Sometimes it is hard to tell the difference between unstable angina and a heart attack. Angina can be a sign of increased risk of stroke. Angina can also trigger sudden cardiac arrest. These are medical emergencies.
If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.
Signs of a heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have symptoms such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test.
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.
Read more about the signs and symptoms of a stroke.
Sudden cardiac arrest:
It is possible for a spasm that causes angina to trigger arrhythmia. This can lead to sudden cardiac arrest. Fainting is usually the first sign of sudden cardiac arrest. If you think someone may be in cardiac arrest, try the following steps:
• If you see a person faint or if you find a person already unconscious, first confirm that the person cannot respond. The person may not move, or his or her movements may look like a seizure.
• You can shout at or gently shake the person to make sure he or she is not sleeping, but never shake an infant or young child. Instead, you can gently pinch the child to try to wake him or her up.
• Check the person’s breathing and pulse. If the person is not breathing and has no pulse or has an irregular heartbeat, prepare to use an automated external defibrillator as soon as possible.Show Less
Angina is a symptom of ischemic heart disease. Your doctor may recommend the following heart-healthy lifestyle changes to help you manage angina:
• Heart-healthy eating. Following a healthy eating plan, including limiting alcohol, can prevent or reduce high blood pressure and high blood cholesterol, helping you reduce angina symptoms and maintain a healthy weight. You should avoid large meals and rich foods if heavy meals trigger your angina. If you have variant angina, drinking alcohol can also be a trigger.
• Aiming for a healthy weight. If you are overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you manage the risk factors for angina.
• Being physically active. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Slow down or take rest breaks if physical exertion triggers angina.
• Managing stress. If emotional stress triggers your angina, try to avoid situations that make you upset or stressed.
• Quitting smoking. Smoking can damage and tighten blood vessels, make angina worse, and raise the risk of life-threatening complications.
• Prevent repeat angina events
Stable angina usually occurs in a pattern. After several events, you will learn what causes the pain to occur, what the pain feels like, and how long the pain typically lasts. To help learn your angina’s pattern and triggers, keep a log of when you feel pain. The log helps your doctor regulate your medicines and evaluate your need for future treatments. When you know what triggers your angina, you can take steps to prevent or lessen the severity of events.
• Know the limits of your physical activity. Most people who have stable angina can continue their normal activities. This includes work, hobbies, and sexual relations. Learn how much exertion triggers your angina, so you can try to stop and rest before the chest pain starts.
• Learn how to reduce and manage stress. Try to avoid or limit situations that cause anger, arguments, and worry. Exercise and relaxation can help relieve stress. Alcohol and drug use play a part in causing stress and do not relieve it. If stress is a problem for you, talk with your doctor about getting help.
• Avoid exposure to very hot or cold conditions, because temperature extremes strain the heart.
• Tell your doctor right away if your pattern changes. Pattern changes may include angina that occurs more often, lasts longer, is more severe, occurs without physical exertion, or does not go away with rest or medicines. These changes may be a sign that your symptoms are getting worse or becoming unstable.
• Seek help for angina that does not improve.
Not all angina improves with medicines or medical procedures. If your symptoms continue, your doctor may change your medicines or therapies to help relieve your chest pain. Additional treatments for hard-to-treat angina include:
• Enhanced external counterpulsation therapy (EECP) to improve the flow of oxygen-rich blood to your heart muscle, which may help relieve angina. EECP uses large cuffs, similar to blood pressure cuffs, on your legs. The cuffs inflate and deflate in sync with your heartbeat. You typically get five 1-hour treatments per week for 7 weeks. Side effects may include back or neck pain and skin abrasions.
• Spinal cord stimulators to block the sensation of pain. Emerging research suggests that this technology can help people be more physically active, feel angina less often, and have a better quality of life.
• Transmyocardial laser therapy to stimulate the growth of new blood vessels or improve blood flow in the heart muscle. It can relieve angina pain and increase your ability to exercise without discomfort. This laser-based treatment is done during open-heart surgery or through cardiac catheterization. Rarely, your doctor may recommend this treatment in combination with CABG.
• Know your medicines
You should know what medicines you are taking, the purpose of each, how and when to take them, and possible side effects. Learn exactly when and how to take nitroglycerin or other short-acting nitrates to relieve chest pain. Then talk to your doctor about the following:
• Any other medicines you are taking, including vitamins and nutritional supplements. Some medicines can cause serious or life-threatening problems if they are taken with nitrates or other angina medicines. For example, men who take nitrates, including nitroglycerin, for their angina should not take medicines for erectile dysfunction without checking with their doctor first.
