Angina: Understanding Chest Pain and What It Means for Your Heart

If you are over 50 and have ever felt chest pressure, heaviness, or pain, you may have wondered, Is this my heart? One of the most common reasons people experience chest discomfort is a condition called angina.

I have seen thousands of patients come in worried about chest pain. Some turned out to have simple issues like acid reflux or muscle strain. Others had angina, which can be a warning sign of serious heart disease.

This article explains what angina is, why it happens, the different types of angina, what symptoms to look for, and how we diagnose and treat it. 

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What Is Angina?

Angina is the medical term for chest pain or discomfort caused by reduced blood flow to the heart muscle.

Your heart needs a steady supply of oxygen-rich blood to keep pumping. If the arteries that feed your heart (the coronary arteries) become narrowed or blocked, the heart muscle does not get enough oxygen. This is called ischemia, and angina is the symptom that results.

Angina is not a disease itself. Instead, it is a symptom of coronary artery disease, the same condition that can lead to heart attacks.

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What Does Angina Feel Like?

Patients often describe angina in many different ways. Some use the word “pain,” but others say it feels more like pressure, heaviness, squeezing, burning, or tightness.

Common features include:

• Chest discomfort that lasts a few minutes and goes away with rest
  
  
• Pain or pressure that may spread to the shoulders, arms, neck, jaw, or back
  
  
• Shortness of breath
  
  
• Sweating
  
  
• Nausea or lightheadedness
  
  

Not everyone has classic chest pain. Women, older adults, and people with diabetes sometimes experience shortness of breath, fatigue, or indigestion-like symptoms instead.

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Types of Angina

Doctors classify angina into different types. Understanding the differences is important because treatment and risk vary.

1. Stable Angina

This is the most common form. It usually happens with predictable triggers, such as:

• Walking uphill
  
  
• Climbing stairs
  
  
• Exercising
  
  
• Emotional stress
  
  
• Eating a heavy meal
  
  

Stable angina typically improves with rest or medication such as nitroglycerin.

2. Unstable Angina

This type is more serious. It may occur at rest, last longer, or come on without a clear trigger. Unstable angina is a warning sign that a heart attack could happen soon. It is a medical emergency that requires immediate care.

3. Variant Angina (Prinzmetal’s Angina)

This rare type is caused by a temporary spasm of the coronary artery rather than a plaque blockage. It often happens at rest and may come in cycles.

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Why Does Angina Happen?

The most common cause of angina is atherosclerosis, or hardening of the arteries. Over time, plaque builds up in the coronary arteries, making them narrower. When you exercise or get stressed, your heart needs more oxygen, but the narrowed arteries cannot supply enough. That mismatch causes angina.

Other causes include:

• Coronary artery spasm (temporary tightening of the artery)
  
  
• Severe anemia (low red blood cell count)
  
  
• Uncontrolled high blood pressure (making the heart work harder)
  
  
• Aortic valve disease (narrowing of the valve the heart pumps through)
  
  

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Risk Factors for Angina

If you are over 50, you are already at higher risk for angina, especially if you also have:

• High cholesterol
  
  
• High blood pressure
  
  
• Smoking history
  
  
• Diabetes
  
  
• Obesity
  
  
• Family history of heart disease
  
  
• Sedentary lifestyle
  
  

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How Angina Is Diagnosed

When a patient tells me about chest pain, the first step is to figure out whether it is heart-related. Several tests can help:

• Electrocardiogram (EKG): Records the electrical activity of the heart.
  
  
• Stress test: Checks how the heart responds to exercise. Sometimes combined with imaging.
  
  
• Echocardiogram: Uses ultrasound to look at heart structure and blood flow.
  
  
• Nuclear stress test: Involves a small amount of tracer to show blood flow in the heart.
  
  
• CT angiography: A CT scan that shows plaque buildup in arteries.
  
  
• Cardiac catheterization: A dye study where doctors directly see blockages in coronary arteries.
  
  

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Treatment for Angina

The goal of treatment is to relieve symptoms, improve quality of life, and prevent heart attacks. Treatment usually involves a combination of lifestyle changes, medications, and sometimes procedures.

Lifestyle Changes

• Quit smoking if you smoke.
  
  
• Eat a heart-healthy diet rich in fruits, vegetables, whole grains, fish, and lean meats.
  
  
• Exercise regularly with your doctor’s approval. Walking, biking, or swimming are good choices.
  
  
• Maintain a healthy weight.
  
  
• Control diabetes and blood pressure.
  
  

Medications

• Nitrates (like nitroglycerin): Relax and widen arteries, providing quick relief.
  
  
• Beta blockers: Reduce heart rate and lower oxygen demand.
  
  
• Calcium channel blockers: Help arteries relax and improve blood flow.
  
  
• Statins: Lower cholesterol and stabilize plaques.
  
  
• Aspirin or blood thinners: Reduce the risk of clots and heart attacks.
  
  

Procedures

If lifestyle and medication are not enough, doctors may recommend procedures:

• Angioplasty and stenting: Opens blocked arteries with a balloon and stent.
  
  
• Coronary artery bypass surgery: Creates a new pathway for blood to flow around blocked arteries.
  
  

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Living With Angina

Many patients live full and active lives with angina, especially when they follow treatment plans closely. Here are a few practical tips I share with my patients:

• Always carry nitroglycerin if prescribed, and know how to use it.
  
  
• Learn what triggers your angina and pace your activities accordingly.
  
  
• Do not ignore new or worsening symptoms. Report them to your doctor right away.
  
  
• Keep your follow-up appointments to monitor your heart health.
  
  

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When to Seek Emergency Help

Call 911 immediately if you experience:

• Chest pain that is new, severe, or lasts more than a few minutes
  
  
• Chest discomfort at rest or during minimal activity
  
  
• Chest pain that does not improve with nitroglycerin
  
  
• Pain spreading to the arm, neck, or jaw
  
  
• Shortness of breath, sweating, or nausea with chest discomfort
  
  

These could be signs of unstable angina or a heart attack.

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My Experience Treating Angina

I have treated angina in thousands of patients over the decades. Some were frightened the first time they felt chest pain, while others ignored symptoms until they could not anymore. The most successful outcomes always came when patients took symptoms seriously and worked closely with their care team.

I have seen patients who struggled with angina at first but made changes in their diet, started walking daily, took medications as prescribed, and avoided smoking. Many of them improved so much that they enjoyed active, fulfilling lives well into their 70s and 80s.

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Conclusion

Angina is chest discomfort caused by reduced blood flow to the heart. It is not always life-threatening on its own, but it is a warning sign of underlying heart disease that should never be ignored.

The good news is that with lifestyle changes, medications, and sometimes procedures, angina can be managed and even prevented from getting worse. If you are over 50 and have risk factors like high blood pressure, diabetes, or high cholesterol, talk with your doctor about your heart health. Your heart is the engine that keeps your body going. Understanding angina and taking steps to protect your arteries will help keep that engine running strong for years to come.

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