What Does Angina Feel Like?

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Overview

Angina is a condition that causes pain, or a tight feeling of squeezing discomfort, in the chest, which is related to the heart muscle’s demands for oxygen, supplied via the blood flow in the coronary arteries to the heart, not being met quickly enough. Usually, the condition itself is not life-threatening and resolves quickly after a situation that has  increased the heart’s demand for oxygen in the blood passes. However, angina is a serious sign of future, potentially critical heart problems which should not be ignored. Angina and heart attack are both complications of the buildup of fatty substances inside the coronary arteries that supply the heart with the blood.6 It is important to address the signs and symptoms of angina and undertake necessary measures to remedy it in a timely manner . This article will discuss how angina feels and provide a comparison with other chest pain-causing heart-related conditions. 

Angina hat is it?

Angina is chest pain arising as a symptom of the inability to satisfy the increased oxygen demands of the heart muscle during periods of increased activity or stress.The chest pain is often described as squeezing, pressure, heaviness, tightness, or burning pain in and around the chest. It may also feel like a tight band around the chest or a heavy weight lying on the chest. It is the main symptom of myocardial ischemia –which means inadequate  blood flow to the heart muscles depriving them of sufficient oxygen. The pain happens following  blockages or narrowing in the vessels supplying blood to the heart called the coronary arteries, which results in a reduction of blood flow, leading to decreased and  insufficient oxygen delivery to the heart muscle. 5  Thus, during periods of stress or increased activity when the blood supply to the heart is required to increase accordingly because the heart muscles are in greater need of oxygen, the reduction in blood flow caused by the blockages or narrowing leads to myocardial ischemia and thus the experience of chest pain and other symptoms. While angina might not on its own be an immediately life-threatening emergency, it  can indicate a future high risk of a heart attack, thus it is important to recognise the feeling of angina symptoms and get then checked out by a physician as soon as possible to prevent this.

Types of angina

There are at least four types of angina that have been characterised:

Stable angina, is a short-lived condition which is a direct consequence of triggering events, such as stress or physical exertion. It is the more common type which  resolves shortly (in a few minutes) after  resting or taking angina medication, as blood and oxygen levelsto the heart muscle are restored. It occurs predictably and generally produces a similar sensation in the chest each time.

Unstable angina, on the other hand, is a more serious event - in fact a medical emergency. It can come on unexpectedly without warning after mild exertion or even while at rest or sleeping. Or the usual angina pain starts  worsening– occurring with less physical effort and with more severe pain that typically has a longer duration of 20 minutes or more. Also the pain doesn't go away with rest or the usual angina medications. If the blood flow does not improve, pain can increase as the heart is starved of oxygen and it can lead to a full heart attack 

Microvascular angina is a manifestation of coronary heart disease, targeting tiny heart arteries. Individuals with this type of angina usually experience chest pains. However, they may not have observable blockages of the coronary arteries. It is thought that the pain is due to the poor function of smaller blood vessels that nourish the heart and extremities. Itis more common in people AFAB. Microvascular angina can be both stable or unstable and presents with longer and more painful disease symptoms. 

Variant angina, also known as Prinzmetal’s angina, is a rare condition which usually occurs only during sleep or at rest rather than after exertion, It is caused by spasmodic tightening and constriction of the coronary arteries that temporarily restricts the flow of oxygenated blood to the heart It responds well to calcium channel blockers that help relax and dilate the arteries again.

Causes and risk factors for angina

The causative Mechanisms of the various types of angina involve the inability to satisfy oxygen demands to the heart muscle, due to impaired blood supply to the heart tissue, also known as heart muscle ischaemia. 1 The causes result in the blockage of blood flow, include the narrowing of coronary arteries, and atherosclerosis. This condition is due to the building up of fatty deposits, and plaques, on arterial walls. 7

Several types of coronary heart disease can manifest as angina.8

Coronary artery disease happens due to atherosclerosis ,which is a buildup of fats, cholesterol and other substances to form a plaque on the artery walls of the large heart arteries that supply blood to the heart. Sometimes, the fatty plaques break open and produce blood clots that can get trapped in the artery and cause its clogging or complete blockage. 