• Any side effects you may experience. Do not stop taking your medicines without talking to your doctor first.
• How to store your medicines correctly and when to replace them.Show Less
Angina raises your risk of having a heart attack. But it’s treatable. Consider it a warning sign and make healthy choices.
Talk with others who have it. That may help you learn how to feel better. Your family, too, may need support to help them understand your angina. They'll want to know what they can do to help.
Angina is not a heart attack, but it is a signal that you are at greater risk of having a heart attack. The risk is higher if you have unstable angina. For this reason, it is important that you receive follow-up care, monitor your condition, and understand your condition, so you know when to get medical help. Your doctor may recommend heart-healthy lifestyle changes and cardiac rehabilitation to help manage angina.
You may need follow-up visits every 4 to 6 months for the first year after diagnosis of angina, and every 6 to 12 months as long as your condition is stable. Your care plan may be changed if your angina worsens or if stable angina becomes unstable. Unstable angina is a medical emergency.
Your doctor may recommend cholesterol-lowering statins as part of your long-term treatment, especially if you have had a heart attack.
Ask your doctor whether physical and sexual activity is safe for you. People who have unstable angina or angina that does not respond well to treatment should not engage in sexual activity until their heart condition and angina are stable and well managed.
Talk to your medical team about vaccinations to prevent the flu and pneumonia.
To monitor your condition, your doctor may recommend the following tests or procedures:
• Blood pressure checks to ensure that your blood pressure is in a healthy range. Keeping your blood pressure under control can help your angina.
• EKGs to detect changes in heart health after treatment or for monitoring the heart during exercise as part of cardiac rehabilitation.
• Repeat lipid panels to see if blood cholesterol levels are at healthy levels. A lipid panel should be done every year and also 2 to 3 months after any change in treatment.
• Stress testing to assess your risk for complications, either before or after starting angina medicines. Stress tests can also make sure your heart is strong enough for physical and sexual activity.Show Less
Your doctor will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital. If your angina is stable and your symptoms are not getting worse, you may be able to control your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot control your angina, you may need a medical procedure to improve blood flow and relieve your angina.
If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control angina events and relieve pain. Often, other medicines are also prescribed to help control angina long-term. The choice of medicines may depend on what type of angina you have.
• Anticoagulant medicines, or blood thinners, such as heparin, to prevent dangerous blood clots and future complications, such as a heart attack or another angina event.
• Antiplatelet medicines to prevent blood clots from forming. If you have stable or unstable angina, your doctor may recommend aspirin to treat angina and reduce the risk of complications of ischemic heart disease. Other platelet inhibitors, such as clopidogrel, may also be prescribed.
• Beta-blockers to help your heart beat slower and with less force. These drugs are often prescribed to help relieve angina. If you cannot take beta-blockers for some reason, long-acting nitrates are the preferred alternative.
• Calcium channel blockers to keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax. Calcium channel blockers may be an alternative medicine if you are unable to take beta-blockers or nitrates. For variant angina, your doctor is likely to order calcium channel blockers and avoid giving you beta-blockers.
• Nitrates to widen and relax blood vessels, which allows more blood to flow to the heart while reducing the heart’s workload. Nitrate pills or sprays, including nitroglycerin, act quickly and can relieve pain during an event. Long-acting nitrates are available as pills or skin patches. If you are hospitalized with chest pain, your doctor may order intravenous (IV) nitrates to relieve your angina pain.
• Statins to prevent plaque from forming and to relieve blood vessel spasms or inflammation, reducing the risk of a heart attack or other complications after emergency treatment.
If you still have symptoms or experience side effects, your doctor may prescribe other medicines, including:
• Morphine to relieve pain and help relax the blood vessels. Your doctor may suggest it if other medicines have not helped.
• Ranolazine to help you have angina symptoms less often. When given with other anti-angina medicines, ranolazine can also increase the length of time you can be physically active without pain. This medicine may work for coronary microvascular disease, which causes microvascular angina. Ranolazine may be a substitute for nitrates for men with stable angina who take drugs for erectile dysfunction.
If lifestyle changes and medicines do not control angina, you may need a medical procedure to treat the underlying heart disease.
Coronary artery bypass grafting (CABG) to treat ischemic heart disease and relieve angina. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.
You can expect to stay in the hospital about a week after you have the procedure. You'll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. Then, you'll move to a regular room to recover.
