Angina: Where is the Pain?

The heart is a complex organ. The coronary arteries supply the heart muscle with blood. The heart muscle pumps the blood throughout your circulatory system. Every piece has its role to play in keeping your heart healthy. However, the coronary arteries can become clogged from a buildup of cholesterol, cells, or other substances, referred to as plaque. This can reduce the blood flow to your heart and result in chest pain. This is what happens in the case of angina. 

Pain anywhere around the chest area can be alarming - especially when you aren’t sure about what is causing the pain. So, let’s look at what angina is in more detail and where the pain associated with angina is located so that you know when to see your doctor. 

What is Angina?

Angina refers to a symptom rather than a condition in itself. The main symptom of angina is chest pain which is caused by a reduced blood flow to heart muscles. Angina is not life-threatening but is often seen as a warning sign that you could be at risk of developing a more serious condition. Therefore, it is something to monitor and bring up with your doctor.

Types of Angina

There are several types of angina. There is stable angina, unstable angina, vasospastic angina, and microvascular angina. 

Stable angina

is often the most common and tends to occur when the heart is under stress or working hard when you are exerting yourself. This pain usually lasts five minutes or so and goes away when you rest or take your medication. 

Unstable angina

can feel slightly different from the more common symptoms of angina. It can occur when you are resting and can feel more intense and last for longer periods of time. Your symptoms may also not improve after resting. In this case, it is best to call 911. 

Microvascular angina

also referred to as cardiac syndrome X, usually occurs when you are under physical pressure, such as when you are exercising, under stress, or feeling anxious. The pain associated with microvascular angina is often caused by spasms in some of the smallest coronary arteries. 

Vasospastic angina

is much rarer than the other types of angina. It is also called artery spasm or Prinzmetal’s angina. Vasospastic angina can happen when you are resting, or even at night. It occurs when the coronary artery that supplies blood and oxygen to your heart goes into spasm, narrows, or tightens, therefore restricting the blood flow. 

Signs and Symptoms

The main symptom of angina is pain or discomfort in the chest area. This pain can also often feel like pressure in the chest or squeezing in your chest that can spread to your arm, jaw, and neck. Other symptoms that often accompany ageing include:^1,2

• Fatigue and lethargy 
• Dizziness 
• Sweating
• Nausea 
• Shortness of breath

It is important to note that the pain associated with angina often stops after a few minutes of rest. 

Where is the pain located?

According to the American Heart Association, angina pain is most commonly located in the chest. This is because the discomfort associated with angina is caused by your heart muscle not receiving enough oxygen-rich blood. However, it is often reported that the pain felt in the chest can spread and be felt in your arms, neck, jaw, abdomen, and back.^1,2

Causes and Risk Factors

Most commonly, the cause of angina is coronary heart disease. Coronary heart disease causes the arteries that supply your heart muscles with blood and oxygen to narrow because of a build-up of a fatty substance called plaque. This causes less oxygen-rich blood to reach your heart muscles, which in turn causes the symptoms of angina.

It is for this reason that angina is associated with certain triggers. Some activities may cause angina pain. For example, individuals may commonly experience angina pain when exercising, when undergoing intense emotional stress, after finishing a big meal, etc. The symptoms usually stop after a few minutes. 

There are several risk factors that can increase your likelihood of coronary heart disease and, therefore, angina. These include the following:

• Diabetes
• Smoking
• Obesity
• High blood pressure or high cholesterol
• Family history of heart disease
• Older age 

Diagnosis

Your doctor may be able to tell you that the symptoms you are experiencing are because of angina just by examining you and listening to your symptoms. However, to confirm the diagnosis, your doctor might also request an ECG (a simple test to check your heart's rhythm), a coronary angiogram (a special kind of X-ray test done to find out whether your coronary arteries are blocked or not) or a heart scan (also called an echocardiogram - to look at the heart and nearby blood vessels in more detail to see if there is any narrowing of the coronary arteries).

Treatment

There are several types of treatment available for angina.⁴ However your doctor will decide which treatment is best for you, taking into consideration the type of angina you have, your symptoms, test results, and other specified risk factors. Nonetheless, the most common treatment options for angina include the following: 

• Most commonly you will be prescribed medications to help control your symptoms such as anticoagulant medication, antiplatelet medication, and nitrates, among many others. 
• Your doctor may also suggest other forms of treatment such as coronary angioplasty, in which a special kind of balloon is gently inflated within the narrowed artery to expand it, allowing more blood to reach the heart muscle. Moreover, some patients have a type of mesh called a stent placed in the artery to keep it open. Many options exist, all of which your doctor will discuss with you. 
• Beyond medication and medical procedures, there are simple lifestyle changes that can help alleviate and control the symptoms of angina, such as focusing on adopting a healthy diet and improving your overall health and wellbeing to reduce the risk of a heart attack in the future. 

Complications

Angina is a fairly common condition that acts as a warning sign of potentially more serious medical conditions. It is for this reason that angina can be often associated with specific medical complications, such as an increased risk of having a heart attack if you do not seek medical attention when experiencing recurrent chest pain. Other complications include stable angina evolving into unstable angina, an increased risk of stroke, or even, in some rare cases, sudden cardiac arrest. 

Angina can also cause some more emotional-related complications. People with angina report higher levels of emotional stress, anxiety, and depression.^3,5

When to See a Doctor

It is advised to book an appointment to see your doctor whenever you are experiencing chest pain, as all types of chest pain should be investigated by a doctor. More specifically, in the case of angina, you should go to see the doctor when you’re experiencing chest pains that go away after resting. This is one of the most common symptoms of angina. You should also see your doctor if you are experiencing more and more related symptoms alongside chest pain, such as shortness of breath, fatigue, etc. Your doctor will help reassure you about the condition and discuss with you the next steps. Furthermore, your doctor may also recommend several heart-healthy lifestyle changes as a part of a more long-term cardiac rehabilitation program. 

Summary

Angina is most commonly defined as a pain in the chest that, in most cases, goes away after resting. Even though in itself it is not life-threatening, it is a sign that your heart health is not as good as it should be, and a signal that you are at a greater risk of having a heart attack. Therefore, it is advised to see your doctor as soon as possible. Many people with angina retain a very good quality of life and continue living as normal. Living an active lifestyle is one of the important steps to take to reduce your risk of underlying coronary heart disease becoming worse. Angina is something you should monitor, but with medication and simple lifestyle changes, it is a manageable condition.