Angina: Symptoms, Diagnosis, Treatment

What is angina?

Angina refers to chest pain or discomfort due to reduced blood flow to the heart. Angina-related chest pain can manifest differently in various individuals. Some experience chest pain/discomfort, while others feel a squeezing sensation or a tightness in their chest. 

The pain/discomfort usually begins at the centre of one’s chest, behind the breastbone, and may spread to the neck, jaw, shoulders, arm, back, and stomach. 

There are two main types of angina:

Stable angina

Stable angina is the most common type of angina. It typically occurs when the heart needs to work harder due to stress or physical exertion but does not receive sufficient oxygen-rich blood. Individuals suffering from stable angina often encounter episodes of chest pain, typically occurring predictably during physical exertion or stressful situations. This discomfort is usually manageable and can be relieved with rest, nitroglycerin, or a combination of both. Some individuals with stable angina may later develop unstable angina.

Unstable angina

Unstable angina is primarily caused by reduced blood flow to the heart muscle due to the narrowing of coronary arteries by fatty deposits known as atherosclerosis. In some cases, these fatty buildups can rupture, causing injury to the coronary blood vessel. This triggers blood clot formation, further obstructing blood flow to the heart muscle and leading to episodes of unstable angina. Unstable angina is dangerous as it is unpredictable and can happen without warning, even at rest.

What is the difference between angina and a heart attack?

Angina occurs when blood flow to the heart muscle is reduced, typically due to narrowed or blocked coronary arteries.

A heart attack, also known as a myocardial infarction, occurs when blood flow to a part of the heart muscle is severely reduced or completely blocked, leading to damage or death of the heart tissue. 

While angina and a heart attack may present with similar symptoms, they differ in their underlying causes, severity, and treatment approaches. Angina is often a warning sign of underlying heart disease, while a heart attack is a medical emergency requiring immediate attention.

What are the symptoms of angina?

Symptoms of angina can vary from person to person. Some common symptoms include:

• Chest pain that feels tight, heavy or dull
• Pain that radiates to the neck, jaw, shoulder, arm, back or stomach (usually left-sided)
• Shortness of breath
• Dizziness
• Nausea
• Fatigue

What are the risk factors for developing angina?

Risk factors for developing angina include:

• Diabetes
• Obesity
• High cholesterol levels 
• High blood pressure
• Stress
• Smoking
• Physical inactivity
• Unhealthy diet 
• Family history of heart disease
• Older age (age 45 years and above for men, age 55 years and above for women)

When might I experience angina?

Angina might be triggered by the following situations:

• Physical exertion from activities that demand increased oxygen supply to the heart, such as climbing stairs or carrying heavy groceries.
• Emotional stress due to intense emotions like anger, frustration, or anxiety can increase heart rate and blood pressure.
• Working in very hot or cold environments can strain the heart, as it works harder to maintain normal body temperature.
• Overeating can increase the heart’s workload.
• Exercising immediately following a meal can strain the heart.
• Engaging in sexual activity can increase heart rate and blood pressure, similar to physical exertion.

How is angina diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Your doctor may request one or more of the following tests: 

• Blood tests
• Electrocardiogram (ECG)
• Stress test
• Coronary angiography
• Echocardiogram
• Chest X-ray
• Magnetic Resonance Imaging (MRI)

How is angina treated?

The treatment and management of angina depend on the type of angina you have. If your angina is stable, you may be able to control it by adopting a healthy lifestyle and taking medications.

Your doctor may prescribe nitroglycerine, which can quickly relieve or prevent chest pain associated with angina. Your doctor will also provide instructions on when and how to take these medications.

If you are using sublingual nitroglycerine:

• Ensure you always have a new, sealed supply with you.
• Store the tablets in their original container to shield them from heat, light, and air, which could diminish their efficacy.
• Discuss refilling your prescription every 3-6 months to avoid using outdated tablets, which may lose their potency.

Other medications prescribed for long-term angina management include:

• Anticoagulants
• Antiplatelets
• Beta-blockers
• Calcium channel blockers
• Statins

Surgical interventions may be recommended when medications do not help control the angina. The two main types of surgery for individuals with angina are:

• Coronary angioplasty and stent insertion: A catheter is inserted into a narrowed/blocked coronary artery where a special balloon is gently inflated to widen the affected artery. In modern angioplasty procedures, a common practice involves the insertion of a small wire mesh tube, known as a stent, into the artery as part of the process. This stent remains permanently, facilitating improved blood flow within the artery.

• Coronary artery bypass graft (CABG): CABG involves creating an alternative pathway for blood flow around narrowed or blocked sections of major arteries to enhance the delivery of oxygen-rich blood to the heart.

When should I see a doctor for angina pain?

Chest pains due to angina should not be taken lightly. It is always best to get medical attention as soon as possible in the event of sudden, unexplained chest pain.

One should see a doctor for angina pain when:

• Your symptoms last longer than usual.
• The severity of your symptoms is worse than usual.
• The frequency of your symptoms has increased.
• The chest pain you have feels different from usual.
• Pain or discomfort persists even at rest or after taking nitroglycerin (after five minutes or three doses).

If you experience an angina attack:

• Stop your activity and rest.
• Use your nitroglycerin medicine.
• If the first dose does not relieve the symptoms, take another dose after five minutes.
• If you still have symptoms five minutes after the second dose, call for an ambulance.

Book an appointment at Pantai Hospitals

A dedicated and expert team of cardiologists at Pantai Hospitals is available for consultation to provide patients with the best care and assistance.

Get in touch with us to book an appointment with a cardiologist today if you have any questions regarding angina and your heart health.

Pantai Hospital Malaysia is accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.