Angina (Chest Pain)

Angina, or chest pain, is the result of myocardial ischemia, which is an improper blood flow through the vessels supplying the heart. It’s caused by the imbalance of blood supply and oxygen demand of the heart.  

Myocardial ischemia can result from atherosclerosis, a buildup of fat and cholesterol that reduce the area inside vessels for blood to flow to the coronary arteries. Other causes of angina include a coronary artery spasm or decreased oxygen-carrying capacity of blood. Angina is an indicator for heart disease.  

The risk factors for angina include:

  • Carboxyhemoglobin/anemia
  • Cardiomyopathy, or disease of the heart muscle
  • Collagen vascular diseases
  • Congenital heart defects
  • Diabetes
  • High cholesterol
  • Hypertension
  • Metabolic syndrome
  • Obesity
  • Smoking
  • Syndrome X, which is chest pain without blockages in the arteries, often found in women

Symptoms of Angina

Angina is chest discomfort or pain, usually a pressure or heaviness. It can also feel like a squeezing of the chest or a burning feeling.

Other common signs include:

  • Pain can also be felt in the back, neck, chest, jaw, or shoulders.
  • Pain does not change with cough or breathing.
  • Pain is usually brought on by exertion, eating, cold, or stress.
  • Pain lasts 1-5 minutes and is relieved by nitroglycerin.

Diagnosis of Angina

Unless there are other causes, your doctor can usually diagnose angina through a normal physical exam.

Other diagnostic techniques include:

  • Coronary angiography – assesses coronary arteries for blockage
  • Electrocardiogram (ECG) tracks changes in the amount of time from the chambers contracting until resting
  • Graded exercise stress test performed with or without echocardiography or myocardial perfusion tests
  • Levine sign – describes the pain by clenching your first over your chest
  • Myocardial perfusion study – evaluates perfusion defects
  • NYHA classification:
    • Class I – ordinary physical activity; does not cause symptoms
    • Class II – ordinary physical activity; does cause symptoms
    • Class III – comfortable at rest, but less than ordinary activities cause symptoms
    • Class IV – symptomatic at rest
  • Stress echocardiography evaluates changes in heart wall motion during exercise

Angina Treatment Options

Lifestyle changes often are a part of treating angina. Common treatment options include:

  • Aspirin daily to thin blood
  • Beta-blockers and calcium-channel blockers for improving blood flow
  • Exercise training to improve blood flow
  • Intra-aortic balloon pump for unstable angina not controlled by medications
  • Nitroglycerin placed under the tongue for symptomatic episodes
  • Smoking cessation
  • Surgery:
    • Angioplasty and stenting
    • Coronary artery bypass graft
  • Treat diabetes, hypertension, obesity, and high cholesterol

UT Southwestern Medical Center’s cardiologists are able to diagnose and treat angina and many other types of heart conditions. Our Heart, Lung, and Vascular Center delivers comprehensive cardiac care specific to your needs.

Request an Appointment

For an appointment at UT Southwestern's facilities in Dallas or for more information about our angina services, request an appointment or call 214-645-8300.