• Percutaneous coronary intervention (PCI), also known as coronary angioplasty, opens narrowed or blocked blood vessels that supply blood to the heart. This procedure requires cardiac catheterization. If PCI includes certain medicines to expand coronary arteries, the procedure may be helpful for some people who have variant angina.
• Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again.
The procedure typically takes less than 2 hours. You’ll probably stay overnight at the hospital.
Enhanced external counterpulsation
Enhanced external counterpulsation (EECP) may be an option to relieve your angina. Your doctor may recommend it if other treatments haven’t worked or aren’t right for you.
EECP uses several blood pressure cuffs on both legs to gently, but firmly, compress the blood vessels there to boost blood flow to your heart. Each wave is timed to your heartbeat. So more blood goes there when it’s relaxing.
When your heart pumps again, pressure is released right away. It lets blood be pumped more easily. It can help your blood vessels make a natural bypass around narrowed or blocked arteries that cause your chest pain. It may help some small blood vessels in your heart open. They may give more blood flow to your heart muscle to help ease your chest pain.
You might have EECP if you:
• Have chronic stable chest pain;
• Aren’t helped by nitrates, calcium channel blockers, and beta-blockers;
• Invasive procedures like bypass surgery, angioplasty, or stenting aren’t right for you.
EECP isn’t invasive. If you’re accepted for EECP treatment, you’ll have 35 hours of therapy. It’s given 1 to 2 hours a day, 5 days a week, for 7 weeks. Studies have shown its benefits include less need for anti-anginal medicine, fewer symptoms, and the ability to be more active without symptoms
• Lifestyle changes
You can still be active, but it's important to listen to your body. If you feel pain, stop what you’re doing and rest. Know what triggers your angina, like stress or intense exercise. Try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often. If you still feel pain, talk to your doctor about having more tests or changing your medications. Because angina can be a sign of something dangerous, it’s important to get checked out.
These lifestyle tips may help protect your heart:
• If you smoke, stop. It can damage your blood vessels and increase your heart disease risk.
• Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. When those are out of normal range, your chance of heart disease is higher. Eat mainly fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.
• Use stress-relieving measures like meditation, deep breathing, or yoga to relax.
• Exercise most days of the week.
• See your doctor regularly.
If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Quick treatment is very important. It can protect you from more damage.Show Less
Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.
• Medical history
Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.
Tell your doctor if you notice a pattern in your symptoms. Ask yourself these questions:
• How long does the pain or discomfort last?
• How often does the pain occur?
• How severe is the pain or discomfort?
• What brings on the pain or discomfort, and what makes it better?
• Where do you feel the pain or discomfort?
• What does the pain or discomfort feel like?
Your doctor will also need information about ischemic heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of serious medical concern. Your doctor can recommend steps you need to take to get medical care.
• Physical examination
As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.
Angina questions for your doctor:
• Do I need any more tests?
• What type of angina do I have?
• Do I have heart damage?
• What treatment do you recommend?
• How will it make me feel?
• What can I do to try to prevent a heart attack?
• Are there activities I shouldn't do?
• Will changing my diet help?
Diagnostic tests and procedures:
Your doctor may have you undergo some of the following tests and procedures:
• Blood tests to check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
• Chest X-ray to look for lung disorders and other causes of chest pain not related to ischemic heart disease. A chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help rule out other causes.
• Computed tomography angiography to examine blood flow through the coronary arteries. This test can rapidly diagnose ischemic heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
• Coronary angiography with cardiac catheterization to see if ischemic heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
• Echocardiogram to assess the strength of your heart beating, to help the doctor determine your risk of future heart problems.
• Electrocardiogram (EKG) to check for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious ischemic heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
• Hyperventilation testing to diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
• Magnetic resonance imaging or other noninvasive tests to check for issues with the heart’s movement or with blood flow in the heart’s small blood vessels.
• Provocation tests to diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
• Stress testing to assess your heart’s function during exercise. A stress test can show possible signs and symptoms of ischemic heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.Show Less
Signs and symptoms vary based on the type of angina you have and on whether you are a man or a woman. Angina symptoms can differ in severity, location in the body, timing, and how much relief you may feel with rest or medicines. Since symptoms of angina and of heart attack can be the same, call 9-1-1 if you feel chest discomfort that does not go away with rest or medicine. Angina can also lead to a heart attack and other complications that can be life-threatening.
Signs and symptoms:
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe, or that they cannot tell exactly where the pain is coming from.
You might mistake an aching or burning for heartburn or gas.
