What is Angina: Symptoms, Causes & Treatment

Have you ever had tightness or pain in the chest when you exercise or get upset? That chest tightness and pain could be angina. It is a warning sign of coronary artery disease (CAD), the leading cause of death in the US. According to the Centers for Disease Control and Prevention (CDC), about one in twenty adults age 20 and older has CAD, and angina is one of its most common symptoms.

Angina patients can have pain, pressure, or discomfort in the chest, arms, neck, jaw, or back. Pain is usually related to exercise or emotional stress. Fortunately, with treatment, angina can be controlled. So, read on to learn the types of angina, what causes it, who is at risk, the signs, and treatments and lifestyle changes that can make it manageable.

What is Angina?

Angina is chest pain or discomfort that happens when the heart muscle (myocardium) doesn’t get enough oxygen-rich blood. It is usually a symptom of myocardial ischemia, often caused by CAD. Although angina is not a heart attack, it can feel very similar. It is a warning signal that the heart is under strain and may lead to more serious heart conditions if not addressed. 

People may feel pressure, squeezing, or heaviness in the chest. The pain can also spread to the arms, neck, jaw, or back. Angina often occurs during physical activity or emotional stress when the heart needs more oxygen. Unlike a heart attack, angina usually goes away with rest or medicines such as nitroglycerin, which help improve blood flow to the heart.

Not everyone feels typical chest pain. Some people, especially those with diabetes, can experience “silent ischemia”. It reduces blood flow to the heart without obvious pain. This makes regular check-ups and monitoring even more important.

What Are The Different Types Of Angina?

Angina can feel different depending on its type, cause, and the circumstances under which it occurs. The various types of angina help you understand how serious the condition might be and what kind of treatment is needed. The four main types of angina and how they affect the heart are discussed as follows: 

• Stable Angina
  • Stable angina is the most common form of angina pectoris. 
  • It happens when the myocardium (heart muscle) needs more oxygen, like during physical exertion, heavy meals, cold weather, or emotional stress.
  • In daily life, it may be triggered by activities like climbing stairs, carrying groceries, or walking uphill. 
  • The pain is predictable, lasts for five minutes or less, and usually goes away with rest or nitroglycerin. It’s linked to atherosclerosis in the coronary arteries.
• Unstable Angina
  • Unstable angina is a serious condition that can occur even at rest. 
  • It is unpredictable and often indicates a partial blockage or rupture of atherosclerotic plaque in the coronary arteries. 
  • The chest pain is more severe, lasts longer for about 15 minutes or more, and often does not improve with rest. 
  • This is a medical emergency that signals an increased risk of a heart attack in the near future and requires immediate evaluation. 
  • Unstable angina is classified under acute coronary syndrome (ACS), along with NSTEMI (Non-ST-segment elevation myocardial infarction) and STEMI (ST-segment elevation myocardial infarction) heart attacks.
• Variant (Prinzmetal’s) Angina
  • Variant angina, also known as Prinzmetal’s angina, is rare and caused by a temporary vasospasm (sudden tightening) of a coronary artery. 
  • It often occurs in younger patients or at night, and may not have classic risk factors. 
  • An ECG taken during an episode typically shows transient ST-segment elevation.
  • The pain is intense but typically relieved by calcium channel blockers (CCBs) or nitrates, which relax the vascular smooth muscles. 
  • CCBs are preferred over beta-blockers here because beta-blockers may worsen vasospasm.
  • Some of the most common triggers of this angina are smoking and drug use (e.g., cocaine). 
• Microvascular Angina
  • Microvascular angina affects the small coronary arterioles rather than the large arteries. 
  • These vessels are too small to be seen on regular angiograms. Therefore, the condition is harder to detect with standard imaging.
  • It causes chest pain due to endothelial dysfunction or impaired blood flow at the microvascular level. The pain may last longer and not respond well to standard tests.
  • This type of angina is often diagnosed by ruling out obstructive coronary artery disease and confirmed through advanced imaging or coronary flow reserve testing. 
  • It’s more common in women and can be linked to cardiac syndrome X. 
  • Treatment often requires a team approach, involving both cardiac specialists and pain management experts to control symptoms effectively.
• Refractory Angina
  • In some cases, patients experience persistent chest pain despite optimal medical therapy and revascularization attempts (like stenting or bypass surgery). 
  • This is known as refractory angina, and it often requires a multidisciplinary pain management and cardiology approach. 
  • It affects 5-10% of patients with chronic coronary syndrome.

Now that we have seen the types of angina, let us see what causes angina. 

What Causes Angina?

The main cause of angina is reduced oxygen supply to the heart muscle. But why exactly does the heart not get pure blood properly? Here are the common causes of angina explained: 

Coronary Artery Disease (CAD)

• Coronary artery disease is the most common cause of angina.
• It occurs when atherosclerosis leads to plaque buildup inside the coronary arteries. This narrows the vessel lumen, reducing blood flow to the myocardium. 
• During increased oxygen demand, this reduced perfusion causes ischemia, leading to chest pain or discomfort known as angina. 
• Unlike variant (Prinzmetal’s) angina, which often occurs at rest due to temporary artery spasm, angina in CAD is usually triggered by physical activity or stress.

