Health and Wellness
Five things to know about angina
Angina occurs when the heart does not receive enough oxygen-rich blood and is often a symptom of a serious heart condition. Interventional Cardiologist Jason Bartos, MD, PhD, shares five things you should know.
- July 19, 2021
- By Staff Writer
Do you feel like someone is squeezing your heart when you get stressed? Perhaps you feel pain in your left arm? Or experience indigestion when you exercise? You could be experiencing angina, or the symptoms people feel when part of the heart muscle is not getting enough oxygen-rich blood.
We spoke with Interventional Cardiologist Jason Bartos, MD, PhD, to learn more about angina, including what to look for and when to seek treatment.
Angina, which becomes more common as people age, can be a sign of other significant health issues, like coronary artery disease. The majority of people who experience angina do so because of plaque buildup on the wall of one or more coronary arteries that slowly and steadily constricts blood flow to the heart. If that artery suddenly becomes completely blocked, a heart attack occurs.
If you’re experiencing angina, it’s important to understand the patterns—for example, what causes it, what makes it better, and how long it lasts—and know how to react appropriately.
There are two major types of angina: stable angina and unstable angina. Other variations of angina exist, but they are rare.
Stable angina keeps a reliable pattern. That is, the symptoms only happen under certain, often predictable, circumstances and usually last less than 10 minutes—but always less than 20 minutes—before they go away. Often, exercise, emotional stress, or large meals trigger this kind of angina.
Unstable angina means the pattern is changing or getting worse. In this case, the symptoms may come on more frequently or easily, such as with less exertion. They may also be more severe, and they may last longer. They can also occur with little to no stress or activity. Sometimes, unstable angina is triggered by blood clots.
If the angina continues for more than 20 minutes, the health risks increase significantly.
Angina is commonly associated with chest pain – but that’s not the whole story. The spectrum of symptoms that occur when the heart itself doesn’t get enough blood is broad. Angina symptoms may also include:
- Chest tightness
- Burning or other discomfort
- Shortness of breath
- Discomfort in other areas of the body (including the shoulders, between the shoulder blades or down an arm)
- Unusual numbness, and other associated symptoms
“Not all chest pain is angina, and not all angina presents with chest pain,” said Bartos. “Angina can manifest classically as left-sided or central chest pain radiating to the left arm, shoulder, neck, jaw, or back. However, it can also present as shortness of breath, indigestion, or pain isolated to only the jaw, neck, left arm, shoulder, or back.
“At the same time, other medical conditions can cause similar symptoms. Therefore, people experiencing these symptoms, particularly if they are brought on by exertion or stress, should seek consultation with their primary care physician or cardiologist,” Bartos added.
Are you unsure whether you’re experiencing angina? If so, take note of repeating patterns. How long do the symptoms last? Do the symptoms start because of exercise, eating, or stress? Do they stop if you stop exercising? Where does the pain occur? Does a change in your position trigger the symptoms? Does deep breathing or coughing affect the symptoms?
If you’re regularly experiencing symptoms that fit some of these patterns, then it may be time to meet with your primary care physician. If the pattern grows less predictable, you could be experiencing unstable angina. It’s always better to err on the side of caution, but if it goes away and stays away, it’s predictable, and it lasts less than 20 minutes, it is more likely to be stable angina.
Angina is rare in people under 35 years of age unless that person has other health problems which make angina more common – such as diabetes or smoking tobacco. Besides age, smoking, and diabetes, risk factors include a history of hypertension or high cholesterol. If an immediate family member was diagnosed with heart disease at a young age, you may have a higher risk of angina and heart disease as well.
Don’t forget: Angina is not a disease. Instead, it is most often a symptom of other heart conditions, including coronary artery disease.
“Angina is most often caused by plaque buildup in the heart arteries,” Bartos said. “However, heart artery disease is a single manifestation of a systemic disease which often causes disease in other blood vessels in the body. Therefore, treatment solutions must be tailored to each individual person, and medications treating the systemic components of the illness are often needed.”
Angina most often occurs when coronary artery disease causes plaque to build up in arteries supplying the heart and limits sufficient blood flow to the heart. If it is a partial obstruction, treatment may include medication, surgery, or stent placement. A total obstruction may lead to a heart attack.
In some cases, the body may create small blood vessels to reroute blood flow around a blocked artery—but only if the blockage builds slowly, allowing the body time to adapt. This is known as chronic total occlusion.
These reroutes provide enough blood flow to the heart to prevent a heart attack, even though there is 100 percent blockage. Historically, the main treatment for a total occlusion has been medication or bypass surgery. Now, however, M Health Fairview cardiologists use a less-invasive catheter method to navigate through the blockage and place a stent in the blood vessel that can relieve even a chronic total blockage.
At M Health Fairview, the team of angina experts take care of the person in addition to the disease, Bartos said.
“We have experts in the diagnosis and treatment of heart artery disease taking advantage of the newest innovations to reduce recovery time and improve long-term outcomes,” Bartos said. “Most importantly, our nurses and physicians are dedicated to ensuring that people understand their illness and participate in the decisions needed to best manage their condition.”