart-healthy changes to prevent heart disease can also help you deal with chest pain, like:

  • Eat a healthy diet rich in fruits and veggies. Limit salt and sugar intake.
  • Maintain a healthy weight for your body type.
  • Don't smoke.
  • Exercise safely. Your doctor can guide you on exercises you can do that won't worsen your chest pain while keeping you healthy.

Medication for angina

Medicine is a mainstay for stable and unstable types of angina.

Nitrates are the most common. Nitrates relax and widen your blood vessels to get more blood flow to your heart.

Your doctor may prescribe other drugs to:

  • Lower blood pressure.
  • Relax blood vessels.
  • Slow your heart rate.
  • Lessen the strain on your heart.
  • Prevent blood clots.

These drugs include:

  • Beta-blockers.
  • Calcium channel blockers.
  • ACE inhibitors.
  • Oral antiplatelets.
  • Blood thinners.

Angioplasty and grafting to treat angina

If medicine and lifestyle changes aren't enough, you may need other treatment methods for your heart disease.

These include:

  • Angioplasty to treat blocked or narrowed coronary arteries. Surgeons thread a thin tube through a blood vessel and inflate the end to open the artery and improve blood flow. Your surgeon may place a stent in the artery to keep it open.
  • Coronary artery bypass grafting to treat angina. Surgeons take healthy arteries or veins from another part of your body and use them to bypass the blocked artery.

Cardiac rehab

rehab program helps you make the lifestyle changes you need to protect your heart.

You'll learn exercises to increase strength, endurance, and energy and get advice and support for diet changes.