What is Angina, stable?

Angina, stable

What is angina?

Angina is the name that doctors use for the discomfort or pain you feel, usually in your chest, when your heart isn't getting enough oxygen. Typically, you get angina when you are active and it goes away when you rest.

If you get angina, taking medication and changing your lifestyle can help you have fewer and milder attacks. But getting angina is also a warning that you could have a heart attack. So your doctor will also talk with you about treatments to lower your chances of having a heart attack.

There are different types of angina. We've looked at treatments for the most common type, called stable angina. To read about the other types, see Other types of angina.

Key points for people with angina

Angina is usually caused by a condition called coronary artery disease.
People often describe angina as a discomfort, an ache, or a burning or heavy sensation, rather than a pain.
People usually get angina in their chest, but you can also get it in your back, arm, jaw or throat.
It's usually brought on by doing something active or by stress.
You should see your doctor to check out all chest discomfort or pain, even if it goes away.
If you do have angina, your doctor can start you on treatment to stop the angina attacks and help you have fewer of them. He or she will probably also suggest medication to lower your risk of a heart attack.
A few changes to your lifestyle also will lower this risk. If you smoke, now is the time to stop.
Learn to recognize what brings on your angina and what makes it go away. If it lasts for longer than usual or the pattern changes, go to the hospital right away. You could be having a heart attack.

How much do you know about angina? Take our quiz to find out.

Your heart and how it works

To understand what happens when you have angina, it helps to know something about your heart and how it works.

Source:
Martini FH.
The heart.
In: Ober WC, Garrison CW, Welch K, et al. Fundamentals of anatomy and physiology 5th edition. Prentice Hall, Upper Saddle River, U.S.A.; 2001.

Your heart is in the middle of your chest. It is a muscle shaped like a fist. It works automatically, so you don't have to think about making it beat.

Your heart works like a pump. Every time it beats, it pushes blood around your body. Blood carries oxygen and food (nutrients) to your cells. The cells in your body will die if they don't get a constant supply of both.

To learn more, see How your heart moves blood around your body.

Your heart works harder, and for longer, than any other organ in your body. If your heart stops working, every other part of your body will die within minutes.

The parts of your heart

Your heart has thick muscular walls. It's divided into two sides, right and left. Each side has an upper part and a lower part. Doctors call these chambers.

The two chambers on the right side of your heart pump blood to your lungs, where the blood picks up oxygen. Blood then returns to the two chambers on the left side. They pump the blood to the rest of your body, taking oxygen and food to your cells.

Your heart works like a pump.

The two upper chambers of your heart are called the right atrium and the left atrium. The two lower chambers are larger. They are called the right ventricle and the left ventricle.

For more, see What happens when your heart beats.

How your heart gets its own supply of blood

To do its job, your heart needs its own supply of blood. The blood carries oxygen to your heart's cells, so that it can do its work.

Coronary arteries bring your heart the blood it needs.

Your heart gets its blood from your coronary arteries. They supply the heart's muscular wall with blood that is rich in oxygen.

Your left coronary artery has two main branches.

One is called the left anterior descending artery (or LAD for short). It supplies most of the blood to your left ventricle, the part of your heart that pumps blood out to your body. This job makes this artery very important to your health.
The other one is called the left circumflex artery.

Your right coronary artery is smaller. Its branches carry blood to the back of your heart. These arteries split into a network of smaller vessels that take blood deeper into your heart muscle.

For more, see How blood moves through your heart.

What happens if you have angina

People usually get angina because of a condition called coronary artery disease. This is when clumps of fat (called plaques) build up on the smooth lining of a coronary artery. Over time, they make the artery narrower, stiffer and rougher.

This is called

atherosclerosis
Atherosclerosis is also called "hardening of the arteries." It happens when fatty material attaches to the inner wall of the arteries. Over time, cholesterol, fats and other blood components stick to the same area and the artery wall becomes thick and narrow, making it progressively more difficult for blood to flow through the affected vessels.

atherosclerosis. It's very common. It can happen in arteries anywhere in your body. If you have atherosclerosis in your coronary arteries, you have coronary artery disease. You might hear doctors call this ischemic heart disease, coronary heart disease or coronary vascular disease.

Any of your coronary arteries can be affected in angina. And you can have narrowing in just one artery or in all of them.

If your coronary arteries are narrow, it means that not enough blood gets through to your heart when it has to work harder. And not enough blood means not enough oxygen. This is what causes the symptoms of angina.

Lots of things can make your heart work harder and bring on angina. For example, the discomfort or pain can start when you walk up a hill, go up stairs or do gardening. Eating a heavy meal or going out in cold weather can bring it on, too. It's also likely to start when you get angry, upset or excited. People usually feel the angina in their chest, but you can also feel it in your back, shoulder, throat, arm or jaw.

