Angina is a clinical symptom indicating that the heart is not receiving enough blood and oxygen. This condition, which mainly manifests as chest pain or discomfort, is often a warning sign of more serious heart diseases, such as myocardial infarction. Although many people confuse angina with a heart attack, it is actually a warning that something is wrong with the blood flow in the heart muscle.
What is angina?
Angina, also known as angina pectoris, is chest pain caused by a temporary decrease in blood flow to the heart. This reduced flow is usually due to narrowing or blockage in the coronary arteries, which supply blood to the heart muscle.
There are two main types of angina:
Stable angina: it is predictable, usually occurs during physical exertion or emotional stress, and improves with rest or medication such as nitrates.
Unstable angina: it is more unpredictable, may occur at rest, last longer, and does not improve with rest or medication. This type requires immediate medical attention, as it may precede a heart attack.
There are also less common forms, such as variant angina (or Prinzmetal’s angina), caused by spasms in the coronary arteries, and microvascular angina, related to dysfunctions in the small arteries of the heart.
What are the symptoms of angina?
The classic symptom of angina is pain or discomfort in the center of the chest, described as:
Tightness
Burning
Pressure
Heaviness
Additionally, the discomfort may radiate to other parts of the body, such as:
Arms (especially the left arm)
Neck
Jaw
Back
Shoulders
Other symptoms that may accompany the pain include:
Shortness of breath
Dizziness
Cold sweat
Nausea
Anxiety
It’s important to note that not everyone experiences the classic symptoms. Women, the elderly, and people with diabetes, for example, may feel only extreme fatigue or shortness of breath.
What causes angina?
The main cause of angina is coronary artery disease (CAD), caused by the buildup of fatty plaques (atherosclerosis) on the artery walls. These deposits reduce blood flow to the heart, especially during physical exertion or stress, when the heart needs more oxygen.
Other risk factors that increase the chances of developing angina include:
High blood pressure
Diabetes mellitus
High cholesterol
Smoking
Obesity
Physical inactivity
Family history of heart disease
Advanced age
Additionally, emotional factors such as intense stress and extreme cold can also trigger episodes of angina in predisposed individuals.
How is the diagnosis made?
The diagnosis of angina involves a combination of clinical evaluation and complementary tests. The cardiologist will consider the patient’s history, reported symptoms, and response to physical exertion.
The most common tests are:
Electrocardiogram (ECG): detects changes in the heart’s rhythm and electrical conduction.
Stress test (exercise test): evaluates the heart’s response during exercise.
Echocardiogram: shows the structure and function of the heart.
Myocardial scintigraphy: identifies areas of the heart with reduced blood flow.
Coronary angiography: an invasive exam that directly shows the coronary arteries, allowing visualization of obstructions.
Treatment of angina
The treatment of angina aims to relieve symptoms, prevent heart attacks, and improve quality of life. It may involve:
Lifestyle changes
Quit smoking
Control blood pressure, diabetes, and cholesterol
Practice regular physical activity (under medical supervision)
Adopt a healthy and balanced diet
Reduce stress
Medications
Nitrates: relieve pain by dilating blood vessels
Beta-blockers: reduce heart rate and workload on the heart
Calcium channel blockers: dilate the coronary arteries
Aspirin and anticoagulants: prevent clot formation
Statins: control cholesterol
Procedures
In more severe cases or when symptoms do not improve with medication, it may be necessary to perform:
Angioplasty with stent: unblocking the arteries by placing a small metal tube
Bypass surgery (revascularization): creates a new pathway for blood to flow around the blocked artery
Is angina the same as a heart attack?
No. Although they share similar symptoms, angina is a warning sign that the heart is suffering from lack of oxygen, but no heart muscle tissue death has occurred yet. A myocardial infarction occurs when there is a complete blockage of a coronary artery, leading to necrosis (death) of part of the heart muscle.
Therefore, episodes of angina — especially unstable angina — should be taken seriously and treated properly to prevent major complications.
Myths and truths about angina
“Angina is a disease.” False. Angina is a symptom, usually caused by an underlying heart disease.
“If the chest pain went away with rest, I don’t need to worry.” False. Even if the pain improves, it may indicate stable angina, which requires investigation and monitoring.
“Only elderly people get angina.” False. Although it is more common with aging, young adults with risk factors can also develop it.
