Diagram of angina pectoris

A feeling of tightness in the chest is one of the symptoms of an angina attack or angina pectoris. It can be triggered by stress. Is that bad ? How to recognize and cure it?

Angina pectoris or angina causes pain in the chest behind the sternum. This symptom can occur at times when the heart needs more oxygen (effort, emotion such as stress, digestion etc). Stable angina attacks are distinguished from unstable angina attacks. The diagnosis is made by the attending physician and a cardiologist. Treatment will depend on the cause. What is angina pectoris? Is that bad ? How to cure it?

Definition: what is angina pectoris?

Angina, also called “angina pectoris” is a damage to the coronary arteries of the heart which do not bring it the necessary oxygen to function properly. This lack of essential contribution is at the origin of a heart pain. We distinguish stable angina (or stable angina or coronary disease) for which the characteristics do not change over time (same cause, same intensity, same duration) and unstable angina pectoris.

What are the symptoms of angina pectoris?

In the early stages, a chest pain behind the breastbone only appears during exercise, digestion or emotion, times when the heart needs more oxygen. The pain is called “anginal”, i.e. it corresponds to a vice-like tightness at the back of the sternum with some possible radiation in the arm or in the shoulder, sometimes accompanied by cough. If the obstruction of the coronaries increases, the symptoms can occur at rest, it is the unstable angina which can be a precursor sign of a myocardial infarction.

Diagram of angina pectoris © VectorMine-Adobestock

What are the different types of angina attacks?

Angina attacks are painful and almost always related to a partially blocked coronary artery. There are several types of angina attacks:

  • The effort angina attack or stable angina occurring during a physical or sporting activity and disappearing when it stops;
  • The crisis of unstable angina which corresponds to a more advanced stage with seizures occurring even at rest, often more frequent and longer.

Angina is a warning sign to consult a cardiologist quickly for a check-up of heart and coronary artery function.

What is unstable angina?

Unstable angina is more serious because it appears both during exercise and at rest and can lead to myocardial infarction (sudden cardiac arrest). It is usually manifested by chest pain that occurs as seizures. The electrocardiogram, ultrasound, scintigraphy and coronary angiography confirm the diagnosis. Angina is unstable in the following situations:

  • the angina pectoris is recent, appeared quickly and unstable from the outset. Painful crises are frequent for less than a month;
  • angina pectoris attacks are longer than 20 minutesregressing spontaneously or not after taking trinitrine;
  • the previously stable angina pectoris worsens and becomes unbalanced. Crises are more and more frequent or occur for minimal effort, after meals during digestion or at rest, especially at night. They are less sensitive to treatment with trinitrin
  • angina appears in the month following a myocardial infarction.

“This unstable angina pectoris is considered a threat of myocardial infarction (we speak of acute coronary syndrome) and requires hospitalization in cardiology“alert theHealth Insurance.

Diagnosis: what tests to do in case of angina pectoris?

The assessment of chest pain is carried out by the attending physician, in coordination with a cardiologist. Typical exams include:

  • a blood test (hemogram, ionogram, glycaemia, lipid and renal assessment);
  • an electrocardiogram (ECG) at restperformed if possible during or just after a painful episode of angina pectoris;
  • resting transthoracic echocardiography or MRI if ultrasound is not feasible. It eliminates other causes of pain (anomaly of a valve, disease of the heart muscle, pericarditis, fissure of the aorta), analyzes the movements of the heart and calculates the ejection fraction of the left ventricle (search for heart failure ).

Sometimes a chest x-ray is prescribed if the doctor suspects a lung disease that may explain the symptoms (pneumonia for example). Specific examinations, called ischemia testsare carried out in a manner adapted to each case:

  • a stress test : stress ECG, stress or stress echocardiography;
  • a stress scintigraphy or MRI…

In an emergency, a coronary angiography can be carried out. This examination may be necessary to directly identify coronary artery stenoses (restricted areas).

At what age are you most at risk of getting angina pectoris?

The risk of angina pectoris gradually increases in frequency with age. It concerns more men over 50, especially smokers, suffering from diabetes, excess cholesterol, high blood pressure or obesity.

What are the causes of angina pectoris?

Angina pectoris is caused by a narrowing of the caliber of the arteries which will slow down the blood flow that reaches the heart. The most common cause is atherosclerosis, that is to say the formation of atheroma plaques inside the coronary arteries because of cardiovascular risk factors: tobacco, overweight, sedentary lifestyle, arterial hypertension, diabetes, hypercholesterolemia and family history. However, some angina attacks can also be related to coronary artery spasms which cause sufficient constriction to decrease blood flow in these vessels as in the case of Prinzmetal’s angina whose origin is unknown.

Treatments for angina may be initially medicatedbut in advanced stages, angioplasty or coronary bypass becomes essential. The treatment consists of the administration of nitrates (Lenitral or Trinitrin). It is important to distinguish anginal pain from the pain encountered in the event of myocardial infarction which does not yield to the administration of trinitrine and which requires emergency treatment. In case of unstable angina, the basic treatment is known by the acronym BASIC : Beta blockers, Antiplatelet agents, Statins, Inhibitors of the converting enzyme and Correction (diet, reduction of risk factors).

Can you live long with angina pectoris?

“In case of chronic coronary syndrome, regular medical follow-up is necessary. It prevents the occurrence of angina pectoris attacks and allows you, most often lead a normal life provided you follow a few rules of good hygiene“informs health insurance. “The prevention of angina is based on the same principles as that of atherosclerosis. It includes a physical exercise program supervised by a doctor, the cessation of cigarettes and the establishment of a balanced dietrecalls Dr. Claire Lewandowski, a doctor specializing in general medicine.

Source :

– Symptoms, medical assessment and evolution of angina pectoris, October 24, 2022, Assurance Maladie

– Living with stable angina or chronic coronary syndrome, October 13, 2022, Assurance Maladie

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