•  Guide to the Heart •  Heart Health Center

Angina is temporary pain or discomfort in the chest that occurs when not enough oxygen-carrying blood reaches your heart. (The term "angina" means "pain," while "pectoris" refers to the chest.) Sometimes angina feels like heartburn, the similar sensations you may get after eating a heavy meal. But if you feel this pain regularly, it may be a symptom of heart disease.

Angina is most often a sign that you have heart disease, specifically a blockage of one or more of the main blood vessels supplying the heart muscle. In fact, angina is the most typical symptom of heart disease. In the United States, approximately 8.9 million people suffer from it. An angina attack occurs when the blocked vessel prevents adequate blood flow, or when there is spasm of the vessel leading to decreased blood flow to the heart muscle.

Usually, angina does not cause any heart damage. Angina is more like a warning signal, and it can mean you're at greater risk of having a heart attack. Whether you're hiking uphill, having a heated argument with your partner, or digesting after a five-course gourmet meal, angina is your heart's way of telling you that you're making it work too hard and that it is not getting enough blood and oxygen.

Although they vary from person to person, these are the typical symptoms:

•A sharp or dull pain, tightness, pressure, or burning sensation in the chest, arms, jaw, or back (These symptoms often occur during physical exertion, emotional stress, or eating.)

•Tingling, aching, or numbness in the elbows, arms, or wrists (especially your left arm)

•Shortness of breath

•Perspiration

•Nausea

By your symptoms and a stress test, which usually means walking on a treadmill. You'll be hooked up to an electrocardiogram (EKG), which measures the electrical activity of the heart before, during, and after the stress test, and your blood pressure will be monitored throughout. Characteristic changes occur on the EKG if heart disease is present. But this test is meant for screening, and you may need other tests, such as a nuclear scan or an angiogram. In an angiogram, a dye is injected into your blood and an x-ray is taken of the heart and its blood vessels.

Nitroglycerine placed under the tongue is the usual medication for an attack of angina: It helps dilate blood vessels so more blood can reach the heart. Nitroglycerin is also available in pill or patch form to prevent symptoms. (Anyone taking nitroglycerine should avoid using Viagra, as a serious drop in blood pressure could result.) After you've undergone a full evaluation, your physician may prescribe other medications, such as beta blockers and calcium channel blockers, that can help prevent angina as well.

You may also benefit from learning stress-reduction techniques such as meditation or relaxation exercises. Check your local community center for classes or workshop listings.

Most people who have been diagnosed with angina are prescribed nitroglycerine tablets. You should always have them on you or nearby. Keep them in several places at home and work. Sit down and rest, if you're not already sitting, and put one tablet under your tongue to dissolve. Nitroglycerine can cause dizziness, so it's important to take it sitting down and to get up slowly once you feel better. The discomfort should go away in two to three minutes. If it hasn't let up after three to five minutes, take another pill. You can take a third pill three to five minutes after the second, if the pain still hasn't subsided. But if you're still feeling discomfort after the third pill, consider it an emergency and call 911 immediately: You may be having a heart attack.

It's easy to mistake an angina attack for a heart attack. They both tend to start with chest pain. Both can be marked by pain, numbness, or tingling in the neck, shoulders, arms, and jaw. The difference is that with the most common form of angina, rest and medication as described relieve the symptoms in two or three minutes.

If you are having a heart attack, the pain will not go away, and it may become more intense. If rest and medication do not relieve pain after three pills at three to five minute intervals, call 911 or your emergency medical system immediately.

Although angina can cause chest pain and discomfort, heart attack pain is also generally more severe. If you ever feel what could be described as "an elephant sitting on your chest", call 911: Such crushing pain is a classic symptom of a heart attack.

It does if you have stable angina, the most common sort. If you've been diagnosed with unstable angina, symptoms of an angina attack will closely mimic those of a heart attack. Often, medication doesn't help unstable angina, and it lasts longer than a few minutes and occurs when you're not exerting yourself. You need to discuss with your doctor how to monitor your condition and when you should consider symptoms an emergency.

Knowing the pattern of your angina attacks should help you identify a true emergency, especially if there are changes in duration, cause, or intensity.

Your doctor will advise you on how much you can do based on the results of your tests. A supervised exercise program for heart patients can be extremely helpful, but you may need to modify your activities so you don't overtax yourself (see Exercise and Heart Disease). If a big, rich meal sets off an attack, try smaller portions. If walking quickly causes symptoms, slow down your gait. In very cold or windy weather you'll probably have to bundle up better and cover your head and face; your doctor may even tell you to put a nitroglycerine tablet under your tongue before stepping outside.

If you have heart trouble, you'll be healthier if follow these guidelines:

•Maintain a low-fat, low-sodium diet.

•If you smoke, quit.

•Reduce or stop your alcohol consumption.

•If you're overweight, try to drop a few pounds.

•Exercise, following prescribed guidelines, unless your doctor forbids it.

Heart disease is generally treated with medication. In some cases, however, people have successfully reversed heart disease by exercising, following a strict, low-fat diet recommended by their doctors, and making other lifestyle changes. For more information, see Reversing Heart Disease Through Diet.

-- Laurie Udesky is an award-winning print and radio journalist based in San Francisco. She has contributed to The Self-Care Advisor (Time Inc. Health) and has written for many medical trade journals, including AIDS Alert and TB Monitor.

Further Resources

American Heart Association
800/242-8721
http://www.americanheart.org

National Heart, Lung, and Blood Institute
800/575-9355
http://www.nih.gov/nhlbi

References

First published May 18, 2001
Last updated April 10, 2008
Copyright © 2001 Consumer Health Interactive

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