You’re likely to have pain behind your breastbone, which can spread to your shoulders, arms, neck, throat, jaw, or back.
Other symptoms include:
• Light-headedness or fainting;
• Nausea, or feeling sick in the stomach;
• Shortness of breath;
• Impending sense of doom.
Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.
Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor.
Each type of angina has certain typical symptoms. Learn more about the symptoms that are characteristic of each type.
• Discomfort that feels like gas or indigestion;
• Pain during physical exertion or mental stress;
• Pain that spreads from your breastbone to your arms or back'
• Pain that is relieved by medicines;
• Pattern of symptoms that has not changed in the last 2 months;
• Symptoms that go away within 5 minutes.
• Changes in your stable angina symptoms;
• Pain that grows worse;
• Pain that is not relieved by rest or medicines;
• Pain that lasts longer than 20 minutes or goes away and then comes back;
• Pain while you are resting or sleeping;
• Severe pain;
• Shortness of breath.
• Pain after physical or emotional stress;
• Pain that is not immediately relieved by medicines;
• Pain that lasts a long time;
• Pain that you feel while doing regular daily activities;
• Severe pain;
• Shortness of breath.
• Cold sweats;
• Numbness or weakness of the left shoulder and upper arm;
• Pain that is relieved by medicines;
• Pain that occurs during rest or while sleeping;
• Pain that starts in the early morning hours;
• Severe pain;
• Vague pain with a feeling of pressure in the lower chest, perhaps spreading to the neck, jaw, or left shoulder.
Angina is not a heart attack, but it suggests that a heart attack or other life-threatening complications are more likely to happen in the future. The chest pain that occurs with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.
The following are other possible complications of angina:
• Sudden cardiac arrest.Show Less
Typically, doctors screen for angina only when you have symptoms. However, your doctor may assess your risk factors for ischemic heart disease every few years as part of your regular office visits. If you have two or more risk factors, then your doctor may estimate the chance that you will develop ischemic heart disease, which may include angina, over the next 10 years.
To prevent angina, your doctor may recommend that you adopt heart-healthy lifestyle changes to lower your risk of ischemic heart disease, the most common cause of angina. Heart-healthy lifestyle changes include choosing a heart-healthy eating pattern such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress. You should also avoid using illegal drugs.
You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:
• Quitting smoking.
• Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol, and diabetes.
• Eating a healthy diet and maintaining a healthy weight.
• Increasing your physical activity after you get your doctor's permission. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and stretch three times a week for five to 10 minutes each time.
• Reducing your stress level.
• Limiting alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
• Getting an annual flu shot to avoid heart complications from the virus.Show Less
You may have an increased risk for angina because of your age, environment or occupation, genetics, lifestyle, other medical conditions, race, or sex.
Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. This means that your risk for ischemic heart disease and angina increases as you get older.
Variant angina is rare, but people who have variant angina often are younger than those who have other types of angina.
• Environment or occupation
Angina may be linked to a type of air pollution called particle pollution. Particle pollution can include dust from roads, farms, dry riverbeds, construction sites, and mines.
Your work life can increase the risk of angina. Examples include work that limits your time available for sleep, involves high stress, requires long periods of sitting or standing, is noisy, or exposes you to potential hazards such as radiation.
• Family history and genetics
Ischemic heart disease frequently runs in families. Also, people who have no lifestyle-related risk factors can develop ischemic heart disease. These factors suggest that genes are involved in ischemic heart disease and can influence a person’s risk of developing angina.
Variant angina has also been linked to specific DNA changes.
• Lifestyle habits
The more heart disease risk factors you have, the greater your risk of developing angina. The main lifestyle risk factors for angina include:
• Alcohol use, for variant angina
• Illegal drug use
• Lack of physical activity. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes, and obesity. However, it is important to talk with your doctor before starting an exercise program.
• Smoking tobacco or long-term exposure to secondhand smoke. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries, including arteries to your heart, allowing deposits of cholesterol to collect and block blood flow.
• Stress. Stress can increase the risk of angina and heart attacks. Too much stress, as well as anger, also can raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.