Coronary microvascular disease is a condition in which the smaller arteries branching off the coronary arteries are either damaged or do not expand normally when the heart is working harder and requires more oxygen rich blood. Reduced blood circulation in these can cause microvascular angina. 

Spasms of large or small coronary arteries can also cause symptoms of angina, since they tighten and narrow the blood vessels, restricting blood flow to the heart muscle. Spasms can happen with or without coronary heart disease and be associated with the use of tobacco, prolonged exposure to cold temperatures, physical stress and the use of chemical stimulants. 

It is important to note that, angina might present as a new painful sensation in the chest shortly after having a big meal and so can be often mistaken for the pain from indigestion.

Who is at risk of angina?

Those who are particularly at risk of coronary heart disease and angina, include:

  • Individuals experiencing high stress levels
  • People who smoker
  • Diabetics
  • People who are overweight and obese 
  • Individuals with high cholesterol
  • Individuals with high blood pressure
  • Individuals with a family history of early heart disease
  • The middle aged and elderly (Risk generally increases with age 45+ for men and 55+ for women)

You may have a higher risk of angina due to your age, gender, ethnicity, certain medical conditions, genetic predisposition, environment or occupation, and lifestyle. 

The main lifestyle risk factors for angina include:

  • Alcohol use – particularly for variant angina
  • Recreational use of Illegal drugs that can cause the heart to race or damage the blood vessels
  • Insufficient daily physical activity
  • Smoking tobacco or long-term exposure to second-hand smoke
  • Stress
  • Unhealthy eating patterns

Symptoms of angina

The main symptom of angina is chest pain, often described as heaviness, severe pressure, burning pain and discomfort, additionally there is a full sensation in the chest area, as described previously above. 

The chest pain may spread to the upper body, shoulder, arms, neck, and jaw, radiating to the back, especially in women who are also more likely to have other symptoms of angina which may sometimes not be recognised as symptoms of a heart problem, such as those below 3

Other common symptoms of angina include:

  • Nausea, heartburn or indigestion
  • Light-headedness or fainting
  • Extreme tiredness 
  • Confusion 
  • Trouble breathing 
  • Heart palpitations
  • Sweating

Are angina symptoms different for people AFAB and AMAB?

The combination of different symptoms experienced and their severity may vary between sexes. People AFAB can tend to experience trouble breathing, light-headedness, nausea and vomiting, and severe  stomach pain. These symptoms have been linked to blockages of smaller arteries in people AFAB, while larger arteries seem to be affected more often in people AMAB.2

According to the American Heart Association women were found to have a higher incidence of stable angina and associated death from coronary heart disease compared to men.5

Is my chest pain angina?

Generally symptoms of coronary heart disease, stroke and heart attack might overlap with symptoms of angina.4

If you have not been diagnosed with angina, but have been experiencing sudden episodes of chest pain which stop shortly after resting, you should get an appointment with a physician immediately.

Only a doctor is capable of a precise diagnosis of angina by using a combination of both clinical presentation, personal and family health history, examination, and various laboratory findings. 

Usually, the doctor will ask questions to build a more complete picture, including questions about the symptoms you are having and what you were doing when the episode started. Importantly, the physician will also ask about your lifestyle including , the type of diet you follow and whether you smoke or drink. 8 Finally, you will be asked if other family members have been diagnosed with angina or other coronary diseases–although angina is a non-heritable condition, various factors causing heart problems tend to run in families.

This will likely  be followed by some general assessments, such as measuring your blood pressure, blood cholesterol levels, and body mass index (BMI).

Diagnosis of angina

If angina is suspected, the doctor will make a diagnosis based on physical examination (assessment of clinical symptoms, risk factors, and family history) as well as various diagnostic tests.