Coronary Artery Spasm

• Also called vasospastic or variant angina, this occurs when a coronary artery undergoes a sudden vasospasm. It is a temporary narrowing caused by the contraction of smooth muscle in the arterial wall. 
• These spasms can occur with or without plaque buildup and may cause transient ST-elevation on ECG. 
• Even without plaque, this spasm reduces blood supply to the heart, causing myocardial ischemia and resulting in anginal chest pain, often at rest. 
• It can even happen in younger individuals without risk factors, especially drug users or people under extreme stress.

Microvascular Disease

• Microvascular angina results from dysfunction in the tiny coronary arterioles. Unlike large-vessel CAD, this condition affects small blood vessels, leading to impaired vasodilation and reduced oxygen delivery to the myocardium. 
• This endothelial dysfunction can cause prolonged chest pain, even when major coronary arteries appear normal on angiography. 
• A high-quality meta-analysis found that about 41% of patients with chest pain and no major artery blockages still had coronary microvascular dysfunction (CMD). 
• CMD is more prevalent in women, particularly postmenopausal women, and may not be detected through traditional angiograms. 

Severe Anemia

• Anemia reduces the blood’s oxygen-carrying capacity due to low hemoglobin levels. Even if coronary arteries are normal, the myocardium may not receive enough oxygen to meet its metabolic demands. 
• This oxygen deficit can lead to myocardial ischemia and angina, especially during physical activity or stress when oxygen needs are higher. 
• Among stable CAD patients, 23% had anemia. Anemic patients faced significantly worse outcomes, i.e., 6.5 times higher risk of death and 3.3 times higher risk of major cardiovascular events. 
• Angina caused by anemia can often improve when the anemia is treated, since restoring hemoglobin levels improves oxygen delivery. 
• In contrast, angina from CAD usually requires more aggressive and long-term interventions, such as medications, stents, or bypass surgery.

Uncontrolled Hypertension

Chronic high blood pressure increases the heart’s workload, causing left ventricular hypertrophy and greater oxygen demand. 

• Over time, it also damages arterial walls, promoting atherosclerosis. This combination of increased demand and restricted supply can lead to myocardial ischemia, resulting in angina during exertion or even at rest in severe cases. 
• About 1 in 3 CAD patients have high blood pressure, and controlling it remains suboptimal (only ~54% achieve control). It highlights the importance of strategies like home blood pressure monitoring and the DASH diet for better management.

Read More: How to Support a Person with a Heart Disease

Who Is At Risk For Angina?

Certain conditions and habits can increase your chances of getting angina or heart disease. These can be divided into modifiable (you can change) and non-modifiable (you cannot change) factors.

Modifiable Risk Factors

• Smoking: Smoking is linked to roughly 36% of coronary artery disease cases, and even one cigarette per day doubles CAD risk. It damages blood vessels, lowers oxygen in the blood, and promotes clotting and plaque buildup.
• High Cholesterol: Too much LDL cholesterol causes plaque to form inside the arteries. This narrows blood flow and raises the risk of ischemia and angina.
• Diabetes Mellitus: High blood sugar harms blood vessels and speeds up atherosclerosis. This greatly increases the chance of angina and heart disease.
• Lack of Physical Activity: Inactivity reduces heart fitness and leads to weight gain. It also raises blood pressure and worsens cholesterol levels.
• Unhealthy Diet: Diets rich in fats, sugars, and processed foods fuel obesity and hypertension. They also promote plaque buildup in arteries.
• Overweight or Obesity: Extra weight makes the heart work harder. It is closely tied to diabetes, high blood pressure, and abnormal cholesterol.
• Chronic Stress: Ongoing stress raises heart rate and blood pressure. It may also trigger coronary artery spasms that cause chest pain.
• Sleep Apnea: This sleep disorder reduces oxygen levels at night and raises blood pressure. It is an independent but often missed risk for CAD and angina.

Non-Modifiable Risk Factors

• Older Age: As people get older, arteries naturally stiffen and blood flow becomes less efficient. Many older adults also develop conditions like high blood pressure or diabetes that add to the risk. 
• Family History: If parents or siblings developed heart problems at a younger age, the risk is even higher. This factor cannot be changed, but awareness helps in early prevention.

Is Angina Hereditary?

Yes, angina can be hereditary. If close family members, like parents or siblings, have heart disease, you may have a higher risk of developing angina due to inherited factors. Genetics can influence conditions such as high blood pressure, high cholesterol, and diabetes, all of which contribute to coronary artery disease and angina. However, having a family history doesn’t mean you’ll definitely get it. 

You can lower your risk through healthy lifestyle choices, such as regular exercise, eating a balanced diet, avoiding tobacco, managing stress, and getting routine medical check-ups. Early prevention and awareness are key to protecting your heart health.

