Types of Angina
Recognizing the pattern of angina matters, because the type determines how urgent it is:- Stable angina: Predictable discomfort brought on by exertion or stress and relieved within minutes by rest or nitroglycerin.
- Unstable angina: New chest pain, pain at rest, or a stable pattern that becomes more frequent or severe — a medical emergency.
- Variant (vasospastic) angina: Caused by spasm of a coronary artery, often occurring at rest or overnight.
Causes and Risk Factors
The underlying problem is almost always atherosclerosis — the gradual buildup of plaque in the arteries. Risk factors include:- High cholesterol: Elevated LDL cholesterol drives plaque formation; see hypercholesterolemia.
- High blood pressure: Damages artery walls and accelerates narrowing.
- Diabetes: High blood sugar injures blood vessels throughout the body; see diabetes mellitus.
- Smoking: One of the strongest and most reversible risk factors.
- Family history and age: Risk rises with age and with early heart disease in close relatives.
Symptoms
Angina is usually felt as pressure, squeezing, heaviness, or burning in the center of the chest. The discomfort may spread to the shoulders, arms, neck, jaw, or back, and may come with shortness of breath, sweating, nausea, or unusual fatigue. Women, older adults, and people with diabetes are more likely to have subtle symptoms — breathlessness or exhaustion rather than classic chest pain. Episodes of stable angina typically last only a few minutes and are more likely in cold air, after heavy meals, or during emotional stress.Diagnosis
Evaluation typically includes an electrocardiogram, blood tests, and stress testing, in which the heart is monitored during exercise or with medication that mimics exertion. Depending on the results, your physician may recommend a coronary CT angiogram or cardiac catheterization to map blockages directly. Keeping a simple diary of when episodes occur and what brings them on helps your physician judge whether the pattern is stable or changing.Treatment
Treatment aims to relieve symptoms and prevent a heart attack, and cardiac rehabilitation along with a heart-healthy diet rounds out the plan:- Nitrates: Long-acting isosorbide mononitrate or isosorbide dinitrate prevent episodes, while sublingual nitroglycerin relieves an attack in progress.
- Beta-blockers: Medications such as metoprolol slow the heart and reduce its oxygen demand.
- Calcium channel blockers: Medications such as amlodipine relax coronary arteries and lower blood pressure.
- Ranolazine: An option when angina persists despite standard therapy.
- Statins and aspirin: Medications such as atorvastatin stabilize plaque and lower cholesterol, while low-dose aspirin reduces clot risk.
- Procedures: Stenting or bypass surgery may be recommended when blockages are severe or symptoms persist.