• Unhealthy eating patterns
Other medical conditions
Medical conditions in which your heart needs more oxygen-rich blood than your body can supply increase your risk for angina. They include:
• A racing heart rate or blood vessel damage due to cocaine or methamphetamine use;
• Cardiomyopathy, or disease of the heart muscle;
• Damage to the heart caused by injury;
• Heart failure;
• Heart valve disease;
• High blood pressure. Over time, high blood pressure damages arteries by accelerating the hardening of arteries;
• Insulin resistance or diabetes. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing cholesterol levels;
• Low blood pressure;
• Metabolic syndrome;
• Overweight or obesity. Obesity is linked with high blood cholesterol levels, high blood pressure, and diabetes, all of which increase your risk of angina and heart disease. If you're overweight, your heart has to work harder to supply blood to the body;
• Unhealthy cholesterol levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol, increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is unhealthy;
• Medical procedures. Heart procedures such as stent placement, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) can trigger coronary spasms and angina. Although rare, non-cardiac surgery can also trigger unstable angina or variant angina;
• Race or ethnicity. Some groups of people are at higher risk for developing ischemic heart disease and one of its main symptoms, angina. African Americans who have already had a heart attack are more likely than whites to develop angina. Variant angina is more common among people living in Japan, especially men, than among people living in Western countries;
• Sex. Angina affects both men and women, but at different ages, based on men and women’s risk of developing ischemic heart disease. In men, ischemic heart disease risk starts to increase at age 45. Before age 55, women have a lower risk for heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack are more likely to develop angina compared with men.
Microvascular angina most often begins in women around the time of menopause. Symptoms of angina in women can be different from angina symptoms that occur in men. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also have symptoms such as:
• Shortness of breath;
• Abdominal pain;
• Discomfort in the neck, jaw or back;
• Stabbing pain instead of chest pressure.
Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat, or back. You may also have shortness of breath, sweating, or dizziness. One study found that women were more likely to use the words "pressing" or "crushing" to describe the feeling.Show Less
Angina happens when your heart muscle does not get enough oxygen-rich blood. Medical conditions, particularly ischemic heart disease, or lifestyle habits can cause angina. Angina usually happens because of heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to your heart muscle. This forces your heart to work with less oxygen. That causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.
• Two types of ischemic heart disease can cause angina.
• Coronary artery disease happens when plaque builds up inside the large arteries that supply blood to the heart. This is called atherosclerosis. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Sometimes plaque breaks open and causes blood clots to form. Blood clots can partially or totally block the coronary arteries.
• Coronary microvascular disease affects the tiny arteries that branch off the larger coronary arteries. Reduced blood flow in these arteries causes microvascular angina. The arteries may be damaged and unable to expand as usual when the heart needs more oxygen-rich blood.
• Spasm of the coronary arteries:
A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether you have ischemic heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart requires more oxygen-rich blood.
Less common causes of chest pain include:
• A blockage in a major artery of your lungs (pulmonary embolism);
• An enlarged or thickened heart (hypertrophic cardiomyopathy);
• Narrowing of a valve in the main part of your heart (aortic stenosis);
• Swelling of the sac around your heart (pericarditis);
• Tearing in the wall of your aorta, the largest artery in your body (aortic dissection).Show Less
• Stable angina. This is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn't a heart attack, but it can be a sign that you're more likely to have one. Tell your doctor if this happens to you.
Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:
• How long your angina events last;
• How often your angina events occur;
• How well angina responds to rest or medicines;
• The causes or triggers of your angina.
If you have stable angina, you can learn its pattern and predict when an event will occur, such as during physical exertion or mental stress. The pain typically goes away a few minutes after you rest or take your angina medicine. If the condition causing your angina gets worse, stable angina can become unstable angina.
• Unstable angina. You can have this while you're at rest or not very active. The pain can be strong and long-lasting, and it may come back again and again. It can be a signal that you're about to have a heart attack, so see a doctor right away. This is a medical emergency! Call 9-1-1.
Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.
Unstable angina is a medical emergency since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.
Unstable Angina Signs:
• Occurs even at rest;
• Is a change in your usual pattern of angina;
• Is unexpected;
• Is usually more severe and lasts longer than stable angina, maybe 30 minutes or longer;
• May not disappear with rest or use of angina medication;
• Might signal a heart attack.
• Variant angina or Prinzmetal's angina. It's caused by a spasm in your heart's arteries that temporarily reduces blood flow. It typically happens when you're resting. It is often severe and may be relieved by angina medication. This type is rare. It might happen at night while you're sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated. It typically happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina.
• Microvascular angina is a sign of ischemic heart disease affecting the tiny arteries of the heart. Microvascular angina events can be stable or unstable. They can be more painful and last longer than other types of angina, and symptoms can occur during exercise or at rest. Medicine may not relieve symptoms of this type of angina. With this type, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women.Show Less