Find care now
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Angina is a squeezing, heavy pressure and pain in the chest that is a symptom of reduced blood flow to the heart—it can be a warning sign of a heart attack. Thanks to technological advances like Coronary Functional Testing, my colleagues and I are better able to help patients identify the cause of their angina pain and tailor a treatment plan to help them.
Angina affects about 10 million people in the U.S. Stable angina, the most common form, usually occurs with exertion and goes away with rest. Unstable angina happens when you’re resting, and its pain tends to get worse over time. The pain is usually severe and lasts for several minutes. Unstable angina is dangerous and can result in a heart attack. It needs emergent evaluation and treatment.
Risk factors for angina include:
- Age over 60
- High blood pressure
- High cholesterol/triglycerides
- Diabetes
- Family history of heart disease
- Inactive lifestyle
- Medications
- Obesity
- Stress
- Drug misuse
There are two primary causes of angina symptoms, and it’s important to distinguish between them to provide effective treatment.
Symptoms of angina in males and females.
Classic symptoms of angina include chest pain that can feel like burning, pressure, or squeezing, along with pain in the arms, neck, jaw, shoulder, or back. Other symptoms can include:
- Difficulty breathing
- Dizziness
- Nausea
- Sweating
- Tiredness
Symptoms of angina in women can be different than in men, and chest pain isn’t always the primary thing patients notice. Women’s angina symptoms can also include:
- Discomfort in the neck, jaw, teeth, or back
- Stabbing chest pain
- Shortness of breath
- Stomach pain, similar to gastric reflux symptoms
Angina symptoms can vary in their severity and how long they last. Talk with your doctor right away about any new or worsening symptoms you experience. The doctor will diagnose which type of angina you have and recommend an appropriate treatment plan.
Related reading: Melanie’s Story: How Determination and Advanced Technology Found the Cause of Her Heart Attack.
Two types of angina: Diagnosis and treatment.
Obstructive coronary artery disease
Most often, angina is often caused by the buildup of fatty plaque deposits in large blood vessels, called atherosclerosis. Over time, these plaques can grow, causing a narrowing of the blood vessel. When too little blood flows through the vessels, the heart can be deprived of oxygen and struggle to pump. Angina can result.
How we diagnose it: Stable angina caused by obstructive coronary disease can be suggested by methods like electrocardiogram, echocardiogram, and stress test. Research has shown that an anatomical test like a cardiac computed tomography (CT) scan can help rule out conditions like triple vessel disease or left main disease, serious conditions that increase the risk of heart attack, heart failure, and stroke.
How we treat it: Traditionally, treatment for angina has involved an invasive catheterization procedure to place a stent that holds the blood vessel open, allowing oxygen-rich blood to reach the heart. Research has demonstrated that personalized medicine can have similar results, sometimes without the need for an invasive procedure.
MedStar Health cardiologists work closely with our patients to make shared decisions about their treatment that are tailored to their lifestyle, goals, and the cause of their angina symptoms. No matter what the root cause of their pain, most patients can benefit from lifestyle improvements like a healthier diet, regular exercise, managing chronic conditions like diabetes and high blood pressure, and quitting smoking.
Research has shown that long-term outcomes for patients who get a stent via catheterization procedure and those who are treated with medications are similar. Medications include drugs to help lower blood pressure (ACE inhibitors, beta blockers, and calcium channel blockers) and open the arteries (nitrates). Statins can also help control cholesterol and blood triglycerides.
If an invasive procedure is needed, because patients are still experiencing symptoms despite being on medication, percutaneous coronary intervention (PCI) opens blocked arteries with a small mesh tube called a stent. Today’s stents include medications and have a very low risk of complications. Modern PCI is optimized with intravascular imaging that provides precise guidance when we’re placing the stent.
Related reading: Coronary Microvascular Dysfunction: New Diagnostic Tools Offer Quick Answers and Treatment.
Angina with no obstructive coronary disease (ANOCA).
In some cases, patients have angina without an obstruction in their coronary arteries. This is caused by spasms or disease of the small vessels near the heart. Called “angina with no obstructive coronary disease” (ANOCA), disease of the tiny blood vessels around the heart like coronary microvascular disease is the cause of stable angina in about 40% of patients who were tested.
Studies have shown that ANOCA can be difficult to diagnose. Almost 35% of patients surveyed said they lived with symptoms for three years or more before being diagnosed, and almost 78% were told their symptoms were not related to their heart.
How we diagnose it: To accurately diagnose disease that causes ANOCA, my colleagues and I perform a comprehensive cardiac catheterization evaluation of both the large and small coronary blood vessels. This Coronary Functional Testing enables us to check for coronary microvascular dysfunction (CMD) or spasm that can be the cause of angina symptoms even when the large blood vessels aren’t blocked.
How we treat it: Medications for diseases of the microvasculature are similar to CAD: Calcium channel blockers, statins, and nitrates. In addition, medications like ACE-inhibitor and ranolazine have been shown to improve symptoms in some patients. However, making the correct ANOCA diagnosis is important, in order to tailor therapies specifically.
Almost all patients are able to find relief from symptoms with medication. If medicines don’t help, other options can help reduce symptoms. These include:
- Spinal cord stimulation to improve pain response
- Enhanced external counter pulsation, in which leg cuffs are inflated and deflated in time with the heart’s rhythms
- Cardiac rehabilitation to improve stamina and improve quality of life
It’s important to understand the precise cause of a patient’s angina symptoms to provide the right treatment. To get an accurate diagnosis, more and more patients are turning to centers like ours with the technology and expertise to make a difference.
Related reading: Global CMD Registry Research Helps Understand Chest Pain Before Tragedy Strikes.
Technology and expertise make a difference for patients.
The best way to get a complete picture of what’s causing chest pain is often cardiac catheterization. In this minimally invasive procedure, doctors guide thin, flexible tubes called catheters through blood vessels to find problems.
MedStar Health’s hybrid labs allow us to perform surgery should it become necessary. Cardiac catheterization procedures allow us to:
- Biopsy the heart muscle
- Measure pressure and flow in the heart’s chambers
- Open a narrowed or blocked blood vessel
- Repair or replace damaged blood vessels or heart valves
Our expert interventional cardiologists perform about 12,000 cardiac catheterizations each year. Often, patients from outside our region find that our experts can offer a diagnosis and advanced treatment when others cannot.
To stay healthy and reduce your risk of coronary artery disease, it’s important to control the risk factors you can. If you have ongoing chest pain, talk with your doctor about seeing a cardiologist. If you’ve been told your heart is “normal” but you still have symptoms, keep asking. We often see patients who didn’t take no for an answer. Between their persistence and our expertise, we’re often able to make a difference to relieve their angina symptoms.
