Frequently Asked Questions
What is angina?
Angina is chest pain caused by insufficient oxygenated blood in the heart muscle.
Angina is usually a symptom of coronary artery disease (CAD). This is caused by atherosclerosis, a build-up of fatty deposits called plaque inside the artery walls which restricts blood flow.
Angina isn't the same as a heart attack. With angina there is still blood flowing through the affected artery or arteries. When blood flow is completely cut off due a blood clot lodging in a coronary artery, the result is a heart attack.
Symptoms and Types of Angina
Angina is described as pain, discomfort, numbness, pressure, squeezing, and/or tightening in the chest area. It may also feel like indigestion. This sensation can radiate to the neck, shoulders, jaw, back, down the left arm, and less often down the right arm. The nature of the symptoms varies according to the type of angina.
- Stable Angina
- Also knows as angina pectoris, stable angina symptoms usually occur during exertion or emotional stress when the heart's need for oxygen is greater. The onset is quite predictable; it tends to occur under the same conditions and the degree and duration of discomfort is similar each time. Pain is relieved with rest or after taking medication.
- Unstable Angina
- This form of angina is unpredictable. It can occur during exertion or when at rest. Rest or medication may not ease the pain which can be more severe than stable angina. Unstable angina is dangerous and might lead to a heart attack so emergency treatment is required.
- Variant Angina
- Also called Prinzmetal's angina, variant angina is caused by a coronary artery spasm and is rare. It usually happens when at rest and occurs between midnight and early morning. Pain can be severe but is relieved with medication.
- Microvascular Angina
- This type of angina, also called Cardiac Syndrome X, is caused by spasms in the tiny arteries that feed the heart. Pain can last a long time and be severe. Medication can bring relief.
- Atypical Angina
- This is more common in women and the elderly. Instead of, or in addition to, regular angina chest pain, atypical angina symptoms may include the following:
- Vague chest discomfort
- Sudden weakness or fatigue
- Feeling faint or blacking out
- Shortness of breath
- Excessive sweating
Risk factors for angina include:
- High cholesterol levels
- High blood pressure
- Lack of exercise
- Unhealthy diet
- Age greater than 45 years in men and 55 years in women
- Family history of heart disease
Your doctor may prescribe medications like nitrates that work to relieve or prevent angina symptoms as well as medications that treat the underlying heath conditions such as anti-platelets, ACE inhibitors, beta-blockers, calcium channel blockers, or statins. These types of medications are described below with examples of each type.
Nitrates are often used to treat angina. They work by relaxing and widening the blood vessels, allowing blood to flow more freely to the heart.
Nitroglycerin is a fast-acting nitrate used to relieve symptoms of an angina episode in progress. It comes as a tablet that dissolves under the tongue or as an oral spray.
Longer-acting nitrates come in the form of tablets or skin patches to help prevent angina episodes. Examples include Isosorbide Dinitrate (Isordil, Sorbitrate, Sorbitrate TR), Isosorbide Mononitrate (Imdur, Monopark, Monoket), and Ranolazine (Ranz, Ranexa).
Before taking any nitrate medication, consult your doctor if you are taking Sildenafil Citrate (Viagra), Tadalafil (Cialis), or Vardenafil (Levitra). Certain drug combinations can cause a massive drop in blood pressure or cardiac arrest.
Your doctor may prescribe anti-platelet medication to help prevent the formation of blood clots that can lead to a heart attack. Over-the-counter low-dose aspirin (75 mg or 81 mg) is commonly prescribed. For patients allergic to aspirin, an alternative medication is Clopidogrel (Clopivas, Plavix, Clavix).
Angiotensin-converting Enzyme (ACE) Inhibitors
Angiotensin-converting enzyme inhibitors reduce the production of a chemical called angiotensin that causes the arteries to restrict.
- Benazepril (Benace, Lotensin)
- Enalapril (Enapril, Vasotec, Enace)
- Fosinopril (Fovas, Monopril)
- Lisinopril (Zestril, Prinivil)
- Perindopril Erbumine (Coversyl, Aceon)
- Ramipril (Cardace, Altace, Tritace)
Beta-blockers reduce certain nerve signals to the heart so it beats more slowly and less forcefully.
- Atenolol (Atpark, Tenormin, Betacard)
- Bisoprolol Fumarate (Concor, Zebita)
- Metoprolol (Betaloc, Lopressor, Toprol, Seloken XL, Toprol XL)
- Propranolol (Ciplar, Inderal, Manoprolol, Ciplar LA)
- Sotalol (Sotalar, Betapace, Sorine)
Calcium Channel Blockers
Calcium channel blockers prevent calcium from entering the cells walls of the heart and arteries. This has the effect of reducing the strength of the heart's contractions and relaxing the arteries.
- Amlodipine (Amlopres, Norvasc)
- Diltiazem HCL (Dilgard, Cardizem, Dilzem, Cardizem CD, Dilgard XL, Dilzem CD, Cartia, Cartia CD, Dilacor, Dilacor CD, Diltia, Diltia CD, Tiazac, Tiazac CD, Angizem)
- Felodipine (Plendil)
- Nifedipine (Nicardia, Adalat, Adalat ER, Adalat XL, Afeditab ER)
- Verapamil (Calaptin, Calan, Calan SR, Covera HS, Isoptin, Isoptin SR, Verelan, Verelan
Statins are commonly prescribed to treat high cholesterol. They work in the liver to reduce production of LDL cholesterol. The following drugs are examples of statins:
- Atorvastatin (Atorlip, Lipitor, Atorva)
- Lovastatin (Lostatin, Altocor, Mevacor, Lovacord)
- Rosuvastatin (Rozucor, Crestor, Rosuvas)
- Simvastatin (Simcard, Zocor, Simvotin)
- What Is Angina? (nhlbi.nih.gov)
- The National Heart, Lung, and Blood Institute describes angina, its causes, risk factors, symptoms, diagnosis, treatments, and prevention.
- Angina (Patient.co.uk)
- Patient.co.uk provides information about angina including lifestyle changes, tests, treatment, and common worries about the condition.
- Angina | Chest Pain (Heart.org)
- The American Heart Association has detailed information including the four types of angina, risk factors, tests, and treatment including cardiac rehabilitation.
- Angina in Women Can Be Different Than Men (Heart.org)
- This short article by the American Heart Association talks about how angina affects women differently than men.
- Nitrate Medications (Womens-Health-Advice.com)
- This site has in-depth information about nitrates with links to angina topics.