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Angina is chest pain caused by an area of your heart not receiving enough blood flow.

Angina isn't a disease but is a symptom of an underlying heart problem.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

What Is Angina?

Angina is chest pain that happens when an area of your heart doesn't get enough blood flow.

It feels like a squeezing in your chest. It can also cause pain in your shoulders, neck, back, arms, or jaw.

Angina isn't a disease. Rather, it's a symptom of an underlying heart problem, most often coronary artery disease or coronary microvascular disease.

Coronary artery disease happens when plaque builds up in your arteries, reducing blood flow to your heart. That lack of blood flow causes angina.

As many as 7 million people in the United States may have angina. It affects men and women equally.

Types of angina

There are four main types of angina:

  • Stable (angina pectoris) — this is the most common type of angina. It happens when your heart muscle is working harder than normal. The pain and severity occur in a regular pattern.
  • Unstable — this type of angina needs emergency treatment. The pain may be severe, and it's unpredictable. It's a signal you may have a heart attack soon.
  • Variant — this rare type, caused by a spasm in your coronary artery, often happens when you're resting.
  • Microvascular — this is another rare type that may cause severe pain and last longer than other types of angina.

Why choose UPMC for angina care?

The UPMC Heart and Vascular Institute provides complete angina care — from screening to diagnosis to treatment and recovery. Our experts work as a team to care for you and empower you to live a heart-healthy life.

Angina Symptoms and Diagnosis

Angina symptoms

Angina often feels like a squeezing, tightening, or burning in the chest behind the breastbone.

You may also have pain in the:

  • Shoulder
  • Arms
  • Neck or throat
  • Jaw
  • Back

The pain may feel like indigestion.

Other symptoms of angina include:

  • Nausea
  • Fatigue
  • Shortness of breath
  • Sweating
  • Light-headedness
  • Weakness

Symptoms may happen during physical exertion or at rest.

With stable angina, symptoms occur in a predictable pattern — mostly during exertion. Rest and medicine can relieve stable angina symptoms.

Other types of angina may cause symptoms even at rest, and medications may or may not ease symptoms.

Diagnosing angina

First, your doctor will do a physical exam and ask about your symptoms and health history.

Before confirming an angina diagnosis, your doctor will decide the cause of your chest pain and rule out a heart attack. Because angina is a symptom of heart disease, he or she will look for signs of heart damage.

Your doctor will also diagnose what type of angina — either stable or unstable — you have.

He or she may do certain tests or order imaging scans such as:

  • Electrocardiogram (EKG) — this test measures your heartbeat and the electrical activity (rhythm) in your heart. Your doctor will look for signs of heart damage from heart disease or prior heart attack.
  • Stress test — this test measures your heart's activity while doing some physical activity that requires your heart to pump harder and faster. The test looks for shortness of breath and abnormal changes in your heart rate and rhythm or electrical activity.
  • Chest x-ray — a chest x-ray looks for signs of heart damage and signs of lung disorders or other health problems. A chest x-ray doesn't diagnose angina, but it may rule out other causes of chest pain.
  • Blood tests — blood tests look for risk factors of heart disease.

Angina Treatments

Your doctor will base your treatment on what type of angina you have.

The main goals of treatment for all types of angina are to lessen your chest pain and prevent a heart attack.

Lifestyle changes for treating angina

Adjust your lifestyle to avoid triggers, such as:

  • Slowing down or taking more breaks during exertion.
  • Eating smaller meals.
  • Limiting stress.

Making heart-healthy changes to prevent heart disease can also help you deal with angina, like:

  • Eat a healthy diet, rich in fruits and vegetables. Limit salt and sugar intake.
  • Maintain a good weight for your body type.
  • Don't smoke.
  • Exercise safely. Your doctor can give you guidance on exercises you can do that won't worsen your chest pain, while keeping you healthy.

Medication for angina

Medications are a mainstay for stable and unstable types of angina. Nitrates are the most common. Nitrates relax and widen your blood vessels to get more blood flow to your heart.

Your doctor may prescribe other drugs to:

  • Lower blood pressure.
  • Relax blood vessels.
  • Slow your heart rate.
  • Lessen the strain on your heart.
  • Prevent blood clots.

These drugs include:

  • Beta-blockers
  • Calcium channel blockers
  • ACE inhibitors
  • Oral antiplatelet medicine
  • Blood thinners

Angioplasty and grafting procedures to treat angina

If medicine and lifestyle changes aren't enough, you may need other treatment methods for your heart disease.

These include:

  • Angioplasty to treat blocked or narrowed coronary arteries. Surgeons thread a thin tube with a device on the end through a blood vessel. Once in place, they inflate the end to open the artery and improve blood flow. Your surgeon may place a stent in the artery to keep it open.
  • Coronary artery bypass grafting to treat angina. Surgeons take healthy arteries or veins from another part of your body and use them to bypass the blocked artery.

Cardiac rehab

A cardiac rehab program helps you make the lifestyle changes you need to protect your heart.

You'll learn exercises to increase strength, endurance, and energy, and get advice and support for diet changes.