Angina is chest pain or discomfort that happens when your heart isn’t receiving enough oxygen-rich blood. As a result, your heart may beat faster and harder to gain more blood, causing you noticeable pain. Angina isn’t a disease. It’s a symptom and a warning sign of heart disease.
About 10 million people in the U.S. experience angina. So, if you have this symptom, you’re certainly not alone. It’s important to learn more about angina, what causes it and how to manage it in your daily life.
Important: Angina can be a warning sign of a heart attack. If you have unexpected or severe chest pain, call 911 right away.
What causes angina?
Reduced blood flow to your heart (myocardial ischemia) causes angina. Several problems with your coronary arteries can prevent your heart from receiving enough blood. These include:
Coronary artery disease (CAD): This is the most common cause of angina. It happens when plaque (a fatty, waxy substance) builds up in your coronary arteries, which supply blood to your heart. These arteries narrow or harden (atherosclerosis), reducing blood flow to your heart.
Coronary microvascular disease: This condition is more common among women and people assigned female at birth (AFAB) compared with men and people assigned male at birth (AMAB). It damages the walls of tiny blood vessels that branch from your coronary arteries. These blood vessels aren’t seen on typical testing for CAD and require special testing that’s not available at all medical centers.
Coronary artery spasm: Your coronary arteries repeatedly constrict (tighten) then open up. These spams temporarily restrict blood flow to your heart. You can have coronary spasms without having coronary artery disease. This may not be diagnosed with routine testing for CAD and may require special testing that’s not available at all medical centers.
Risk factors for angina
There are many risk factors for angina. Some factors raise your risk of heart problems that directly cause angina, like coronary artery disease. Other factors limit how much oxygen-rich blood can reach your heart.
Some risk factors (like aging) can’t be changed. You may be able to manage others through lifestyle changes and medications. Talk with your provider about how to lower your risk.
Your healthcare provider will treat the underlying heart problem that’s causing your angina. The goals of treatment are to improve blood flow to your heart and lower your risk of complications. Your provider will give you a physical exam and perform testing to learn more about your condition and determine the best treatments.
Even with treatment, some people still experience angina. Your provider may prescribe a medication to quickly open your blood vessels when you have pain. Nitroglycerin is a common angina medication.
Enhanced external counterpulsation (EECP) is another option for people with continued pain. This therapy applies pressure to your lower legs to help improve blood flow to your heart. It may help ease your angina.
What can I do at home to manage angina?
Talk with your healthcare provider about how to manage angina in your daily life. They’ll offer advice based on the type of angina you have and what’s causing it. Some general tips include:
Keep a log of your angina episodes. Include the date and time, what it felt like and possible triggers (activities, emotions, weather, etc.). Also include the pain level on a scale of 1 to 10. Share the log with your provider.
Know when to call for emergency help.
Take medication as prescribed to treat your angina.
Try to avoid the triggers that lead to an angina attack.
If you have angina, you may worry about what’ll trigger an angina attack. You may wonder if it’s safe for you to do the following activities:
Drive.
Exercise or play a competitive sport.
Have sex.
Work a job that involves manual labor.
Talk with your provider about which activities are safe for you. Many people can continue their normal routine, but should keep medicine with them in case of an angina attack. You may need to reduce heavy lifting or other strenuous tasks that could trigger an angina attack. But your provider will offer guidance based on your individual situation.
How can I prevent angina?
You can help prevent angina by living a heart-healthy lifestyle. Take these steps for better heart health:
Avoid smoking and all tobacco products. Also, avoid exposure to secondhand smoke.
Eat a heart-healthy diet. The DASH Diet and the Mediterranean Diet are good options. Lower your intake of saturated fat, trans fat, sugar and sodium.
Find new ways to manage stress. Try meditation, yoga or talking with a counselor or friend. Journal writing is another way to process emotions and concerns.
Keep a weight that’s healthy for you. Ask your provider what you should aim for, and ask for advice on how to reach that goal.
Manage risk factors for coronary artery disease. These include high blood pressure, high cholesterol, high triglycerides and diabetes.
Move around more. Try to exercise for at least 150 minutes (2.5 hours) every week. Go for walks or find other activities you enjoy. Find a friend to join you.
Take medications prescribed by your cardiologist. Many of these medications have been shown to reduce or eliminate the anginal symptoms you have.
A correct diagnosis is important because it can predict the likelihood of a heart attack.
The doctor will:
perform a physical exam
ask about symptoms
discuss any risk factors
check the individual’s personal and family medical histories
If the doctor believes that the issue is angina, they may recommend one or more of the following tests:
blood tests, to check fat, cholesterol, sugar, and protein levels
an EKG, to record electrical activity in the heart and detect any lack of oxygen
a stress test, involving physical activity, blood pressure readings, and an EKG
a nuclear stress test, to detect abnormalities in blood flow to the heart during physical activity
a chest X-ray, to see the structures within the chest
coronary angiography, which involves using dye and special X-rays to show the insides of the coronary arteries
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