Read More: How to Handle Heart Attack Cases and Stay Heart Healthy?

How Does Angina Feel In Most People?

Angina doesn’t always feel the same for everyone. The most common angina attack symptoms include:

• Chest pain or discomfort (pressure, squeezing, tightness)
• Pain in the shoulders, arms, neck, jaw, or back
• Shortness of breath
• Fatigue
• Sweating
• Nausea
• Dizziness

People with diabetes may develop silent ischemia, where reduced blood flow to the heart causes little or no pain, making it harder to detect.

Symptoms of Angina in Women

Women are more likely to have atypical symptoms such as fatigue, indigestion-like discomfort, or anxiety. Therefore, their angina is often misdiagnosed as stress, digestive problems, or panic attacks, which can delay proper treatment. The symptoms of angina in women include:

• Nausea or vomiting
• Stomach pain (like indigestion)
• Shortness of breath
• Unusual tiredness (even without activity)
• Pain in the back, neck, or jaw
• Anxiety or lightheadedness

As these signs of angina can be mistaken for other problems, angina in women is often missed or diagnosed late.

Now that we know what angina is and its symptoms, let us see how to treat it.

What Procedures or Surgeries Might Be Needed?

Sometimes, medications alone aren’t enough to manage angina chest pain, especially if the arteries are severely blocked. In such cases, doctors may suggest procedures or surgeries to improve blood flow to the heart. Two common treatments that help open or bypass blocked arteries and reduce the risk of heart attacks are:

• Angioplasty and Stenting

Percutaneous coronary intervention (PCI) involves inflating a balloon inside a narrowed coronary artery to restore blood flow. A stent, usually drug-eluting, is then inserted to keep the artery open and reduce the risk of future ischemic events.

• Coronary Artery Bypass Surgery

Coronary artery bypass grafting (CABG) uses blood vessels from other parts of the body to create new pathways around blocked coronary arteries. This improves myocardial perfusion and is often recommended for severe or multiple-vessel coronary artery disease.

Doctors decide between PCI and CABG based on several factors, such as how many arteries are blocked, the location, and the severity of blockages. For example, PCI is often preferred for one or two blocked vessels, while CABG may be recommended for multiple blockages or in diabetic patients for better long-term outcomes.

What Lifestyle Changes Can Help Manage Angina?

Making healthy lifestyle changes is one of the best ways to manage angina and protect your heart. Simple habits like eating better, staying active, and reducing stress can help protect your heart. Lifestyle tips that can help reduce angina attack symptoms and prevent future heart problems.

1. Quit Smoking

Smoking causes endothelial dysfunction and accelerates atherosclerosis, increasing the risk of angina. Quitting smoking improves vascular health, enhances oxygen delivery, and reduces the risk of myocardial infarction and other cardiovascular complications.

2. Eat Heart-Healthy Foods

A heart-healthy diet is low in saturated fats, trans fats, sodium, and added sugars. Nutrient-rich foods like fruits, vegetables, whole grains, and lean proteins help manage cholesterol, blood pressure, and glucose, lowering the risk of coronary artery disease.

3. Exercise Regularly

Regular physical activity improves cardiovascular fitness and helps control blood pressure, body weight, and lipid levels. Moderate aerobic exercise, as prescribed by a healthcare provider, enhances myocardial oxygen efficiency and reduces anginal symptoms over time. For people with unstable angina or recent heart events, a cardiac rehabilitation program or doctor-supervised exercise plan is the safest way to start.

4. Manage Stress

Chronic stress increases catecholamine release, elevating heart rate and blood pressure. Stress management techniques, like mindfulness, deep breathing, or therapy, can reduce sympathetic nervous system activity and lower the risk of triggering angina. Tools such as heart rate variability (HRV) tracking apps or cognitive behavioral therapy (CBT) may also help people build healthier coping strategies.

5. Maintain a Healthy Weight

Excess body fat raises the risk of hypertension, dyslipidemia, and insulin resistance. Maintaining a healthy body mass index (BMI) reduces strain on the cardiovascular system and lowers the likelihood of angina and heart disease.

6. Limit Alcohol Consumption

High alcohol intake can raise blood pressure and contribute to arrhythmias and cardiomyopathy. Limiting alcohol supports heart health by reducing oxidative stress and inflammation, and helps maintain stable blood pressure and lipid levels.

Stay Prepared For Heart Emergencies With the Right Course! 

Angina is a warning sign, but with treatment and lifestyle changes, you can take control. To protect yourself and others, get certified in CPR/BLS today.  The main types include stable, unstable, variant, and microvascular angina. Each type feels different but usually causes chest pain, pressure, or discomfort. Some people, especially women, may feel tired, dizzy, or have pain in their stomach, jaw, or back instead of chest pain.

But the good news is that angina can be managed. Medicines, surgeries like angioplasty or bypass, and healthy habits can reduce symptoms and protect your heart. Ready to Protect Your Heart and Others? Take a 100% online, self-paced CPR/AED and First Aid course today.