What is angina ?

Angina (Breathlessness) is common symptoms of Heart attack

Angina is a chest pain which cause by the reduced blood flow to the heart. It can be symptom of Coronary artery disease (CAD). Also it can feel like a heart attack with squeezing or feeling pressure in your chest. Sometimes it called as angina pectoris or Ischemic chest pain. 

Even though angina is a common condition, it can be challenging to differentiate it from other causes of chest pain, such as indigestion. Seek medical attention as soon as possible if you experience unexplained chest pain.

Angina Types

1. Stable angina:

This is the most common type of angina. It occurs when the heart is working harder than usual, such as during physical exertion or stress.

The pain is typically predictable and often described as a tightness, pressure, or squeezing sensation in the chest. It usually subsides with rest or medication.

Consistent angina pain is recognisable and typically resembles prior chest pain episodes. Usually, the chest pain subsides after five minutes or less.

2. Unstable angina:

Unlike stable angina, unstable angina doesn’t follow a predictable pattern. It can occur even at rest and is often more severe and prolonged than stable angina.

Usually severe, it lasts for at least 20 minutes, longer than stable angina. Neither relaxation nor the standard angina drugs relieve the discomfort. A heart attack happens when the heart is oxygen-starved and the blood flow doesn’t improve. Unstable angina is dangerous and needs to be treated immediately.

3. Variant (Prinzmetal’s) angina: 
This type of angina is caused by a temporary spasm in the coronary arteries, which supply blood to the heart muscle.
It can occur at rest and is not necessarily related to physical exertion or stress. Variant angina often occurs in the early hours of the morning and can be relieved by medication that relaxes the arteries.

4. Microvascular angina:
In this type of angina, the pain is caused by abnormalities in the tiny blood vessels (microvessels) that supply blood to the heart muscle.
It can be more difficult to diagnose because it doesn’t always show up on standard tests for heart disease, such as an angiogram.


1. Chest pain or discomfort, often described as pressure, squeezing, fullness, or tightness.

2. Pain may radiate to the neck, jaw, shoulders, arms, or back.

3. Shortness of breath.

4. Nausea.

5. Fatigue.

6. Sweating.

7. Dizziness or lightheadedness.

An burning sensation could be confused for gas or heartburn.

Pain behind your breasts is probably the most common, and it can radiate to your arms, neck, throat, jaw, shoulders, and back.

Resting typically helps with stable angina. Angina that is unstable might not, and it might worsen. There is an emergency and immediate medical attention is required.

Angina in women

In women, angina symptoms can sometimes differ from those in men. They may include:
1. Chest discomfort, pressure, or pain.
2. Pain in the neck, jaw, shoulder, upper back, or abdomen.
3. Shortness of breath.
4. Nausea, vomiting, or indigestion-like symptoms.
5. Unusual fatigue.
6. Sweating.
Women experiencing any of these symptoms, especially chest discomfort, should seek medical evaluation promptly, as angina can be a sign of underlying heart disease.

Angina Causes

Angina is primarily caused by reduced blood flow to the heart muscle. The most common cause of reduced blood flow is coronary artery disease (CAD). 

Which occurs when the arteries that supply blood to the heart become narrowed or blocked due to the buildup of plaque. This narrowing or blockage limits the amount of oxygen-rich blood that can reach the heart muscle, leading to symptoms of angina.

Other factors that can contribute to or exacerbate angina include:
1. Atherosclerosis: Hardening and narrowing of the arteries due to the accumulation of fatty deposits (plaque).
2. High blood pressure (hypertension).
3. High cholesterol levels.
4. Smoking tobacco.
5. Diabetes.
6. Obesity.
7. Lack of physical activity.
8. Stress or anxiety.
9. Cocaine use.
10. Certain medications that constrict blood vessels or increase heart rate.

Angina risk factors

2. High blood pressure (hypertension)
3. High cholesterol levels
4. Smoking tobacco
5. Diabetes
6. Obesity or being overweight
7. Lack of physical activity
8. Family history of heart disease
9. Age (risk increases with age)
10. Gender (men are more likely to develop angina than premenopausal women, but the risk equalizes after menopause)
11. Stress or anxiety
12. Unhealthy diet, particularly one high in saturated fats, cholesterol, and sodium.


1.ECG or EKG: This test records the electrical activity of your heart. Changes in the ECG pattern may indicate reduced blood flow to the heart muscle.
2. Stress Test: This test measures how your heart responds to exertion. It may involve walking on a treadmill while your heart activity is monitored, or using medication to simulate exercise if you’re unable to walk on a treadmill.
3. Echocardiogram: This test uses sound waves to create images of your heart. It can show areas of the heart that aren’t receiving enough blood flow.
4. Cardiac Catheterization (Angiography): This invasive procedure involves injecting dye into the coronary arteries and taking X-ray images to visualize blockages or narrowing in the arteries.

Angina Treatment

1. Lifestyle Modifications:
   – Adopting a heart-healthy diet low in saturated fats, cholesterol, and sodium.
   – Regular exercise to improve cardiovascular health and manage weight.
   – Smoking cessation.
   – Stress reduction techniques, such as relaxation therapy or meditation.

2. Medications:
   – Nitroglycerin: Helps relax and widen blood vessels, improving blood flow to the heart and relieving angina symptoms.
   – Beta-blockers: Reduce heart rate and workload on the heart, decreasing the frequency and severity of angina attacks.
   – Calcium channel blockers: Dilate coronary arteries, improving blood flow to the heart muscle and reducing angina symptoms.
   – Aspirin: Helps prevent blood clots that can lead to heart attack or stroke.
   – Statins: Lower cholesterol levels to reduce the risk of plaque buildup in the arteries.
   – ACE inhibitors: Help lower blood pressure and reduce strain on the heart.

3. Nitroglycerin Therapy:
   – Sublingual nitroglycerin tablets or sprays are used to provide rapid relief during angina attacks.
   – Long-acting nitroglycerin preparations may be prescribed to prevent angina episodes.

4. Percutaneous Coronary Intervention (PCI):

– Also known as angioplasty, PCI involves widening narrowed or blocked coronary arteries using a balloon catheter.

   – A stent may be inserted to help keep the artery open and improve blood flow to the heart.

5. Coronary Artery Bypass Grafting (CABG):
   – In cases of severe coronary artery disease, CABG surgery may be recommended to bypass blocked arteries and improve blood flow to the heart.

6. Cardiac Rehabilitation:
   – A structured program of exercise, education, and support to help individuals with heart disease improve their cardiovascular health and reduce the risk of future complications.

EECP Treatment:

EECP (Enhanced External Counterpulsation) is a non-invasive treatment option for angina.
A full course of EECP treatment typically involves multiple one-hour sessions, usually five days a week, for a total of 35 hours.
   – The entire course may last for several weeks, and the benefits may persist after completion of the sessions.

  Benefits of EECP:
   – Improved exercise tolerance.
   – Reduction in angina symptoms.
   – Increased blood flow to the heart muscle.
   – Potential improvement in quality of life.

 Candidates for EECP:

– EECP is often considered for individuals with chronic stable angina that persists despite optimal medical therapy.

   – It may also be an option for those who are not suitable candidates for invasive procedures like angioplasty or bypass surgery. Also to avoid angioplasty and bypass surgery.