Angina is a feeling of pain,
tightness, pressure, or discomfort in and around your chest. It can occur if your
muscle isn’t getting enough oxygen-rich blood. There are 2 kinds of angina. They are
Stable angina occurs at times you can
predict. It is constant in how long it lasts and how intense it is. This might be
after exercise or when exerting yourself. This type of angina can often be managed
medicine or rest.
Unstable angina does not occur at
predictable times. It can be more intense and last longer. And it may not respond
usual forms of treatment. It's a warning that a heart attack (acute myocardial infarction)
is possible in the near future. For this reason, it should be treated right away.
If you have questions, be sure to ask
your healthcare provider.
Coronary disease causes angina
Your heart is a muscle. It gets
oxygen from the blood sent through the coronary arteries. Coronary artery disease
occurs when fatty material (plaque)builds up within your artery walls. Plaque irritates
and inflames the artery wall. The buildup of plaque can reduce blood flow to your
This reduces the amount of oxygen your heart gets. The lower amount of oxygen can
the chest pain of angina. Other symptoms of angina include lightheadedness, shortness
breath, nausea, abdominal (belly) pain, or unexplained sweating.
The difference between stable and unstable angina
Stable angina. This type of
angina occurs most often during exercise or times of stress. Stable means that
this type of angina is consistent and predictable. Stable angina goes away when
you rest or take nitroglycerin. This is a medicine that allows the heart muscle to
relax. It helps increase blood flow through your arteries.
Unstable angina. This type of
angina is caused when a piece of plaque breaks off (ruptures). A blood clot can
form at the site of the rupture. The clot reduces blood flow even more. It can
also occur if the artery gets narrower over time. Unstable angina is described as
chest pain that occurs unpredictably even at rest. You may also be diagnosed with
unstable angina if you have stable angina that becomes more severe, lasts longer,
or that is not relieved by rest or medicine.
How unstable angina feels
Unstable and stable angina have the same symptoms. With unstable angina, the symptoms
are more severe and last longer. Symptoms include:
Discomfort, aching, heaviness, tightness, squeezing, or pressure. You may feel this
in your chest or back. You may also feel it in your arm, shoulder, neck, jaw, or upper
Feeling more tired than usual for no clear reason
Shortness of breath
Not everyone who has a heart attack has the typical symptom of chest pain. You may
be having a "silent" (unrecognized) heart attack if you lose consciousness (syncope),
or have confusion, weakness, or changes in thinking (delirium). Get medical help right
away to find out if you are having a heart attack or another serious condition.
Because unstable angina can lead to
a heart attack, it is viewed as an emergency. If you are having symptoms of unstable
angina, you should
call 911 right away. Your healthcare
provider will ask about your symptoms and examine you. Tests will be done quickly.
Common tests include:
Blood tests. These can help
tell if there is damage to your heart. They may be repeated often, usually every 6
to 8 hours until you have 3 sets. They can also check for cholesterol in the
blood, which leads to plaque buildup. They can check for other health problems
that affect the heart, such as diabetes.
Electrocardiogram (ECG). This
test records your heart’s electrical patterns. A resting ECG can show if you have
damage to your heart muscle or a change in the way your heart beats. It's the
quickest way to diagnose an acute heart attack, however not every heart attack is
found on ECG. A stress ECG (stress test) can show how well the blood flows to your
heart while you exercise or when a medicine is given once your symptoms are more
Angiography. This test can
show where your arteries are narrowed. The healthcare provider puts a long tube
(catheter) in an artery in your arm, neck, or leg (groin). They slowly guide it to
your heart. Dye is sent through the tube and into the coronary arteries. This
makes the arteries show up clearly on X-rays. This helps show any blockages or
areas where plaques have narrowed the artery.
Treating unstable angina
Your treatment will depend on the results of your tests. Possible treatments include:
Observation. If your symptoms
are severe, you may need to stay in the hospital to be watched. If your chest pain
gets better and tests show no sign of damage to your heart, and your stress test
shows you are at low risk for a future heart attack, you may be able to go home.
Medicines. Your healthcare
provider will likely give you nitroglycerin. They also may give you medicines that
help prevent blood clots, such as aspirin. They may also give you medicines to
help reduce your blood pressure or slow your heart rate.
Procedures to improve blood flow.
If your chest pain doesn't get better, your healthcare provider may suggest
procedures to improve blood flow to your heart muscle. These can include
angioplasty with stenting or bypass surgery. Your provider will tell you more
about these treatments if you need them.
Lifestyle changes. Lifestyle
changes usually include not smoking, eating healthy foods, losing weight, and
getting regular exercise. These changes will take time to reduce your risk of
having a heart attack. For them to work, you will need to do them for the long
term. The sooner you start, the better it will be for your overall health. If you
have other health problems, such as high blood pressure, diabetes, or high
cholesterol, these need to be treated as well. They can increase your risk for a
heart attack. Lifestyle changes can make unstable angina attacks less frequent and
less severe. Staying away from alcohol and stimulants can reduce the stress on
your heart as well. They also help you manage CAD and reduce your risk for a heart
When taking nitroglycerin
If your healthcare provider
prescribes nitroglycerin, be sure to follow their instructions on how to use it. Also
sure to tell your provider if you’re taking any other medicines. This includes other
prescription and over-the-counter medicines, as well as herbs and other supplements.
Don't take nitroglycerin if you take medicines to treat erectile dysfunction or
pulmonary hypertension. These can include sildenafil, tadalafil, or vardenafil. The
combination of these medicines can cause a dangerous drop in blood pressure.
When to call
Call 911 or go to the emergency
room (ER) right away if your chest pain:
Occurs when you’re not
Wakes you up from sleep
Comes back and is not
relieved by your usual dose of nitroglycerin
Occurs with weakness,
dizziness, fainting, heavy sweating, nausea, or vomiting
Lasts longer than 5
Feels like it's getting worse