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Angina (chest pain)

Angina is chest pain caused by the blood flow to the heart muscles being restricted.

Angina is often caused by arteries becoming hardened and narrowed over time.

Angina chest pain is described as feeling like a dull, heavy or tight pain. The chest pain may spread to the left arm, neck, jaw or back.

The pain is sometimes called an angina attack, and may be set off by exertion or stress.

What are the types of angina?

The types of angina are:

  • Stable angina. The pain is predictable and present only during exertion or extreme emotional distress, disappearing with rest.
  • Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, last longer, or come on with minimal activity. Although this type of angina can often be relieved with medication, it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.
  • Prinzmetal's angina. This is when angina occurs at rest, when sleeping, or when exposed to cold temperatures. In these cases, the symptoms are caused by decreased blood flow to the heart's muscle from a spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease. These spasms occur close to the blockage.

Can angina occur without coronary disease?

Angina can occur in the absence of any coronary disease. Up to 30% of people with angina have a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart. People with severe anaemia may have angina because their blood doesn't carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don't get enough.

How is angina evaluated?

To evaluate your angina, your doctor will first ask you a series of questions to determine what your symptoms are and what causes them. After examining you, your doctor will arrange one or more of a series of tests to determine the underlying cause of the angina and the extent of coronary artery disease, if present. These tests include:

  • Exercise stress test
  • Electrocardiogram (ECG)
  • Stress imaging tests, such as nuclear tests or stress echocardiography. These are specialised imaging tests that can accurately localise the part of the heart that has decreased blood flow.
  • Echocardiogram
  • Cardiac catheterisation
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