Angina Pectoris — Chest Pain from the Heart
Angina pectoris is chest pain or discomfort caused by reduced blood flow to the heart muscle — a symptom of underlying coronary artery disease. It is not a heart attack, but it is a warning that the heart is not receiving enough oxygen and that the risk of a heart attack is elevated. Understanding the difference between stable and unstable angina, and when to seek emergency care, is critical.
What does angina feel like?
Angina is typically described as a tightness, pressure, heaviness, squeezing, or burning sensation in the chest — often spreading to the left arm, jaw, neck, or upper back. Unlike muscular chest pain, angina is usually triggered by exertion or emotional stress and relieved by rest or a nitrate spray within 5 to 10 minutes. It typically lasts 2 to 15 minutes.
Atypical presentations are common — particularly in women, diabetics, and elderly patients. Breathlessness, jaw ache, arm heaviness, or fatigue without classic chest pain may be the only manifestations.
Types of angina
| Stable angina | Predictable pattern — occurs at a reproducible level of exertion, relieved by rest within minutes. Suggests a fixed significant coronary artery narrowing. Managed with medications and, in many cases, elective angioplasty. |
| Unstable angina | New onset angina, or angina occurring at rest, on minimal exertion, or increasing in frequency and severity. A medical emergency — indicates plaque instability and high risk of imminent heart attack. Requires urgent hospital assessment. |
| Variant (Prinzmetal) angina | Angina from coronary artery spasm — typically occurring at rest, often in the early morning hours. ECG shows transient ST elevation during attacks. Treated with calcium channel blockers and nitrates. |
| Microvascular angina | Angina with normal or near-normal coronary arteries on angiogram — caused by dysfunction of small coronary vessels. More common in women. Responds to specific medications including ranolazine and ivabradine. |
When to seek urgent help
Sudden worsening breathlessness, inability to lie flat, coughing pink frothy sputum, or rapid weight gain of more than 2 kg in 48 hours are signs of acute decompensated heart failure requiring emergency assessment. Call +91-9000352998 immediately.
Diagnosis
- Resting ECG — May show evidence of prior heart attack changes, ST-segment depression during active angina, or may remain normal between episodes.
- Exercise stress test (TMT) — Reproduces symptoms and ECG changes during exertion, helping confirm myocardial ischaemia.
- Stress echocardiogram — Detects stress-induced wall motion abnormalities that indicate reduced blood flow to the heart muscle.
- CT coronary angiogram — A non-invasive imaging test that maps coronary artery anatomy and identifies plaque or narrowing.
- Coronary angiogram with FFR — Considered the gold standard investigation, identifying coronary blockages and confirming whether they are haemodynamically significant.