Cardiovascular Diseases

Angina Pectoris


  • ‘Angina pectoris’ is the chest pain resulting from decreased blood flow to the heart muscle.   
  • It is usually not life threatening; however, it can be a warning sign and a precursor to a heart attack or stroke.
  • Not all chest pain is a sign of heart disease.
  • Angina can be controlled and the risk factors that lead to it can be reduced.

What is angina pectoris?
Angina is not a disease; rather, it is a symptom of the coronary artery disease. Angina is chest pain caused by reduced oxygen-rich blood flow to your heart muscle. 

Other Names:
Ischemic heart disease

Types & Symptoms:
1. Stable angina (ischemic):
 Stable angina is the most common type of angina.  It is usually triggered by physical activity and goes away when you rest.  Stable angina is accompanied by chest pain, either because of a disease affecting the coronary arteries of the heart, or their narrowing or blockage, resulting in the heart muscle not getting the amount of blood it needs. It occurs when the heart muscle needs more blood than usual during physical activity. The heart works harder and requires more oxygen, especially during times of vigorous physical activity or strong emotions. Its symptoms include:
  • Feeling pressure or pain in the center of the chest. The pain may spread to the arms, back, jaws, or neck.
  • It lasts a short time, perhaps 5 minutes or less.
  • Disappears sooner if you rest or use your angina medication.

It should be noted that there are reasons other than angina for feeling chest pain, such as: Heartburn.

2. Unstable angina (the most dangerous type): 
It is an unpredictable medical emergency. It can also occur without physical activity and does not go away after rest or medication, which may signal a heart attack. Unstable angina may occur while the person is resting or sleeping, due to reduced blood flow to the heart muscle. Coronary arteries are narrowed due to fat accumulation (atherosclerosis). This leads to blood clotting inside them. It eventually causes a blockage that prevents blood flow to the heart muscle. Its symptoms include: 
  • Sudden pain in the center of the chest.
  • It is usually more severe and lasts longer than stable angina, maybe 30 minutes or longer.
  • It can get worse over time and might also lead to a heart attack.

3. Prinzmetal's angina (variant angina): 
This type of angina usually happens when you're resting, especially during the time between midnight and early morning. It is often severe. Prinzmetal's angina is caused by a spasm of the coronary arteries that supply oxygen to the heart muscle.   Its symptoms include: Sudden pain in the center of the chest that is usually severe. It can be relieved by angina medication.

4. Microvascular angina:
It is a disease that affects the smallest blood vessels in the coronary artery, causing spasms that lead to a decrease in blood flow to the heart muscle, resulting in chest pain. It is often first noticed during times of stress, and its symptoms include:
  • Chest pain that lasts more than 10 minutes, up to more than 30 minutes.
  • It may be more severe and could last longer than other types of angina. 
  • Usually accompanied by shortness of breath, sleep problems, fatigue, and lack of energy.

Risk Factors:
  • Family history
  • A high level of bad, low-density lipoprotein (LDL) cholesterol
  • High blood pressure (hypertension)
  • Smoking
  • Diabetes
  • Overweight and obesity
  • Unhealthy diet
  • Older age, as men older than 45 and women older than 55 have a greater risk than do younger adults. 

When to see a doctor?
When you feel chest pain.

  • Irregular heartbeat
  • Cardiomyopathy
  • Sudden cardiac arrest.

Diagnosis is done by conducting a physical examination, looking for symptoms, inquiring about risk factors, and a family history of cardiovascular diseases. Additionally, the doctor may recommend the following procedures:
  • Electrocardiogram
  • Stress ECG
  • Blood tests
  • Chest X-ray
  • Coronary angiography and cardiac catheterization
  • CT scans

  • A healthy lifestyle: It can help control symptoms and is deemed an essential part of treatment.
  • Medications: Patients are prescribed medications that treat angina when it occurs (taken only when needed) to prevent further attacks, or reduce the risk of heart attacks and strokes.
  • Heart surgery:  It aims to improve blood flow to the heart muscles.

Following a healthy, balanced diet is one of the best methods of prevention. It generally reduces the occurrence of cardiovascular diseases. The type and quantity of food a person eats influences other risk factors that can be controlled, such as: Cholesterol, blood pressure, diabetes, and weight gain. It is crucial to create balance between a person’s diet and the extent of physical activity that he does.
Choose a diet with a high intake of vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, and nuts. Limit the intake of sweets, sweetened beverages, and red meat. 
Avoid smoking and exposure to secondhand smoke. You can do this by: Avoiding places with smokers; 
Maintaining a healthy weight;
Doing regular physical activity. Doing a moderately-intense  physical activity for at least 150 minutes per week can help lower blood pressure and cholesterol, and keep weight at a healthy level.

  • Does every chest pain I feel mean I have angina?
    • No, other conditions can also cause chest pain, such as:
      • Pulmonary embolism (blockage of lung arteries);
      • Pneumonia;
      • Aortic valve stenosis;
      • Enlarged heart;
      • Pericarditis;
      • Panic attacks.

Clinical Education General Department
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Last Update : 26 August 2020 10:59 PM
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