Angina is type of chest pain that occurs when not enough oxygen reaches the heart muscle. It may feel like a heaviness or pressure in the chest that spreads to the throat, arms, (particularly the left arm), jaw, back, and between the shoulder blades. Angina can result from “coronary spasm,” a sudden narrowing or tightening of part of a coronary artery; abnormalities of the heart valves or heart rhythm; not enough red blood cells carrying oxygen to the heart (anemia); too many red blood cells, which can cause your blood to thicken; and certain thyroid conditions. But by far the most common cause of angina is coronary artery disease (CAD).

CAD is a type of heart disease that causes the walls of the coronary arteries-arteries that carry oxygen-rich blood to the heart itself-to become lined with fatty deposits called “plaque.” This gradual process is known as “atherosclerosis”. As the plaque builds up, the arteries become narrower and narrower, forcing the heart to pump harder to deliver blood to the heart muscle. At some point, a blood clot or the plaque may completely block the coronary artery. When this happens, you are at risk for a heart attack.

Angina is an important warning sign that you may be in danger of having a heart attack. It can occur in men and women of any age, but is more common among people who are middle-aged or older. It usually occurs during exercise, emotional upset or stress, exposure to cold air, or after eating a big meal. However, angina may also occur while you are relaxing or even asleep.

What causes an angina attack? Although angina may occur while you are resting or sleeping, it usually occurs when increased strain is put on the heart. This is referred to as “effort angina.” An attack may be brought on by climbing stairs, walking uphill, sexual intercourse, or other forms of exercise. Angina can also occur shortly after eating (particularly after a large meal), during emotional stress, or during exposure to cold weather.

The symptoms of angina Typically, an angina attack lasts less than 5 minutes. In addition to the chest pain described earlier, other symptoms include: stomach pain that may feel like an ulcer or indigestion; nausea and sweating; light-headedness, and difficulty breathing.

How is angina diagnosed? Your doctor will probably take your medical history and do a physical exam, paying special attention to your pulse, blood pressure, neck, heart, lungs, and abdomen. Blood and urine tests and an “electrocardiogram” or ECG, a test that records your heart rhythms, may be done. (This can show certain changes that occur when you have a coronary spasm.) You may be given a stress or treadmill ECG, which records the activity of your heart while you exercise on a stationary bike or treadmill. You may also receive a coronary “angiogram,” a special x-ray that can show blockages in your arteries and, possibly, areas of spasm. In addition, your doctor may have you ear a small, portable ECG recorder, called a Holter monitor, when you leave the office. This will record your heart rhythms for 24 to 72 hours.

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