Source:
Gibbons RJ, Abrams J, Chatterjee K, et al.
ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.
November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

When you are at rest, or calmer, your heart doesn't have to work so hard. So it has enough oxygen for it needs, and you don't feel the discomfort.

In many ways, angina is like the muscle cramp in your arm or leg that you can get after exercise. It means the working muscle isn't getting as much blood as it needs. That's why angina warns you to stop and rest for a few minutes or calm down a bit.

We have looked at angina caused by coronary artery disease. Some people have angina that is caused by another condition that stops their heart from getting enough oxygen. For more, see Other causes of angina. If your angina is caused by something else, talk to your doctor about how it should be treated.

There are different types of angina, too.

Source:
National Heart, Lung and Blood Institute.
What is angina?
November 2007. Available at http://www.nhlbi.nih.gov/health/dci (accessed on 8 October 2008).

³ On these pages, we look at the most common type. Doctors call this stable angina. For more on the others, see Other types of angina.

Stable angina has a regular pattern to it. Typically, you get it when your heart is working harder than usual, and it goes away after you rest for a few minutes or take your angina medication. After several bouts, you learn to recognize the pattern and know when it will happen. Doctors say you have stable angina when you've had such symptoms for more than two months.

Why me?

We don't know exactly why fatty clumps (plaques) build up in some people's arteries and cause angina. But we do know that some things make you more likely to get coronary artery disease and angina. Doctors call these things risk factors. Having a risk factor doesn't mean you'll get angina for sure. It just means you are more likely to get it than someone who doesn't have that risk factor.

The risk factors for angina are the same as the risk factors for heart disease. We've listed the main ones below.

Source:
Dawber TR.
The Framlingham study: the epidemiology of atherosclerotic disease.
Harvard University Press, Cambridge, U.S.A.; 1980.

⁴

Source:
Scottish Intercollegiate Guidelines Network.
Management of stable angina.
Scottish Intercollegiate Guidelines Network clinical guideline 51. 2001.

⁵

Being male
Being middle-aged or older
Having heart attacks run in your family
Smoking
Having

high cholesterol
If you've been told that you have high cholesterol it usually means that your total cholesterol level is 240mg/dL or higher. But doctors also look at the amount of good (HDL) and bad (LDL) cholesterol you have in your blood. Having high levels of bad cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.

high cholesterol
Having

high blood pressure
Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."

high blood pressure
Being overweight or

obesity
If your body stores more energy than you need for daily functioning, this can make you overweight. The excess energy is stored in your fat cells. If your weight goes above a certain level, doctors call this obesity. Obesity is considered a medical condition. The excess weight can be a strain on your bones and joints. And if you are obese, you're more likely to get other diseases. Doctors have developed a scale for telling how much excess weight you have. This measure, called the body mass index (BMI), depends on your height.

obese
Not getting enough exercise
Having

diabetes
Diabetes is a condition that causes too much sugar to circulate in your blood. It happens when your body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes).

diabetes

The more risk factors you have, the more likely you are to get angina. But you and your doctor can work to make some of these risk factors less dangerous. This can reduce the chances that your angina will get worse and that you will have a heart attack.

You can't do anything about some risk factors, like conditions that run in your family or getting older. But you can do something about others, like smoking. If you smoke, now is the time to stop. And eating better and exercising will both help.

Being under stress may affect some risk factors. For example, if you're stressed, you might eat or smoke more than usual. We don't know if stress by itself makes you more likely to get angina.

Source:
Martini FH.
The heart.
In: Ober WC, Garrison CW, Welch K, et al. Fundamentals of anatomy and physiology 5th edition. Prentice Hall, Upper Saddle River, U.S.A.; 2001.

For more on steps you can take to stay as healthy as possible, see What you can do to help yourself.

You can also get good treatments for some of the things that put you at risk for getting angina. For more, see our articles on these topics.

Sources for the information on this page:

Martini FH.The heart.In: Ober WC, Garrison CW, Welch K, et al. Fundamentals of anatomy and physiology 5th edition. Prentice Hall, Upper Saddle River, U.S.A.; 2001.

Gibbons RJ, Abrams J, Chatterjee K, et al.ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

National Heart, Lung and Blood Institute.What is angina?November 2007. Available at http://www.nhlbi.nih.gov/health/dci (accessed on 8 October 2008).

Dawber TR.The Framlingham study: the epidemiology of atherosclerotic disease.Harvard University Press, Cambridge, U.S.A.; 1980.

Scottish Intercollegiate Guidelines Network.Management of stable angina.Scottish Intercollegiate Guidelines Network clinical guideline 51. 2001.

This information was last updated on Apr 14, 2009

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