(Also called: Chest pain, heart pain, angina pectoris, stable angina, unstable angina, acute coronary syndrome)

Man grabbing chestAngina is a symptom of heart disease that indicates the heart muscle is not receiving as much oxygen as it needs. People describe angina as a chest tightness or pressure that often spreads to the arms, back, neck, or jaw, or a feeling something like indigestion. In some cases, it is accompanied with shortness of breath (more common with people who have diabetes). There are different types of angina. Treatment usually includes medications and healthy lifestyle change.

If you are experiencing chest pain or angina for the first time, seek immediate medical attention.

What is Angina

Angina is a type of chest pain or discomfort that occurs whenever your heart is not receiving all the oxygen that it needs to do its job. Angina is often described as pain or pressure in the middle of the chest that may spread to the arms, neck, or jaw. Sometimes there may also be shortness of breath, sweating, or nausea.

There are different types of angina; the most common types are stable angina and unstable angina.

Stable Angina

This is the most common form of angina and occurs when your heart has to work harder than usual. It is usually triggered by physical exertion, such as walking or climbing stairs. It can also be triggered when you feel worried or upset. It will usually go away within a few minutes if you rest or take your angina medication called nitroglycerin. Stable angina usually does not result in any damage to the heart.

Unstable Angina

This type of angina comes on suddenly with or without physical exertion. It happens more frequently and lasts longer than usual. Rest and medication may not relieve the pain.

Unstable angina usually occurs because plaque buildup in one of the coronary arteries has cracked open. When this happens, the blood forms a clot over the cracked plaque partially blocking the artery and reducing blood flow to part of your heart.

Unstable angina is an urgent medical condition which places you at high risk for heart attack.

If you are experiencing new or more frequent angina, seek immediate medical attention.


Illustration showing difference between healthy artery and a coronary artery with plaque buildup

Angina is usually caused by coronary artery disease. Other heart conditions such as atrial fibrillation, cardiomyopathy, heart failure, heart valve disease and pulmonary hypertension can also cause angina.
Drugs such as cocaine can cause the arteries in the heart to go into spasm and become constricted. This reduces blood flow to the heart causing angina.

People describe angina pain as a dull, squeezing pressure or tightness. It can start in the middle of the chest and may spread to the arms, neck, back, or jaw. Along with angina, people may also experience breathlessness, sweating, and dizziness.

Women may experience angina differently. For example, women may feel symptoms such as severe fatigue or trouble falling asleep or waking up frequently at night because of a nagging ache or pain in their chest. Women also commonly describe angina as feeling more like indigestion with pain or burning in the upper abdomen or chest. Additionally, women often report feeling nervous or apprehensive for no apparent reason.


Your doctor will likely ask you to describe your symptoms, take a complete health history and do a physical examination including some blood tests. If angina is suspected, you will likely have one or more of the following tests:

  • Electrocardiogram (ECG): to identify problems with heart rhythm or signs of a heart attack
  • Treadmill testing: to measure how well your heart functions when challenged to work harder than normal (during exercise). This is also called a stress test.
  • Nuclear perfusion imaging: to identify areas of your heart which are receiving less blood.
  • Echocardiogram: to determine the volume of blood pumped by your heart. This test may be done during exercise or after the administration of medication to stimulate your heart.
  • CT coronary angiography: to identify blockages in the arteries in your heart.
  • Cardiac catheterization: to identify blocked or restricted arteries. 

The main goal of treatment for angina is to ease the pain quickly and, ideally, prevent it from happening again.

Nitroglycerin spray is a fast-acting treatment for angina. It works to open the arteries and lowers the workload of your heart so that the flow of blood and oxygen to your heart is improved. Speak to your doctor or nurse about nitroglycerin spray. They can help you to decide if it is right for you and teach you how to use it effectively.

If you are having angina, please do the following:

At the first sign of discomfort → Stop immediately and rest

If no relief with rest → Take 1st Nitroglycerin spray

If no relief within five minutes → Take 2nd nitroglycerin spray

If no relief within five minutes → Call 911 and take 3rd nitroglycerin spray

It is important to let your cardiologist and family doctor know if you experience any changes in your symptoms.

Ongoing treatment for angina usually includes lifestyle changes and medications, sometimes in combination with cardiac procedures or surgery. The best treatment combination will be based on your individual circumstances.


There are many medications that can help to control angina. Your doctor will likely prescribe a combination of medications that will work to:

  • Lower the workload of your heart
  • Help relax the blood vessels
  • Lower cholesterol
  • Help prevent blood clots from forming

You will be taking these medications for the rest of your life.  

Cardiac Procedures

Sometimes a cardiac catheterization is needed to show the blockages . The information is used to determine whether medications are sufficient for treatment or whether you need an angioplasty (also known as percutaneous coronary intervention (PCI). With an angioplasty, a small balloon is inserted into the blocked vessel to open it up, and a stent is inserted there to keep it open. A stent is a wire mesh tube that keeps the artery open. Sometimes coronary artery bypass surgery is necessary to attach new arteries or veins to literally “bypass” or go around the blockages.

Lifestyle Changes

To manage angina and coronary heart disease, it is important to:

  • Quit smoking because cigarette smoking narrows the blood vessels. Smoking cessation aids are available to patients who find it difficult to quit on their own.
  • Get your cholesterol checked and get high cholesterol under control. This can reduce or prevent further plaque buildup in your vessels.
  • Eat a healthy diet low in saturated fat, cholesterol, and salt.
  • Exercise regularly.
  • Maintain a healthy weight. Losing weight if you are overweight reduces the burden excess weight places on the heart. Regular exercise helps control weight and reduce other risk factors for coronary artery disease, such as high blood pressure.
  • If you have diabetes, it is important to ensure that you keep your blood sugar levels under healthy control
  • If you have high blood pressure, make sure your blood pressure is checked regularly and maintained at normal levels

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