Angina & Chest Pain

Typically, symptoms of angina are chest pain or pressure, which may extend to the neck, jaw or arm. However, some people experience angina as shortness of breath, upper belly pain, indigestion, lightheadedness, extreme weakness or tiredness or general discomfort. Women often have other symptoms in addition to chest pain or pressure symptoms. Keep in mind that there are other reasons why you might have chest pain, like eating too quickly, acid reflux, muscle spasms or breathing issues.

Know what your angina feels like and what is typical for you, so you know when to call for help. Do not wait to call 911 if your angina is worse than normal, for example more severe, more frequent or lasting longer. If any of these occur, call your healthcare professional right away. Also, call for emergency help if your chest pain is severe and occurs while you are at rest (not exerting yourself). 

Chest pain can occur for several reasons, some that are serious and directly related to your heart and some that are either due to other important health issues or that may be harmless. Separating angina from other causes of chest pain is not always easy.

Your healthcare professional will take a thorough history and physical exam. They will ask you about the pain in your chest. Where do you feel it? Do you have other symptoms as well? When do you feel it? How long does it last? What makes it better or worse?

In addition to these important features of your symptoms, tests are available to help determine whether you are having cardiac problems. These include:

• An electrocardiogram (ECG), which shows how fast or evenly the heart is beating, can show signs of past heart attacks or have findings suggesting active decrease in blood flow to the heart muscle, called ischemia. It also can help show if any further testing might be needed.
• A stress test can be more accurate than an ECG to tell us if there are further signs of decreased blood flow to the heart muscle. Most of these tests use additional imaging techniques that can indicate reduced blood flow to the heart and even tell us which specific parts of your heart, if any, do not get enough blood due to a narrowing or blockage of an artery.
• Coronary computed tomography (CAT scan) can look directly at the heart arteries using contrast material without using catheters to go inside your body. CAT scan technology has advanced so that coronary artery narrowing, or blockages, can be directly and accurately be seen.
• Other tests, such as coronary calcium score can provide clues about hardening of your coronary arteries and your risk of developing future heart problems.
• If there is a concern about a heart attack, blood work may be done. You may be advised to go directly to the emergency department. 

To prevent angina caused by atherosclerosis, it is important to try to decrease the risk factors that lead to coronary artery disease.

Medication

Aspirin – If you have atherosclerosis, your healthcare team may recommend a “baby” aspirin daily because it helps blood flow through blood vessels. If you have had a heart attack or stroke, aspirin will help prevent another one and potentially help you live longer.

Statins – Statins help reduce levels of low-density lipoprotein (LDL), also called the “bad” cholesterol, in your blood. Too much LDL cholesterol in your blood means that there is a greater chance of it being inside the blood vessels in the heart or in the brain. This can lead to a heart attack or stroke. If you have had a heart attack or stroke, statins will help prevent another one and help you live longer. Even if you have not had a heart attack or stroke, statins may decrease the chances of a cardiac event in certain people, including those with angina.

Important reminder: Don’t stop or start taking any medication without talking to your care team first.  

Lifestyle changes

Lifestyle changes are also important in preventing heart disease and angina. These include:

• Control blood pressure: Keep your blood pressure readings within a healthy range with lifestyle changes and medications, if needed.
• Stop Smoking: Smoking is the No. 1 cause of preventable death in the U.S. Quitting smoking also is one of the best changes you can make to help prevent a heart attack. We understand how challenging it can be to break free from the grip of tobacco and nicotine addiction. That’s why we offer free support and resources to help you quit smoking and using other tobacco products. Learn more about our free tobacco cessation program, including our free nicotine replacement therapy.
• Exercise: Staying active is important for your heart. You should try to exercise (brisk walking, running or biking) for 30 minutes at least five times a week. This can reduce blood pressure, increase HDL (good) cholesterol and improve control of sugar, called glucose, in your blood.
• Healthy Diet: Everyone – especially if you have heart disease or a higher chance of developing heart disease – should eat a well-balanced diet high in fruits, vegetables, whole grains, fish and lean meats. Stay away from sugary beverages, refined grains and processed or red meats.
• Stress Reduction: Stress is physical, mental or emotional strain or tension. Low to moderate levels of stress can be healthy by increasing motivation and productivity. However, chronic high levels of stress can lead to heart disease and angina. A well-balanced life is important for heart health. If you experience stress that causes or worsens your symptoms of angina, talk about these symptoms with your healthcare professional.