Angina is chest discomfort that arises when the heart muscle is not getting enough oxygen-rich blood. Far from a disease itself, angina is a symptom of underlying heart problems, most often coronary artery disease.
How Angina Feels
The classic description is a pressure, tightness, squeezing, or heaviness in the center of the chest. Some patients describe burning or indigestion-like discomfort. The sensation may radiate to the left arm, jaw, neck, shoulder, or back.
Stable Angina
Stable angina occurs predictably with exertion, emotional stress, cold weather, or heavy meals. It typically lasts a few minutes and resolves with rest or nitroglycerin. The pattern remains consistent over weeks or months. Stable angina suggests fixed coronary narrowing.
Unstable Angina
This more dangerous form occurs at rest, with minimal exertion, or in an escalating pattern. It signals an unstable plaque in a coronary artery that may be on the verge of complete blockage. Unstable angina requires immediate medical attention.
Variant Angina
Also called Prinzmetal angina, this rarer form is caused by spasm of a coronary artery rather than fixed obstruction. Episodes often occur at rest, sometimes in the early morning, and respond to calcium channel blockers.
Diagnosis and Workup
Evaluation includes an electrocardiogram, blood tests for cardiac biomarkers, stress testing in stable cases, and often coronary imaging. The specific testing depends on the clinical presentation and risk assessment.
Treatment Goals
Treatment aims to relieve symptoms and reduce risk of heart attack and death. Nitroglycerin treats acute episodes. Daily medications, lifestyle changes, and sometimes revascularization with stenting or bypass surgery address underlying disease. For comprehensive patient information, the American Heart Association offers excellent resources.