What is angina pectoris: how does it manifest and how is it treated?

Pain or discomfort in the chest during physical exertion, emotional stress, or brisk walking is a symptom that should not be ignored. In many cases, such sensations are caused by angina — one of the forms of coronary artery disease associated with a temporary insufficient blood supply to the myocardium.

This condition does not always mean critical heart damage, but it indicates that the coronary arteries do not fully meet the heart muscle’s need for oxygen. With timely medical consultation and properly selected therapy, the course of the disease can be controlled and the risk of complications significantly reduced.

In this article, we will consistently review what angina is, how it manifests, how it differs from a heart attack, and what modern approaches are used for treatment and prevention.

What Is Angina

Angina is a clinical syndrome that occurs as a result of a temporary decrease in blood supply to the heart muscle. At that moment, the myocardium receives less oxygen than required for full function, which leads to pain, a squeezing sensation, or pressure in the chest.

The most common cause is narrowing of the coronary arteries due to atherosclerotic changes. During physical exertion, emotional stress, or exposure to cold, the heart’s need for oxygen increases. If the vessels cannot provide sufficient blood flow, short-term ischemia develops, which manifests as a painful episode.

Angina is a form of coronary artery disease and indicates the presence of impaired coronary blood flow. Unlike a heart attack, it does not involve myocardial tissue necrosis; however, frequent attacks may indicate progression of vascular damage.

Depending on the conditions of occurrence, angina is classified as:

• exertional angina — symptoms appear during physical activity or psycho-emotional stress;

• rest angina — pain occurs without an obvious triggering factor, sometimes at night or during rest.

Understanding the mechanism of development helps to properly assess risks and seek timely consultation with a cardiologist.

How Angina Manifests

Symptoms most often occur when the heart is working more intensively — during brisk walking, climbing stairs, emotional stress, exposure to cold, or after a heavy meal.

A characteristic feature is that the discomfort usually subsides after stopping the activity or taking medications prescribed by a doctor. In most cases, the episode lasts from a few minutes up to 10–15 minutes. If the pain persists longer or intensifies, urgent medical attention is required.

What Are the Symptoms of Angina

The main manifestation is pain or a squeezing sensation behind the sternum. Patients describe it as pressure, burning, heaviness, or a “stone” in the chest. The pain may radiate to the left shoulder, arm, under the shoulder blade, to the lower jaw, or to the upper abdomen.

In addition to pain, the following symptoms may occur:

• shortness of breath or a feeling of lack of air;

• rapid heartbeat;

• weakness, dizziness;

• increased sweating;

• a feeling of anxiety.

In some patients, especially with an atypical course, the pain may be mild or manifest mainly as shortness of breath or abdominal discomfort. Therefore, any recurrent episodes of chest pain require consultation with a cardiologist.

What Is the Heart Rate in Angina

During an attack, the heart rate usually increases, as the body responds to physical or emotional stress by activating the sympathetic nervous system. The heart starts beating faster to supply organs with oxygen.

The following values are most commonly observed:

• 80–100 beats per minute — during mild exertion;

• 90–120 beats per minute — during active movement or stress;

• over 120 beats per minute — during significant exertion or pronounced emotional stress.

In some patients, the heart rate may remain within the normal range (60–80 beats per minute), especially if the attack occurs at rest or the person is taking beta-blockers. Irregular heartbeats may also occur in the presence of concomitant rhythm disorders.

It is important to remember that a specific heart rate value neither confirms nor excludes angina. The overall set of symptoms and the results of ECG and other examinations are evaluated.

What Is the Blood Pressure in Angina

Blood pressure during an attack may change depending on underlying diseases and the body’s response to pain and stress.

The most common variants include:

• an increase to 140–160/90–100 mmHg — during physical or emotional stress;

• a more significant rise (above 160/100 mmHg) — in patients with hypertension;

• a decrease below 100/60 mmHg — possible in cases of severe pain syndrome or heart rhythm disturbances.

Elevated blood pressure increases myocardial oxygen demand and may therefore provoke or intensify an attack. A sharp drop in blood pressure, especially when combined with weakness, cold sweat, and prolonged chest pain, requires an immediate call for emergency medical services.

Assessing the condition based solely on blood pressure or heart rate numbers is insufficient. The nature of the pain, its duration, triggering conditions, and cardiological examination findings are of decisive importance.

The Difference Between Angina and Myocardial Infarction

Angina and myocardial infarction are both associated with impaired coronary blood flow, but they differ in their mechanism of development, duration of symptoms, and consequences for the heart muscle. The key differences are summarized in the table below.

Prolonged or unusual chest pain always requires medical evaluation. If symptoms do not improve within 15–20 minutes or become more intense, emergency medical assistance should be called immediately.

