Angina & Chest Pains

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Angina is a type of chest pain that results from reduced blood flow to the heart muscle. It is usually felt as a heavy or crushing pain in the chest that can spread to the arms, shoulders and back, similar to what is experienced during a heart attack. Angina, however, is not a disease itself; it is a sign that an underlying heart disorder is causing the restricted blood flow. The nature of the symptoms can therefore vary depending on the type of angina and its originating cause. 

  • Stable angina, or angina pectoris, is the most common type. It is seen when coronary arteries are narrowed or blocked and insufficient oxygen is delivered by the blood to the heart during physical exertion. This type of angina signals an increased likelihood of heart attack, but it is often manageable. 
  • Unstable angina, or acute coronary syndrome, occurs even without physical exertion and signals a more significant blockage in the coronary arteries that should be treated immediately. 
  • Variant or Prinzmetal angina is a rare type of angina that results from spasms in the coronary arteries. Like unstable angina, pain in variant angina can also occur at rest, but the pain tends to occur in cycles and can disappear entirely for periods of time. 
  • Microvascular angina results from disease in the microvasculature, or the small vessels, as opposed to the large vessels, in the heart. It is usually associated with systemic disease, such as hypertension and diabetes. The pain with this type can be similar to stable angina but may be accompanied by fatigue and shortness of breath.


Treating Angina
Because angina is not itself a disease but a symptom of an underlying heart disorder, physicians at Houston Methodist will carefully assess your cardiac health, investigate whether the chest discomfort is angina and determine a course of treatment that focuses on relief of angina pain and also addresses the cause of the pain. In stable angina or chest pain, a stress test is usually performed as part of the investigation. You will also likely be advised to live a healthy lifestyle, which includes a sensible diet and regular exercise as well as avoiding smoking and excessive alcohol consumption, so as to maintain heart health and prevent development of further disease.

If you have stable angina, you may be given one of several medications including nitrates, calcium channel blockers or beta blockers. These medications reduce the work and stress on the heart and control symptoms. Your physicians will also regularly monitor your heart function to detect worsening disease as early as possible.

If you have unstable angina, it is a medical urgency. Immediate intervention is required to restore normal blood flow to the heart. In addition to the above medications, your physicians will schedule you to undergo a cardiac catheterization, to get a more detailed view of the coronary arteries. You will then be scheduled for the procedure that best addresses the problem or simply treat it with medications if this is more appropriate for your case.

Percutaneous coronary interventions (PCI) are commonly employed to treat narrowing of the coronary arteries. The procedure involves inserting a catheter into the affected arteries in order to widen them and allow for better blood flow. After inflating a small balloon, a small mesh tube called a stent is used to keep the artery open.

When several arteries are blocked or the main artery of the heart is involved (left main), coronary artery bypass surgery is advised, where veins from the legs or other areas of the body are removed and grafted to the diseased coronary artery, allowing the blood to bypass the blockage and allow unimpeded flow to the heart.

If you have one of the rare variants of angina caused by spasms in the heart vessels or microvascular angina caused by blockages in small vessels, your physician will likely prescribe medication to control the pain and prevent further attacks. Adopting a healthy lifestyle, reducing risk factors for heart disease and continuous monitoring are also key components of managing these types of angina.

Our experts at Houston Methodist are committed to managing your angina pain while also addressing the underlying cause. We work as a team with you and all of your treating physicians to maximize your heart health and prevent further disease.