What is angina?

Angina is the medical term for chest pain that occurs when blood flow to the heart is reduced. Rather than a condition or disease, angina is actually a symptom, usually of heart disease.

People describe angina in different ways. Some people compare it to a burning sensation, while others experience pressure, squeezing or tightness in the chest. Mild angina may also feel similar to an upset stomach. In some cases, the pain may spread to other parts of the body, such as the jaw, neck, shoulders, arms or back.

Healthcare providers categorize angina based on the cause and duration of discomfort, as well as how well rest and treatments relieve pain. There are five main types of angina:

1. Stable angina: Also called angina pectoris, stable angina is the most common type experienced by Americans. Pain associated with stable angina is predictable and occurs in response to certain triggers, such as physical activity or stress. With rest or medication, the pain usually resolves within a few minutes.

Coronary artery disease (CAD) is usually the cause of stable angina. CAD is a form of heart disease where waxy plaque builds up in the arteries, restricting blood flow to the heart. Other potential causes of stable angina include:

• Anemia
  
• Arrhythmia
• Heart failure
• Heart valve problems
• Hyperthyroidism

To ease stable angina when it arises, healthcare providers may prescribe nitroglycerin, a medication that relaxes the blood vessels to restore blood flow to the heart. A treatment plan may also include medications, therapies or surgical procedures to address the underlying cause of the chest pain.

2. Unstable angina: With unstable angina, chest pain doesn’t follow a set pattern and doesn’t go away with rest or other treatments. The pain from unstable angina is often more severe than the discomfort experienced with stable angina, and it can last longer.

Because unstable angina can progress to a heart attack, it’s a medical emergency. Coronary artery disease is usually the cause of unstable angina.

3. Microvascular angina: Microvascular angina, caused by problems with the small blood vessels surrounding the heart, can be stable or unstable. It’s often marked by more severe pain.

Coronary microvascular disease is usually the cause of microvascular angina. More common in women than in men, this form of heart disease happens when the small blood vessels around the heart become damaged, leading to painful spasms and decreased blood flow to the heart.

Treatments for microvascular angina are similar to those for stable angina. Healthcare providers may prescribe nitroglycerin for chest pain and recommend additional medications, therapies and surgeries to treat coronary microvascular disease.

4. Variant angina: Also called vasospastic angina or Prinzmetal angina, variant angina is less common than other types of angina. Pain associated with this type of angina often occurs in cycles, and many people experience symptoms between midnight and
midmorning.

Unlike other forms of angina, variant angina isn’t associated with heart disease. The pain happens due to spasms in the arteries that block blood flow to the heart. Causes of these spasms may include:

• Medications, such as ephedrine and sumatriptan
  
• Recreational drug use
• Smoking
• Exercise
• Stress
• Cold temperatures

Treatment for variant angina usually involves identifying triggers and then taking steps to avoid them. In addition, healthcare providers may prescribe nitrates, calcium channel blockers or the statin drug fluvastatin.

5. Refractory angina: With refractory angina, chest pain persists for long periods, often for several months. Typical treatments for angina don’t alleviate the discomfort. Coronary artery disease is usually the cause of the pain. Coronary angiography with stent placement or coronary artery bypass grafting may be advised if medical treatment is not successful in controlling symptoms that affect quality of life.

Angina, or chest pain, is a serious symptom that should be evaluated by a healthcare provider. If you’re experiencing new chest pain, seek emergency medical care immediately.

Updated August 2024.