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What is angina?

The heart is the pump responsible for circulating blood throughout the body. Myocardium (myo=muscle + cardium=muscle) is the heart muscle that contracts to pump that blood and like any other muscle, it requires oxygen rich blood for energy. Angina pectoris describes the pain, discomfort, ache, or other associated symptoms that occur when blood flow to heart muscle cells is not enough to meet its energy needs.

The myocarium is supplied with blood by the coronary arteries. If these blood vessels narrow, there may not be enough blood delivered to the contracting heart muscle to meet its energy needs and angina may occur.

The classic description of angina is a crushing pain, heaviness or pressure that radiates across the chest, sometimes down the arm, into the neck, jaw or teeth, or into the back. It may be associated with shortness of breath, nausea, vomiting, sweating, and weakness.

Many patients do not use pain as a description for angina, instead describing the sensation as a fullness, tightness, burning, squeezing, or ache. The discomfort may be felt in the upper abdomen, between the shoulders, or in the back. The pain may be felt just in an arm, right, left or both, and may or may not be associated with other symptoms.

Angina is often brought on by exercise and other strenuous activities and gets better with rest. When the body requires the heart to pump more blood, the heart muscle is asked to do more work and that can cause it to outstrip its energy supply. When the body rests, angina should start to subside.

Angina tends to progress slowly over time and patients may not recognize that their symptoms are due to heart disease. It may be fatigue and exercise intolerance, the gradually inability to perform work or other activities that had once been easier to do. It may be shortness of breath with activity like walking up steps or uphill. It is worrisome when the pain comes on at rest or at sleep, since it means that little activity is causing enough stress to cause angina symptoms.

This is the same situation that occurs when muscles in the leg or arm fatigue because of overuse and they begin to ache. The difference is that one can stop lifting or running but the heart cannot stop beating to rest. The other difference is that the symptoms of angina are felt in different ways by different patients and may not be recognized as coming from the heart.

Unfortunately for some patients, they may have no symptoms at all, even with significant narrowing of their coronary arteries, and they may first present for care in the midst of a myocardial infarction or heart attack, when a coronary artery is completely blocked. This is especially true for women who may have atypical angina symptoms including fatigue, malaise, weakness, and dizziness.

Angina is a warning sign that the heart muscle is not getting adequate blood supply and oxygen. If unheeded it may lead to a heart attack or myocardial infarction (myo=muscle + cardium=heart + infarct=death).

The term mesenteric angina may also be used to describe abdominal pain due to decreased blood supply to the intestine from narrowing of the mesenteric arteries that supply the small and large bowel.

Unfortunately, there are a couple of eponyms that contain the term angina, that have nothing to do with pain from decreased blood flow. Ludwig's angina is a serious infection of the floor of the mouth. Vincent's angina is another term for trench mouth, where painful ulcerations affect the gums, mouth, and tongue.

Return to Angina

See what others are saying

Comment from: 45-54 Male (Patient) Published: April 15

During the past two weeks, I have had what I thought were mild heart attacks. They occurred while walking, but the feeling went away when I stopped. Then yesterday, I was just getting up and, wham � I thought I was dying. I got scared enough to go to the ER. My EKG came back normal (of course) and they diagnosed me with atypical chest pain. I disagree with the diagnosis, though. Something was going on in my body, for sure. The fact that it occurred while walking, and again when just getting up, along with the fact that it went away after lying down for a couple hours, makes me think it is angina. I will return to the ER if I get an attack like that again � I just can't believe it's just a strange pain in my chest, jaw, and arm, with my left hand going numb. Even after the pain was gone, I was weak, and short of breath still. I know the difference between a panic attack (it wasn't), indigestion, and something else. So I will have to return when it happens again.

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Comment from: Anan, 35-44 Male (Patient) Published: March 27

The pain is interval and only at times in the chest, along with a high heart rate.

Was this comment helpful?Yes

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