Chest pain (angina)

Angina (also known as angina pectoris) is a type of chest pain that occurs when the heart muscle doesn’t get enough oxygen-rich blood. While it’s not the only type of chest pain, it’s among the most common. Angina is generally a symptom of a more serious underlying condition, such as coronary artery disease, coronary artery spasm, or coronary microvascular disease.

There are many different types of angina, ranging from mild to severe. Approximately 11 million people in the United States experience angina. If you or your loved one experiences sudden severe chest pain, seek medical help immediately.

There are four main types of angina. Each type has a different primary cause and varying symptoms.

• Stable angina: Chest pain due to coronary heart disease. Stable angina is triggered and worsened by strenuous physical activity and is often relieved through medication or long periods of rest.
• Unstable angina: When the coronary arteries are blocked because of fatty buildup, causing reduced blood flow to the heart muscles. Unlike stable angina, which is made worse by physical exertion, chest pain from unstable angina can come on unexpectedly and occurs when resting.
• Microvascular angina: This type of angina is the result of coronary microvascular disease (CMD), which affects the heart’s smallest blood vessels in the coronary artery.
• Variant angina: One of the rarer forms of chest pain, this very painful type of angina is caused by a spasm in your coronary arteries.

While the symptoms of angina may vary according to the type of angina you’re experiencing, some of the most common include:

• Painful pressure beneath the breastbone
• Faint, fatigued, or tired feeling
• Shortness of breath
• Pain that spreads to other parts of the body (back, arms, neck, ears, etc.)

While angina itself is generally not life-threatening, progressive and persistent chest pain can indicate the onset of a heart attack or other serious cardiac event. Angina can also be caused or worsened by physical activity, so it’s important to rest and try and catch your breath when you start to experience symptoms.

Angina can emerge from a variety of different causes.

• Coronary artery disease: Chest pain can occur when an excess of plaque builds up in the coronary arteries and causes them to narrow. This plaque blocks blood flow to the heart and creates pressure and discomfort.
• Coronary microvascular disease: This disease impacts the inner lining of tiny blood vessels in the heart, causing intermittent spasms and blockage.
• Pulmonary embolism (blockage of arteries in the lungs): Chest pain is one of the most common symptoms of pulmonary embolism. An acute blockage restricts blood flow to the heart, causing immediate and severe pain under the breastbone or on one side of the chest. This can be either sharp or dull and cause a burning sensation.
• Aortic dissection: Caused by a tear in your aorta, it’s a life-threatening condition that causes blood to flow between the layers of the aortic wall, potentially leading to rupture or reduced blood flow to vital organs.
• Aortic stenosis: Aortic stenosis is a narrowing of your heart’s aortic valve. It can restrict blood flow through the valve from the left ventricle to the aorta.
• Cardiomyopathy: A disease of the heart muscle, it can cause it to enlarge, thicken, or become stiff. This impacts its ability to pump blood to the rest of the body.
• Pericarditis: Inflammation or swelling of the pericardium (the thin membrane surrounding the heart). It can cause chest pain, but symptoms often go away without the need for treatment.
• Panic attacks: Often caused by acute or long-term stress and anxiety, panic attacks are often the result of an underlying mental health issue.

While you may not be able to prevent angina entirely, you can reduce your risk by making lifestyle changes and managing underlying conditions.

• Adopt a heart-healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit saturated fats, trans fats, and cholesterol.
• Stay physically active: Regular exercise can help improve heart health and reduce the risk of heart disease.
• Maintain a healthy weight: Achieving and maintaining a healthy weight can lower your risk of heart problems.
• Quit smoking: If you smoke, quitting can significantly improve your heart health and reduce angina risk. Ask your doctor about Penn Medicine’s smoking cessation program if you need help.
• Manage stress: Practice stress-reduction techniques such as mindfulness, yoga, or meditation.
• Control blood pressure and cholesterol: Regular check-ups and following your doctor’s advice on medications and lifestyle changes can help manage these conditions.
• Manage diabetes: Keep your blood sugar levels under control if you have diabetes.
• Limit alcohol intake: Drink alcohol in moderation, if at all.

By making these changes, you can lower your risk of angina and improve your overall heart health. Always consult with your provider for advice and recommendations.