 These tests will likely include:

  • Blood tests– generic blood count tests and assessment for specific proteins, troponins, which are released when your heart muscle is damaged during a heart attack
  • An electrocardiogram – measurement of electrical activity and rhythm of the heart muscle to detect abnormal patterns
  • An exercise stress test – to assess how good the heart blood pumping capacity is during  exercise.
  • Imaging tests – including chest X-rays to differentiate between other chest pain causing conditions and eliminate them from the diagnosis, followed by echocardiograms, CT and MRI scans to find the origin of the chest pain

Other causes of chest pain

A heart problem usually causes pain, particularly to the left side of the upper chest Symptoms of various heart-related conditions are very similar and it is essential to be able to differentiate between different causes of chest pain.

Other causes of chest pain may be due to:

  • Respiratory problems
  • Indigestion
  • Affected bones and muscles
  • Physical and mental health

The table below provides a comparison of heart-related conditions that cause a painful sensation in the chest area.4, 11

ConditionSigns and SymptomsPain durationand magnitude
AnginaPressure, heaviness and feeling of the heart muscle being squeezedPain radiating into the upper bodyFeeling sick and/or nauseousPain severity varies among individualsResolves shortly after  rest (2-3 min)
Heart attackSharp, cutting pain, tightness, pressureTrouble breathingLight-headedness and confusionCold sweatsSigns of shockAnxietyNumbness in the arm or handOften presents with considerable painPersists despite  resting
MyocarditisModerate painPressure in the chestSwelling in the legsHeart palpitationsvarious
Pericarditis Sharp, dull pain starting in the centre or left side of the chestFatigue Muscle painFevervarious
CardiomyopathyShortness of breath (related to recent physical activity)Swelling of the legs, ankles, and feet.Intense chest pain with exertion or after eating a mealHeart palpitationsIrregular heart rhythmSymptoms get worse over time if condition is untreated
Aortic aneurysmDiscomfort in the chest
Chest, back, and stomach area is “tender” to the touch
Cough
Trouble breathing
Can be completely silent i.e., painlessConsequently: potentially lethal aortic rupture (associated with severe pain in the chest, jaw and neck)
Valve problemsChest pain, pressure, or tightnessShortness of breathAbnormal heartbeat Worsens over time in elderly individuals

Angina and heart attack share a common cause atherosclerosis. Excessive buildup of fatty plaques can narrow the vessels and cause several episodes of angina. Rupture of these plaques can potentially result in an artery clogging with a clot and loss of blood supply to the heart muscle, thereby triggering a heart attack.6  It can be tricky sometimes to identify the precise cause of the chest pain due to major overlaps in symptoms in coronary health conditions. 

What to do if you have symptoms of an angina attack?

If you suspect an onset of an angina episode, try to sit down and relax for a couple of minutes and take a single dose of nitro-glycerine if it has been prescribed for you.2

Becauseangina-related chest pain results directly from an inability to satisfy the need for increased blood flow and oxygen to the heart, when blood circulation is restored and the increased demand for blood goes away, angina symptoms resolve too.  Although symptoms usually resolve quickly, the episodes of angina are undeniably a sign of a malfunctioning heart and are potentially precursors of more severe heart disease. 

If you have not been diagnosed with angina, but you have been experiencing sudden episodes of chest pain which stops shortly after resting, you should get an appointment with a doctor. Usually treatment of angina and heart health preventative and protective measures involve essential lifestyle changes, and potentially medical procedures and sometimes surgery. 

