The types of angina are stable, unstable, microvascular, and variant. The types vary based on their severity or cause.
Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:
If you have stable angina, you can learn its pattern and predict when an event will occur, such as during physical exertion or mental stress. The pain usually goes away a few minutes after you rest or take your angina medicine. If the condition causing your angina gets worse, stable angina can become unstable angina.
Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.
Unstable angina is a medical emergency, since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.
Microvascular angina is a sign of ischemic heart disease affecting the tiny arteries of the heart. Microvascular angina events can be stable or unstable. They can be more painful and last longer than other types of angina, and symptoms can occur during exercise or at rest. Medicine may not relieve symptoms of this type of angina.
Variant angina, also known as Prinzmetal’s angina, is rare. It occurs when a spasm—a sudden tightening of the muscles within the arteries of your heart—causes the angina rather than a blockage. This type of angina usually occurs while you are at rest, and the pain can be severe. It usually happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina.
Angina happens when your heart muscle does not get enough oxygen-rich blood. Medical conditions, particularly ischemic heart disease, or lifestyle habits can cause angina. To understand the causes of angina, it helps to understand how the heart works.
Two types of ischemic heart disease can cause angina.
A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether or not you have ischemic heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart needs more oxygen-rich blood.
What happens in the heart during an angina event?
In one day, your heart beats about 100,000 times and pumps about 2,400 gallons of blood throughout your body. To meet this demand, your heart’s cells needs a great deal of oxygen, which is supplied by the large coronary arteries and the tiny arteries that branch off the large arteries. When your heart is working hard, such as during physical activity or emotional stress, its demand for oxygen increases. Angina occurs when there is an imbalance between the heart’s need for oxygen-rich blood and the ability of the arteries to deliver blood to all areas of the heart.
You may have an increased risk for angina because of your age, environment or occupation, family history and genetics, lifestyle, other medical conditions, race, or sex.
Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. This means that your risk for ischemic heart disease and angina increases as you get older.
Variant angina is rare, but people who have variant angina often are younger than those who have other types of angina.
Angina may be linked to a type of air pollution called particle pollution. Particle pollution can include dust from roads, farms, dry riverbeds, construction sites, and mines.
Your work life can increase your risk of angina. Examples include work that limits your time available for sleep, involves high stress, requires long periods of sitting or standing, is noisy, or exposes you to potential hazards such as radiation.
Ischemic heart disease often runs in families. Also, people who have no lifestyle-related risk factors can develop ischemic heart disease. These factors suggest that genes are involved in ischemic heart disease and can influence a person’s risk of developing angina.
Variant angina has also been linked to specific DNA changes.
The more heart disease risk factors you have, the greater your risk of developing angina. The main lifestyle risk factors for angina include:
Medical conditions in which your heart needs more oxygen-rich blood than your body can supply increase your risk for angina. They include:
Some groups of people are at higher risk for developing ischemic heart disease and one of its main symptoms, angina. African Americans who have already had a heart attack are more likely than whites to develop angina.
Variant angina is more common among people living in Japan, especially men, than among people living in Western countries.
Angina affects both men and women, but at different ages based on men and women’s risk of developing ischemic heart disease. In men, ischemic heart disease risk starts to increase at age 45. Before age 55, women have a lower risk for heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack are more likely to develop angina compared with men.
Microvascular angina most often begins in women around the time of menopause.
Typically, doctors screen for angina only when you have symptoms. However, your doctor may assess your risk factors for ischemic heart disease every few years as part of your regular office visits. If you have two or more risk factors, then your doctor may estimate the chance that you will develop ischemic heart disease, which may include angina, over the next 10 years.
To prevent angina, your doctor may recommend that you adopt heart-healthy lifestyle changes to lower your risk of ischemic heart disease, the most common cause of angina. Heart-healthy lifestyle changes include choosing a heart-healthy eating pattern such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress. You should also avoid using illegal drugs.
Signs and symptoms vary based on the type of angina you have and on whether you are a man or a woman. Angina symptoms can differ in severity, location in the body, timing, and how much relief you may feel with rest or medicines. Since symptoms of angina and of heart attack can be the same, call 9-1-1 if you feel chest discomfort that does not go away with rest or medicine. Angina can also lead to a heart attack and other complications that can be life-threatening.
