What is Angina pectoris, its causes, types and treatment

Angina pectoris is pain or discomfort in the chest that occurs when the heart does not receive enough blood supply due to a partial blockage of the coronary arteries. If the obstruction lasts only a few minutes and the patient recovers, it is called angina pectoris.

This pathology can originate when the heart is forced to make a more significant effort, and the body cannot increase the blood supply to the said organ.

Angina pectoris is very common; in men, it usually occurs after 30 years of age, and in women later.


The cause, in most cases, is atherosclerosis. Angina pectoris is usually preceded by physical or emotional arousal; it can occasionally be triggered by eating a large meal or driving a car during rush hour.

Another cause may be exercising in a cold environment, in which case some patients experience almost immediate relief when moving from a cold room to a warm room.

When the heart’s (coronary) arteries are affected and can’t adjust to the increased demand for blood, the heart’s nerves send painful, urgent warning messages to the brain. This pain, which usually does not exceed 20 minutes, is due to the brain due to confusion, feeling the impulses from nearby locations, such as the arms, neck or jaw.

On the other hand, there are a series of modifiable risk factors that can favour the formation of atherosclerosis plaques:

  • Smoking.
  • Obesity.
  • Diabetes.
  • Hypertension.
  • Increased cholesterol.


The main manifestations of angina pectoris are:

Chest pain and a sensation of intense and suffocating pressure: Usually behind the sternum and sometimes extended to the left arm and sometimes to the right. Chest pain usually lasts between 1-2 minutes and 10-15 minutes (sometimes, there is a feeling of heaviness or tightness in the chest that does not become a pain). 

  • Feeling of anxiety or imminent death.
  •  Profuse sweating ( hyperhidrosis ).
  •  Pallor.


Angina pectoris is triggered by a coronary obstruction, which in many cases is due to a genetic predisposition that the patient cannot influence.

However, certain risk factors influence the onset of the disease. For example, if the patient intervenes, the condition could progress more slowly and reduce the symptoms.

The changes that the patient must carry out are:

  • Quit smoking.
  • Perform moderate physical activities constantly.
  • Maintain good figures for blood pressure, cholesterol and glucose.
  • Avoid obesity.


Different classifications have been proposed depending on the circumstances in which anginal pain appears (such as those that generally indicate the mechanism that causes it). The three types of angina:

exertional angina

It is caused by physical activity or other situations involving an increased need for oxygen in the heart. It is usually brief and disappears when exercise is stopped or with the administration of nitroglycerin. In turn, it is classified as initial if its seniority is less than one month; progressive if it has worsened during the last month in terms of frequency, intensity, duration or level of effort in which it appears; stable if the patient’s characteristics and functional capacity have not changed in the last month.

angina at rest

It occurs spontaneously, with no apparent relationship to changes in oxygen consumption in the heart. Its duration is variable. Sometimes, the episodes are very long and resemble a heart attack.

Mixed or unstable angina

Angina in which exertional angina and rest angina coexist, without a clear predominance of one or the other. Both initial angina, progressive effort angina, and rest angina follow unpredictable forms of evolution, and their prognosis is variable, which is why they are also grouped under the name of unstable angina.

Its treatment differs considerably from that of stable angina. This always occurs when performing the same level of exercise and the duration of the crises is similar. For example, unstable angina can be a warning sign of an impending heart attack and needs special treatment.

History of unstable angina is frequent attacks of angina pectoris not linked to physical activity. Sometimes it is perceived differently, without any fixed pattern, and it extends to the upper part of the abdomen, which causes it to be attributed to indigestion.

As the clinical manifestations can vary, the doctor must make a conclusive diagnosis with the help of electrocardiograms and laboratory tests.


The diagnosis of angina pectoris begins with clinical suspicion after experiencing pain. It concludes with the performance of specific tests that help rule out other cardiovascular pathologies, such as an electrocardiogram. The main difficulties that doctors perform are:

  • Stress test: Also called ergometry. This test is the most used to determine the diagnosis and obtain information on the prognosis of the pathology.

The patient will perform physical exercise on a treadmill or stationary bicycle in the test. At the same time, the doctor evaluates if there is pain during the activity and what is the electrical response of the subject (if there are changes in the electrocardiogram).

  • Coronary arteriography is performed through catheterisation, and a contrast is injected. It is the reference method for diagnosing coronary narrowing and is usually performed to correct the narrowing of the arteries (dilation and stent implantation) in cases with a poor prognosis.


Among the most effective and recommended treatments are:

  • Nitroglycerin dilates the coronary arteries, and the pain usually reverses in minutes. It is taken by placing a pill under the tongue or as a spray. It can give you a headache as a side effect.
  • Calcium antagonists or blockers of calcium channels: They prevent calcium entry into the heart’s cells. This decreases the tendency of the coronary arteries to narrow and the strain on the heart, so your oxygen needs are also reduced.

Beta-blockers: These work by blocking many effects of adrenaline in the body, particularly the stimulating effect on the heart. The result is that the heart beats more slowly and with less force and therefore needs less oxygen.

  • Surgery: In the case of unstable angina or stable angina that resists drug treatment, you can correct the obstruction of the coronary vessels, either by bypass (bypass) or, in some cases, by coronary angioplasty.

How is it different from a heart attack?

Myocardial (heart muscle) infarction and angina pectoris are the most common cause of acute chest pain (chest pain). While in angina, the pain is due to a transient lack of oxygen, infarction necrosis (death) of myocardial cells occurs. The origin of the problem is the lack of sufficient oxygen to keep the heart cells active.

This lack of oxygen produces intense pain, pressure or discomfort in the heart region, which extends to the shoulder and left arm, suffocating and, at the same time, marked anxiety or anguish.

It can also be noticed on the back, both arms, behind the breastbone, and sometimes even on the jaw or in the pit of the stomach. In either case, oxygen does not reach the heart because the blood does not reach it in sufficient quantity either. The reason is that the coronary arteries (blood vessels that carry oxygen to the heart) are partially (angina pectoris) or entirely (heart attack) blocked.


The prognosis depends on the extent of the disease, so some patients can live under control with hardly any symptoms, while others will have a very short life expectancy and even die.

Controlling risk factors helps improve the prognosis of angina.

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