Conditions

Angina Pectoris

Chest discomfort can be an early warning sign of heart disease

Is Your Chest Pain a Warning Sign? Understanding Angina from a Heart Specialist's Perspective

It often begins subtly — a tightness in your chest while climbing stairs, a wave of fatigue during a stressful meeting, or a strange pressure that passes when you rest. These moments are easy to brush off. But for many of my patients, they were early signs of something serious: angina — the heart’s way of waving a red flag.

What Is Angina, Really?

Angina, or angina pectoris, is not a disease by itself. It’s a symptom — a warning that your heart muscle isn’t getting enough oxygen-rich blood. This usually happens when the coronary arteries that feed your heart are narrowed by plaque buildup, a hallmark of coronary artery disease (CAD). The pain may feel like pressure, tightness, burning, or heaviness in the chest. But not everyone experiences it the same way. In some, it radiates to the neck, jaw, shoulder, or back. Others may just feel short of breath or unusually tired.

Think of angina as your heart whispering: “I’m struggling.” If you don’t listen, it may start to shout — in the form of a heart attack.

Types of Angina: What Your Symptoms May Be Telling You

1. Stable Angina

The most common type, triggered by exertion or stress. The pain is predictable, usually lasts a few minutes, and improves with rest or medication like nitroglycerin.

2. Unstable Angina

More dangerous and less predictable. It can strike at rest, last longer, and doesn’t go away easily. It’s often a sign that a heart attack may be imminent, requiring urgent medical care.

3. Variant (Prinzmetal’s) Angina

Caused by spasms in the coronary arteries, not blockages. Often happens at night or early morning and can be treated with specific medications.

4. Microvascular Angina

This type involves tiny blood vessels that don’t function properly. More common in women, it can cause fatigue and chest discomfort without obvious blockages.

What Causes Angina?

The underlying issue is reduced oxygen supply to your heart, and common culprits include:

• Coronary artery disease (CAD) from plaque buildup
• Microvascular dysfunction in small vessels
• Blood clots that suddenly block flow
• Artery spasms reducing circulation
• Rarely, non-cardiac causes like pulmonary embolism or aortic dissection

Angina Symptoms to Look Out For

While chest discomfort is the hallmark, symptoms can vary:

• Pressure, heaviness, or burning in the chest
• Pain radiating to jaw, neck, back, shoulders, or arms
• Shortness of breath
• Fatigue, nausea, or dizziness
• Cold sweats

Note: Women may experience more subtle symptoms like indigestion or fatigue.

Who’s at Risk for Angina?

Several risk factors increase your chances:

• Coronary artery disease
• High blood pressure and cholesterol
• Smoking and diabetes
• Family history of heart disease
• Obesity, poor diet, and stress

If these sound familiar, it’s worth having a heart check-up — even if you feel “fine.”

How Do We Diagnose Angina?

As a cardiologist, I use a combination of tools:

• Medical history and physical exam
• Blood tests for heart markers
• Electrocardiogram (ECG)
• Stress testing (treadmill or pharmacological)
• Cardiac CT or coronary angiography for detailed imaging

Treating Angina: What Are Your Options?

We tailor treatment to relieve symptoms, improve blood flow, and prevent heart attacks.

Medications

• Nitrates (e.g., nitroglycerin) for quick relief
• Beta blockers to reduce heart workload
• Calcium channel blockers for vessel relaxation
• Aspirin to reduce clot risk
• Statins for cholesterol management

Lifestyle Changes

• Quit smoking
• Eat a heart-healthy diet (think Mediterranean)
• Regular exercise under supervision
• Stress management (meditation, breathing techniques)
• Maintain a healthy weight

Procedures

• Angioplasty and stenting to reopen arteries
• Coronary artery bypass surgery (CABG)
• Enhanced External Counterpulsation (EECP) — a non-invasive option for some patients

Can Angina Be Prevented?

Absolutely. Prevention is powerful — and often life-saving.

• Control blood pressure, cholesterol, and diabetes
• Stay physically active
• Eat nutritious, low-sodium meals
• Avoid tobacco and excessive alcohol
• Get regular heart screenings if you’re at risk

When to Seek Emergency Help

If you or someone you love experiences:

• Chest pain that doesn’t go away with rest or medication
• Chest pain plus shortness of breath, dizziness, or sweating
• Pain radiating to the jaw, back, or arms

Call emergency services immediately. Time is heart muscle — the faster we act, the more heart tissue we save.