Key lifestyle modifications for people diagnosed with angina are:

  • Quit tobacco smoking, and avoid passive exposure to the smoke
  • Maintain a healthy and balanced diet, low in saturated and trans fat, as well as salt 
  • Treat and manage high blood pressure and blood cholesterol levels 
  • Avoid exposure to extreme temperatures. 
  • Manage stress.
  • Maintain adequate activity levels and regular exercise
  • Contact your doctor immediately if you notice changes in frequency or severity of your angina. For instance, if you get angina while resting or if symptoms become worse

It is critical to seek an emergency help If the chest pain persists and is not resolved  neither by resting, nor by a tablet of nitro-glycerine, because it can be indicative of a heart attack.6

Summary

Angina, or chest pain, is among the most common consequences of ischemic heart disease. Usually it causes discomfort in the chest, including tightness, squeezing and abnormal heaviness, and sometimes severe pain. Sometimes symptoms associated with angina radiate to the left side of the upper abdomen and body areas , such as the arms (particularly the left)  neck, jaw, shoulders, stomach and back. Causes underlying the angina can be heart-related, but sometimes they have nothing to do with the heart. Therefore, it is essential to seek investigation by a physician for this reason, but also because angina is a serious sign of future, potentially critical heart problems which should not be ignored. You might experience angina due to the arteries spasming on a cold day, after rigorous exercise or after a  heavy meal. The symptoms of angina usuallyfade a couple minutes after  resting, or after taking  prescribed medicines such as glyceryl trinitrate (GTN). 

References

  1. COLLINS P. Pathophysiology of angina. The Lancet. 1990;335(8681):94-96.Available from:https://pubmed.ncbi.nlm.nih.gov/1967428/
  2. British Heart Foundation. Angina - Causes, symptoms & treatments [Internet]. Bhf.org.uk. 2022 [cited 5 August 2022]. Available from: https://www.bhf.org.uk/informationsupport/conditions/angina
  3. Heart Attack and Stroke Symptoms. Angina (Chest Pain) [Internet]. www.heart.org. 2022 [cited 5 August 2022]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain
  4. Clarke J-RD. Introductory Chapter: The Patient Presenting with Chest Pain. In: Differential Diagnosis of Chest Pain [Internet]. IntechOpen; 2020 [cited 2023 Sep 17]. Available from: https://www.intechopen.com/chapters/71562.
  5. Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I. Incidence and Prognostic Implications of Stable Angina Pectoris Among Women and Men. JAMA. 2006;295(12):1404. Available from:https://jamanetwork.com/journals/jama/fullarticle/202584
  6. Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) - Heart and Blood Vessel Disorders. MSD Manual Consumer Version [Internet]. [cited 2023 Sep 17]. Available from: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina.
  7. Libby P, Bornfeldt K, Tall A. Atherosclerosis. Circulation Research. 2016;118(4):531-534.Available from: https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.116.308334
  8. National Heart, Lung and Blood Institute. Angina (Chest Pain) - Types | NHLBI, NIH [Internet]. Nhlbi.nih.gov. 2022 [cited 5 August 2022]. Available from: https://www.nhlbi.nih.gov/health/angina/types
  9. Centres for Disease Control and Prevention. Know Your Risk for Heart Disease [Internet]. https://www.cdc.gov/heartdisease/risk_factors.htm. 2022 [cited 5 August 2022]. Available from: https://www.cdc.gov/heartdisease/risk_factors.htm
  10. Tomaselli G, Harty M, Horton K, Schoeberl M. The American Heart Association and the Million Hearts Initiative [Internet]. Circulation. 2022 [cited 5 August 2022]. Available from: https://doi.org/10.1161/CIR.0b013e3182327084
  11. McCONAGHY JR, Oza RS. Outpatient Diagnosis of Acute Chest Pain in Adults. afp [Internet]. 2013 [cited 2023 Sep 17]; 87(3):177–82. Available from: https://www.aafp.org/pubs/afp/issues/2013/0201/p177.html.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Nafisa Djumaeva

Bachelor's degree, Applied Medical Science, UCL

Biomedical scientist with professional experience in health communications. Experienced in medical writing and account management, I am a believer that translation of most recent research and HCP/patient education drives improved quality of medical care.

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