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Angina pectoris - Chest pain

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Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen. Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. Angina pain can be similar to the pain of a heart attack. It's the middle of the night or maybe the beginning of a busy workday when you suddenly feel pain in your chest. You may try to ignore it at first, but the pain has you scared and worried. Could you be having a heart attack? Should you go to the emergency room? Chest pain is one of the most common reasons people call for emergency medical help.

Fortunately, chest pain doesn't always signal a heart attack. Often it's unrelated to any heart problem. But even if the chest pain you experience has nothing to do with your cardiovascular system, the problem may still be important - and worth the time spent in an emergency room to have it evaluated.


In most cases, the cause of angina is coronary atherosclerosis (thickening of the arteries supplying blood to the heart). These arteries supply the cardiac muscle with blood and therefore oxygen and nutrients. Narrow coronary arteries reduce the blood flow to the heart muscle. This is usually noticed at times when the heart muscle needs more blood supply, such as during exercise.

The heart, when it increases its workload, will receive too little oxygen which causes pain in the heart. In severe cases this can also happen when the heart is at rest.

Other causes

Angina can be aggravated by other illnesses including:

  • a sustained fast heartbeat.
  • anaemia (thin blood).
  • heart valve diseases, such as severe aortic stenosis - a narrowing of the outflow valve of the heart.
  • thickening of the heart muscle - hypertrophy - which can occur in patients with high blood pressure over several years.
  • more rarely, a severe spasm of a coronary artery can occur even when the patient has relatively minor coronary atherosclerosis.

Risk factors

Atherosclerosis affects many people in developed countries. It may start as early as your 20s and increases with age.

Numerous 'risk factors' are known to be associated with the development of atherosclerosis.

  • A family history of atherosclerosis.
  • Hypercholesterolaemia - a high content of (LDL) cholesterol in the blood.
  • Hypertension (high blood pressure).
  • Smoking.
  • Being male.
  • Diabetes Type 1 and Type 2.
  • Obesity.
  • Stress.
  • Lack of regular exercise.


All symptoms typically occur in connection with physical exertion or psychological stress. They are often worse in cold or windy weather, and sometimes after big meals.

  • A squeezing or heavy pressing sensation on the chest.
  • A sense of heaviness or numbness in the arm, shoulder, elbow or hand (usually on the left side).
  • A constricting sensation in the throat.
  • The discomfort can radiate into both arms, jaw, teeth, ears, stomach or between the shoulder blades.
  • Increased shortness of breath on exercise.
  • More severe unstable angina can be associated with the same symptoms at rest.


  • Do something to eliminate the risk factors mentioned.
  • Eat a varied and healthy diet; leafy vegetables, unprocessed cereals, low-fat, high-fibre products. Avoid saturated fats.
  • Stop smoking. Your doctor or pharmacist will be able to provide advice about stop smoking programmes and smoking cessation products.
  • Lose weight, if you are overweight.
  • Exercise more (a half-hour walk each day is much better than nothing at all).
  • If you suffer from diabetes Type 1 or Type 2, or high blood pressure maintain treatment for these conditions.
  • Follow your GP's advice.


The diagnosis is often based on the presence of typical symptoms, medical history and the immediate effect of glyceryl trinitrate spray or tablets under the tongue to relieve chest pains.

When available, a resting ECG performed during an episode of pain is also helpful.

In addition, your doctor can give you an exercise test on a treadmill or exercise bike (a stress test) to determine if the heart muscle is the source of the pain. This test is usually done by a specialist in a hospital.

In many cases, an examination of the coronary arteries (a coronary angiogram) will be required. This consists of an injection of a contrast medium (dye) into the circulation through plastic tubes introduced into the main artery in the groin. The coronary arteries will then show up on X-ray pictures. This examination will be done in hospital as a day-case procedure.

What can the doctor do?

  • First and foremost, he or she can help identify and reduce the patient's risk factors, particularly in the treatment of high cholesterol and blood pressure that are not responding to lifestyle changes.
  • Prescribe medicines for relief of angina.
  • Refer the patient for further examinations by a cardiologist.
  • If required, the cardiologist may arrange for an interventional procedure to dilate (open up) a narrowed coronary artery (angioplasty), or a bypass operation, where an internal artery and superficial vein from the leg are joined to the coronary artery to bypass the obstruction to blood flow.


Coronary artery atherosclerosis, can sometimes lead to a coronary thrombosis when a coronary narrowing (plaque) ruptures. This may lead to an acute coronary syndrome such as unstable angina (severe angina at rest) or myocardial infarction (blockage of the coronary artery leading to heart muscle damage).

But the number of future attacks and hospitalizations can be reduced if the blood supplied to the heart can be restored to an adequate level. This can be done either by balloon dilatation (angioplasty) or in certain cases by a bypass operation.



Aspirin (in low dose): reduces the tendency of small blood cells called platelets to stick together, which helps prevent the formation of a thrombosis.


    • Glyceryl trinitrate (GTN tablets or spray) relax the arteries of the heart and relieve angina attacks.
    • Long-acting nitrates reduce the frequency of angina attacks.
    • Beta-blockers block the effect of the hormone adrenaline so that the pulse is slowed and the blood pressure lowered. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle. They are also important in protecting the heart after heart attacks.
    • Calcium-channel blockers reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure.
    • Potassium-channel activators reduce the muscular tension in the blood vessel walls, expanding them and improving the flow of blood and the supply of oxygen.
    • Several medicines may be needed to control symptoms and improve the condition without side effects from the treatment itself. In this way, the medicine is tailored to each patient's individual needs.


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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 05/14/08 07:37 AM