What is angina?
Angina (also termed angina pectoris) is a condition characterized by chest pain, sometimes severe, that is caused by an inadequate blood supply to the heart. The pain may wax and wane. It may also spread to the shoulders, arms, and/or neck. Although this is the classic definition of angina, there are important variations in symptoms and types (stable, unstable, variant, and microvascular). When diagnosing angina, the type of angina is determined. Typing is designated according to the symptoms. In addition, angina of any type may be considered to be a symptom of coronary artery disease (CAD).
The diagnosis of angina begins with a history, including a family health history, risk factors, and a physical exam. If your doctor thinks you have evidence of angina, tests are likely to be scheduled. Although there are several types of angina (unstable, stable, variant [Prinzmetal], and microvascular), it is most important to determine if you have unstable angina because it is the one type that is most likely to require emergency medical treatment. Consequently, the symptoms of unstable angina are important to know because they distinguish unstable angina from the other types that can be diagnosed under non-emergent conditions. The American Heart Association considers the following chest pain or chest discomfort symptoms to provide presumptive diagnosis of unstable angina:
- Often occurs while you may be resting, sleeping, or with little physical exertion
- Comes as a surprise
- May last longer (more than 5 minutes) than stable angina
- Rest or medicine usually do not help relieve it
- May get worse over time
- Can lead to a heart attack
If a presumptive diagnosis of unstable angina is made, several tests may be done sequentially to either confirm the diagnosis or actually treat the cause (coronary artery disease). The first tests are usually an EKG, chest X-ray, and blood tests to determine if any heart damage has occurred or is ongoing or if other problems are responsible for the chest pain. If there is evidence of CAD by these tests, percutaneous coronary intervention (PCI) may be done to show partial or complete vessel blockage. PCI may also result in a balloon opening of the artery and possible stent placement to relieve the blockage and the symptoms. If PCI is not available, drugs may be given by IV lines to treat the patient.
Diagnosis of other kinds of angina
Symptoms for the other types of angina are not listed here because the emphasis of angina diagnosis should be on identifying (and treating) unstable angina. However, like unstable angina, the symptoms help only to presumptively identify the angina type.
Like the tests for unstable angina, EKGs, blood tests, and occasionally PCI may be used to diagnose the other types of angina. If unstable angina is not the diagnosis, usually the next test done is exercise stress testing (walking on a treadmill while monitoring heart activity). This test is usually done as an outpatient (in a clinic and not an emergency room). Outpatient tests may include CT angiography, an MRI scan, or other tests to rule out or identify other conditions your symptoms may mimic.
However, if you or someone you know develops symptoms of unstable angina, you should call 9-1-1.
Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease
"Angina: Chest Pain." American Heart Association. 15 Apr 2013.
"Angina Pectoris: Stable Angina." American Heart Association. 19 Mar 2013.
"Microvascular Angina." American Heart Association. 19 Mar 2013.
"Prinzmetal's Angina, Variant Angina and Angina Inversa." American Heart Association. 19 Mar 2013.