Angina (chest pain)

Angina is a feeling of pain, squeezing, or pressure in the chest. It happens when a part of the heart receives less blood and oxygen than usual. Angina isn’t a disease, but a symptom of an underlying heart problem, usually coronary heart disease (CHD). Alone, angina is not life threatening, but it can resemble the symptoms of a heart attack, and it is a sign of heart disease.

Angina symptoms

Angina involves any of the following sensations in the chest:

• Squeezing
• Pressure
• Heaviness,
• Tightening
• Burning or aching across the chest (usually starting behind the breastbone).

The pain often spreads to the neck, jaw, arms, shoulders, throat, back, or teeth.

Other possible symptoms include:

• Indigestion
• Heartburn
• Weakness
• Sweating
• Nausea
• Cramping or shortness of breath

The duration of these symptoms depends on the type of angina.

Different types of angina

Stable angina:

• Stable angina is the most common form of angina, and is usually triggered by physical activity. When you climb stairs, exercise or walk, your heart demands more blood, but narrowed arteries slow down blood flow. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina. Rest or medication often relieve the symptoms.

Unstable angina:

• Unstable angina does not follow a regular pattern and usually occurs during rest. It results from a particularly tight blood vessel(s) preventing blood from reaching the heart muscle. The pain lasts longer than 5 minutes and may worsen over time. Rest and medication alone may not im-prove the symptoms. Unstable angina or angina at rest can indicate a very high risk of an im-pending heart attack. Anyone with unexpected angina should receive emergency care.

Microvascular angina:

• Microvascular angina can occur with coronary microvascular disease (MVD). Microvascular disease is essentially narrowing that affects the smallest coronary arteries. In some patients, only these small vessels are affected, while the larger coronary arteries appear to be free of significant disease. Angiography, the test used to look into the blood vessels to see whether there is any narrowing may miss the diagnosis in these patients. As well as chest pain, a person may experience: fatigue and low energy, sleep problems and/or shortness of breath. Microvascular angina tends to be more persistent than stable angina. It often lasts longer than 10 minutes and sometimes longer than 30 minutes.

Variant angina:

• Variant angina is rare. Doctors sometimes call it Prinzmetal angina, and it can develop when the body is at rest, often around midnight or the early morning. It happens when a spasm – sudden tightening of the muscle in the wall of the artery - occurs in the coronary arteries. Possible triggers can include exposure to cold, stress, medicines, smoking, or cocaine use. It is a chronic condition, but medication and avoidance of triggers, particularly cocaine, can help manage it.

Angina is frequently confused with heart burn or musculoskeletal chest pain. As a result, all chest pain should be checked out by a healthcare provider. If you have chest pain, your doctor will want to find out whether it's angina and if it is, whether the angina is stable or unstable. If it's un-stable, you may need emergency medical treatment to try to prevent a heart attack.