What is angina?
Angina is pain, discomfort, or pressure in your chest that happens when your heart isn't getting enough oxygen. The lack of oxygen is caused by a narrow or blocked artery to your heart (coronary artery disease Overview of Coronary Artery Disease (CAD) The heart is a muscle that pumps blood. Like all muscles, the heart needs a steady supply of blood to work. Blood that pumps through the heart doesn't feed the heart muscle. Instead the heart... read more 
). Angina is often a warning sign of a heart attack.
Go to the hospital right away if you have pain, pressure, or burning in your chest, back, shoulders, jaw, or arms
Angina happens when you're exerting yourself and gets better quickly when you rest
Doctors usually do an ECG/EKG (electrocardiography) Electrocardiography Electrocardiography is a test that measures your heart’s electrical activity. It's quick, painless, and harmless. The results of that test are shown in an electrocardiogram. It looks like a... read more
and a stress test Stress Testing A stress test lets doctors see how your heart works when it’s under stress, such as when you exercise. Many heart problems are easier for your doctor to find when your heart is working hard... read more or cardiac catheterization Cardiac Catheterization Cardiac catheterization (also called cardiac cath) is a heart procedure done in a hospital. The doctor puts a thin plastic tube (catheter) through an artery and into your heart. Doctors get... read more 
Treatment is with medicines or sometimes a procedure such as angioplasty Open blocked arteries
or bypass surgery Open blocked arteries
Supplying the Heart With Blood
Like any other tissue in the body, the muscle of the heart must receive oxygen-rich blood and have waste products removed by the blood. The right coronary artery and the left coronary artery, which branch off the aorta just after it leaves the heart, deliver oxygen-rich blood to the heart muscle. The right coronary artery branches into the marginal artery and the posterior interventricular artery, located on the back surface of the heart. The left coronary artery (typically called the left main coronary artery) branches into the circumflex and the left anterior descending artery. The cardiac veins collect blood containing waste products from the heart muscle and empty it into a large vein on the back surface of the heart called the coronary sinus, which returns the blood to the right atrium.  |
What causes angina?
The most common cause of angina is narrowing of the arteries that carry blood to your heart (coronary arteries). That narrowing is most often caused by atherosclerosis Atherosclerosis , commonly known as hardening of the arteries. A fatty deposit builds up and can slowly block your arteries and slow down or stop the flow of blood. When your heart muscle doesn't get enough blood, it hurts.
Angina can also be caused by a coronary artery spasm, a sudden tightening of the artery. Certain illicit drugs such as cocaine may trigger a spasm.
Severe anemia Overview of Anemia Anemia is not having enough red blood cells or hemoglobin. Red blood cells carry oxygen from your lungs to all of your other organs. Hemoglobin is the substance inside your red blood cells that... read more (low blood count) increases your risk of having angina. With anemia, you have fewer red blood cells to carry oxygen.
In people with atherosclerosis, patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or blocked blood flow.
This photo shows an atherosclerotic plaque (atheroma; see arrow) visible in an artery.
BSIP VEM/SCIENCE PHOTO LIBRARY
Normally, the coronary arteries carry oxygen-enriched blood to the heart. In coronary artery disease, fatty deposits accumulate along the walls of the coronary arteries, obstructing the flow of blood. This inadequate blood supply deprives the heart muscle of oxygen and damages the heart tissue (depicted in gray).
What are the symptoms of angina?
You may feel:
Discomfort, pressure, or aching in the middle of your chest
The discomfort may travel to your shoulder, down your arm, or to your throat, jaw, or teeth
Angina usually comes when you exert yourself, for example, by climbing stairs or walking up a hill. It goes away in a few minutes when you rest. You usually get angina each time you do the same amount of exertion. For example, you may get angina every time you walk up a certain hill. As your coronary arteries get narrower, you get angina with less and less exertion. For example, if you first got angina climbing 2 fights of stairs, later you might get it with only 1 flight of stairs.
Angina that comes without any exertion or that gets worse very quickly is:
Unstable angina is a warning you might be about to have a heart attack Heart Attack A heart attack is when blood flow to part of your heart is suddenly blocked and some of your heart muscle dies. Go to an emergency department and chew on an aspirin tablet if you think you're... read more .
How can doctors tell if I have angina?
