Angina is chest pain usually caused by narrowing of blood vessels in the heart from blockage or spasm. Less blood can reach the heart, so it has less oxygen for pumping blood. Angina may mean serious heart problems and needs immediate attention.
Coronary artery disease from atherosclerosis (i.e., fatty deposits in blood vessels to the heart), abnormal heart rhythms (arrhythmias), fewer oxygen-carrying red blood cells (anemia), and spasms of the coronary arteries can reduce blood flow.
At increased risk for angina are men older than age 60, women after menopause, people with a family history of heart disease, people who eat high-fat high-cholesterol foods, people who don’t exercise regularly, smokers, and people with diabetes, high blood pressure (hypertension), or high cholesterol levels.
The primary symptom is a feeling of tightness, dull ache, or heaviness that begins in the chest and sometimes spreads to the back, neck, left shoulder, and down the arms (especially left arm). Pain may be dull or sharp or feel like heartburn or indigestion. Some people describe a smothering or crushing pain. It may begin slowly or be severe and sudden. Sweating, nausea, feeling faint or weak, dizziness, or shortness of breath may also occur.
The health care provider makes a diagnosis by checking symptoms, doing examinations and laboratory and other tests. Tests include electrocardiograms (ECGs) and treadmill or exercise tests. A heart catheterization (checking the heart’s blood flow by putting a device through an artery into the heart) may also be done if the initial tests show signs of blocked heart (coronary) arteries.
The goal is to improve blood flow to the heart or to reduce the heart’s work. Resting or reducing activity is the first treatment.
Aspirin improves blood flow. Nitrates such as nitroglycerin can also help blood flow. Other medications such as beta blockers slow down the heartbeat and the work done by the heart. Medicine for other diseases (e.g., hypertension, arrhythmias, diabetes, high cholesterol) may be given if these diseases are present.
Anyone with angina should take aspirin daily unless told not to by a health care provider.
Lifestyle changes (exercise, diet, weight control, quitting smoking) are important.
If medicine doesn’t work, surgery (angioplasty, an operation to open clogged blood vessels with a balloonlike device) may be needed. A small wire mesh tube, called a stent, is often inserted into the blocked artery after it has been opened to prevent it from narrowing again. Open heart surgery (coronary artery bypass graft, or CABG) may be necessary for severely blocked arteries.
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