What to Do in Case of Angina

An attack usually occurs suddenly — during physical exertion, brisk walking, emotional stress, or even after overeating. In most cases, timely and appropriate actions help quickly relieve symptoms and prevent complications.

How to relieve an angina attack:

• Immediately stop physical activity. Stop, sit down, or take a semi-reclining position with back support.

• Calm your breathing. Breathe slowly and evenly, trying to reduce anxiety.

• Take the medication prescribed by your doctor. Most often this is nitroglycerin 0.5 mg under the tongue or in spray form (1 dose).

• Assess your condition after 3–5 minutes. If the pain has decreased — continue resting for another 10–15 minutes.

• Repeat the medication if necessary. Up to 3 doses of nitroglycerin may be taken at 5-minute intervals if recommended by your doctor.

• Call emergency medical services if the pain lasts more than 15–20 minutes. Especially if symptoms intensify, cold sweat appears, or severe weakness or dizziness develops.

Do not exceed the recommended dose of medications or self-medicate. If attacks become more frequent, occur with less exertion, or appear at rest, this may indicate disease progression and requires urgent consultation with a cardiologist.

How to Treat Angina

After learning the diagnosis, patients often ask whether angina can be treated. In most cases, symptoms can be well controlled. With properly selected therapy, lifestyle modification, and regular follow-up with a cardiologist, attacks become less frequent or disappear, and the risk of complications significantly decreases. At the same time, it is important to understand that angina is often a manifestation of coronary artery disease; therefore, treatment is usually long-term and requires a systematic approach.

Treatment of angina is aimed at two key goals:

• reducing the frequency and intensity of attacks;

• lowering the risk of cardiac complications.

Treatment strategy is determined after a comprehensive examination, which allows the type of angina (stable or unstable) to be established, the degree of coronary blood flow impairment to be assessed, and concomitant diseases to be identified, including diabetes mellitus and arterial hypertension, which increase the risk of complications.

The treatment program includes:

• Drug therapy. The doctor may prescribe medications for rapid relief of attacks, as well as agents for prevention and disease control (beta-blockers, calcium channel blockers, antiplatelet agents, statins, and other drugs according to indications). Medication selection is always individualized.

• Treatment of concomitant conditions. Elevated blood pressure, cholesterol levels, blood glucose, anemia, and other factors that may worsen myocardial blood supply must be corrected.

• Surgical interventions when indicated. If coronary artery narrowing is significant or drug therapy does not provide adequate symptom control, restoration of coronary blood flow through stenting or coronary artery bypass grafting may be recommended.

• Lifestyle modification. Recommended measures include dosed physical activity, weight normalization, smoking cessation, stress control, and adequate sleep. This reduces cardiac workload and myocardial oxygen demand.

It is not allowed to independently change the treatment regimen or discontinue medications, even if symptoms decrease. The best results are achieved by combining regular cardiac monitoring, adherence to recommendations, and therapy tailored to the specific clinical situation.

Diet in Angina

Nutrition plays an important role in controlling angina, as it directly affects cholesterol levels, body weight, blood pressure, and vascular condition. The main goal of the diet is to reduce atherosclerotic changes in the coronary arteries and stabilize metabolism.

The diet should be balanced: with sufficient amounts of vegetables, fruits, fish, lean meat, whole grains, and plant-based fats. It is important to control calorie intake, especially in cases of excess body weight.

Special attention should be paid to patients with concomitant diabetes mellitus, as elevated glucose levels accelerate vascular damage. In such cases, carbohydrate metabolism control and dietary planning with a doctor are necessary.

What should not be eaten with angina:

• fatty cuts of meat and processed meat products;

• fried dishes and foods high in trans fats;

• fast food and industrial baked goods;

• excessive butter and fatty sauces;

• foods high in salt (pickled and smoked products);

• confectionery, as well as sugary carbonated beverages and alcohol.

Limiting salt intake to 5 g per day helps stabilize blood pressure, and reducing saturated fats contributes to cholesterol control. Meals should be regular, without overeating, as a large volume of food increases the workload on the heart.

Can You Drink Coffee with Angina

Coffee contains caffeine, which stimulates the cardiovascular system. It may temporarily increase heart rate and blood pressure, which in some cases can provoke an attack.

In most patients with stable angina, moderate consumption is acceptable — 1 small cup per day (up to 100–150 mg of caffeine), provided that no chest discomfort, palpitations, or blood pressure elevation occurs afterward.

It is not recommended to:

• drink strong coffee on an empty stomach;

• consume more than 2 cups per day;

• combine coffee with smoking or alcohol;

• consume energy drinks high in caffeine.

If chest pain, shortness of breath, or palpitations occur after drinking coffee, the beverage should be avoided. Final recommendations depend on the form of the disease, the presence of arterial hypertension, and other concomitant conditions; therefore, caffeine intake should be discussed with a cardiologist.