Angina: Causes, Symptoms and Prevention

What is Angina?

Angina is the discomfort that one experiences when there is a narrowing of the heart’s artery, or when the heart does not receive enough blood supply, particularly while exercising because during exercise or any strenuous activity, the heat rate and blood pressure goes up and the heart needs more blood supply.

Angina is a symptom of coronary artery disease and is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Also known as angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort due to indigestion. Therefore in case of unexplained chest pain, one should seek immediate medical attention.

What causes Angina?

Angina is caused by reduced blood flow to the muscles of the heart. Our blood carries oxygen, which is necessary for the heart muscle to survive. When the heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). The heart (coronary) arteries can become narrowed by deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — due to which the heart does not get enough oxygen-rich blood. So, during times of low oxygen demand, eg. while resting the heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when there is an increased demand for oxygen, such as during exercise, this can cause angina.

What are the symptoms of Angina?

Symptoms associated with angina include:

    1. Chest pain or discomfort
    2. Pain in the arms, neck, jaw, shoulder or back accompanying chest pain
    3. Nausea
    4. Fatigue
    5. Shortness of breath
    6. Sweating
    7. Dizziness

Chest tightness, breathlessness and fatigue after any kind of exertion, whether it is swimming or cycling or running or even walking up a few stairs or slope, could be an indication of Angina.

The severity, duration and type of angina can vary. It's important to recognize if there is any new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

How can Angina be diagnosed and managed?

If the chest pain lasts longer than a few minutes and doesn't go away even after rest or taking angina medications, it may be a sign of a heart attack. Call for emergency medical help immediately.

To diagnose angina, the doctor will start by doing a physical exam and by understanding the symptoms. Risk factors, including family history of heart disease are important. There are several tests your doctor might recommend in order to confirm angina, like:

    1. Electrocardiogram (ECG)
    2. Stress test/Treadmill test
    3. Echocardiogram 
    4. Chest X-ray 
    5. Coronary angiography
    6. Cardiac computerized tomography (CT) scan

If there are any blockages, one may experience these kind of symptoms, so these tests play a very important role to ascertain if there is any problem in any of the heart’s arteries. 

Even if a blockage is ruled out is advised to improve the fitness levels, reduce excess weight and continue a good exercise regime. 

There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of the symptoms and to lower the risk of heart attack and death.

Lifestyle changes and medications are frequently used to treat stable angina. But surgical procedures, such as angioplasty, stenting and coronary artery bypass surgery, may also be required sometimes to treat angina. 

Dr. Sreekanth B. Shetty
Senior Consultant & Head - Interventional Cardiology
MD (Internal-Medicine), DM (Cardiology)
Institute of Cardiac Sciences