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe or that they cannot tell exactly where the pain is coming from.
Other symptoms include:
Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.
Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor.
Each type of angina has certain typical symptoms. Learn more about the symptoms that are characteristic of each type.
Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.
Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.
Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:
Your doctor will also need information about ischemic heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem. Your doctor can recommend steps you need to take to get medical care.
As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.
Your doctor may have you undergo some of the following tests and procedures.
Your doctor will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital. If your angina is stable and your symptoms are not getting worse, you may be able to control your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot control your angina, you may need a medical procedure to improve blood flow and relieve your angina.
If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control angina events and relieve pain. Often other medicines are also prescribed to help control angina long-term. The choice of medicines may depend on what type of angina you have.
If you still have symptoms or experience side effects, your doctor may prescribe other medicines, including:
If lifestyle changes and medicines do not control angina, you may need a medical procedure to treat the underlying heart disease.
Angina is not a heart attack, but it is a signal that you are at greater risk of having a heart attack. The risk is higher if you have unstable angina. For this reason, it is important that you receive follow-up care, monitor your condition, and understand your condition so you know when to get medical help. Your doctor may recommend heart-healthy lifestyle changes and cardiac rehabilitation to help manage angina.
You may need follow-up visits every 4 to 6 months for the first year after diagnosis of angina and every 6 to 12 months as long as your condition is stable. Your care plan may be changed if your angina worsens or if stable angina becomes unstable. Unstable angina is a medical emergency.
Return to Treatment to review possible treatment options for your angina.
To monitor your condition, your doctor may recommend the following tests or procedures:
Angina is a symptom of ischemic heart disease. Your doctor may recommend the following heart-healthy lifestyle changes to help you manage angina:
Your doctor may recommend these heart-healthy lifestyle changes as part of a larger cardiac rehabilitation program that your doctors oversee.
Stable angina usually occurs in a pattern. After several events, you will learn what causes the pain to occur, what the pain feels like, and how long the pain usually lasts. To help learn your angina’s pattern and triggers, keep a log of when you feel pain. The log helps your doctor regulate your medicines and evaluate your need for future treatments. When you know what triggers your angina, you can take steps to prevent or lessen the severity of events.
Tell your doctor right away if your pattern changes. Pattern changes may include angina that occurs more often, lasts longer, is more severe, occurs without physical exertion, or does not go away with rest or medicines. These changes may be a sign that your symptoms are getting worse or becoming unstable.
Not all angina improves with medicines or medical procedures. If your symptoms continue, your doctor may change your medicines or therapies to help relieve your chest pain. Additional treatments for hard-to-treat angina include:
You should know what medicines you are taking, the purpose of each, how and when to take them, and possible side effects. Learn exactly when and how to take nitroglycerin or other short-acting nitrates to relieve chest pain. Then talk to your doctor about the following:
What’s the safest and most effective way to use short-acting nitrates like nitroglycerin to treat stable angina events?
Here are some tips for taking short-acting nitrates.
Call 9-1-1 if the pain continues after taking a second dose. This could be a symptom of unstable angina, which is a medical emergency.
Sometimes it is hard to tell the difference between unstable angina and a heart attack. Angina can be a sign of increased risk of stroke. Angina can also trigger sudden cardiac arrest. These are medical emergencies.
If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.
Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have symptoms such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test.
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.
Read more about the signs and symptoms of a stroke.
Sudden cardiac arrest
It is possible for a spasm causing angina to trigger arrhythmia. This can lead to sudden cardiac arrest. Fainting is usually the first sign of sudden cardiac arrest. If you think someone may be in cardiac arrest, try the following steps.
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have angina. Research on this topic is part of the NHLBI’s broader commitment to advancing Heart and Vascular Disease scientific discovery.
In support of our mission, we are committed to advancing angina research, in part, through the following ways.
Learn about exciting research areas the NHLBI is exploring about angina.
We lead or sponsor studies on angina. See if you or someone you know is eligible to participate in our clinical trials.
To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment 800-411-1222.
After reading our Angina Health Topic, you may be interested in additional information found in the following resources.