If you have symptoms that suggest angina, doctors will do tests such as:
Stress test Stress Testing A stress test lets doctors see how your heart works when it’s under stress, such as when you exercise. Many heart problems are easier for your doctor to find when your heart is working hard... read more —a test to see whether your heart is getting enough blood when it works hard (is under stress), such as when you exercise
ECG/EKG Electrocardiography Electrocardiography is a test that measures your heart’s electrical activity. It's quick, painless, and harmless. The results of that test are shown in an electrocardiogram. It looks like a... read more
—a test that measures your heart’s electrical activity, which can be abnormal in coronary artery diseaseCT (computed tomography) scan Computed Tomography A CT scan uses a large machine shaped like a large donut to take x-rays from many angles. A computer then takes the x-rays and creates many detailed pictures of the inside of your body. Each... read more
—an imaging test to look for hardening of the coronary arteries
If your angina is severe or getting worse, doctors may do:
Cardiac catheterization Cardiac Catheterization Cardiac catheterization (also called cardiac cath) is a heart procedure done in a hospital. The doctor puts a thin plastic tube (catheter) through an artery and into your heart. Doctors get... read more
—an invasive test that allows doctors to see if and where your coronary arteries are blocked
In cardiac catheterization, doctors put a long, thin catheter (small flexible tube) into an artery in your arm or leg, up to your heart, and into each of your coronary arteries and then inject contrast material that is seen on x-ray.
During an exercise tolerance (stress) test, the person walks at an increasingly rapid pace on a treadmill. The person wears a blood pressure cuff (the black arm band), which monitors blood pressure throughout the procedure. A video monitor displays the pulse and ECG. The results help determine the presence of coronary artery disease.
Video from Video Tape Library, Ltd.
How do doctors treat angina?
Doctors will give you treatments for:
When you get angina
Preventing angina
The problem that's causing your angina
When you get angina, doctors will have you take:
Nitroglycerin tablets or spray under your tongue
Nitroglycerin should work in a few minutes.
To prevent angina, doctors may give you:
Long-acting nitroglycerin pills or skin patches
Medicines to keep your heart from working too hard
To treat the problem that's causing your angina, doctors usually give you:
Sometimes a procedure to open a blocked artery
They will also have you change any behaviors that are hurting your heart, such as smoking, not exercising, and eating a poor diet.
Depending on how much your coronary arteries are blocked, doctors may do a procedure to clear your artery. They may do angioplasty or bypass surgery (also called coronary artery bypass grafting or coronary artery bypass surgery).
During angioplasty:
The doctor puts a small, flexible tube (catheter) into an artery in your upper leg (groin) or in your wrist
The catheter is pushed up the artery to your heart and then into one of your coronary arteries
A small balloon on the tip of the catheter is inflated
The balloon pushes the blockage open
Then the doctor slips a wire mesh tube (stent) off the end of the catheter into the blocked area
The wire mesh tube helps hold the blocked area open
During bypass surgery:
Doctors take a piece of healthy artery or vein from another part of your body
They sew one end of that piece of artery or vein to your aorta (the major artery that takes blood from your heart to the rest of your body)
They sew the other end to your blocked artery past the point of the blockage
Your blood then flows through this new route, bypassing the blockage
The heart is a beating muscle that continually pumps blood to the rest of the body. The coronary arteries supply the heart itself with the necessary oxygen and nutrients it needs to function effectively.
Over time, fatty deposits called plaque can build up inside the arteries, clogging the passages and reducing the flow of blood. If the coronary arteries develop plaque, blood flow to the heart can be compromised.
Balloon angioplasty is a procedure which opens arteries that have become narrowed or clogged from plaque buildup. During this procedure, a small incision is made in the thigh to gain access to the femoral artery. A guide wire is then inserted into the femoral artery and is threaded through the artery to the site of the blockage.
A catheter that is attached to a deflated balloon moves along the guide wire to the site of the blockage. When the balloon is inflated, it compresses the plaque against the arterial wall enlarging the opening of the artery. This enables blood to move normally through the artery.
Oftentimes during angioplasty, a stent is inserted at the site of the blockage to help the artery from re-closing. A stent is a wire mesh tube placed around the deflated balloon catheter. When the catheter is guided to the blockage site and is inflated, the stent expands and adheres to the artery wall. The catheter and guide wire are then removed and the stent remains in place.
Both angioplasty and angioplasty with stenting may need to be repeated if the plaque buildup returns.
In coronary artery bypass grafting (CABG), doctors take an artery or vein from another part of the body to connect the aorta (the major artery that takes blood from the heart to the rest of the body) to a coronary artery past the point of its blockage. Blood flow is thus rerouted, skipping over (bypassing) the narrowed or blocked area.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
cocaine |
GOPRELTO, NUMBRINO |
nitroglycerin |
Deponit, GONITRO , Minitran, Nitrek, Nitro Bid, Nitrodisc, Nitro-Dur, Nitrogard , Nitrol, Nitrolingual, NitroMist , Nitronal, Nitroquick, Nitrostat, Nitrotab, Nitro-Time, RECTIV, Transdermal-NTG, Tridil |
