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Angina (angina pectoris) is a type of temporary chest pain, pressure or discomfort. It is often described as a crushing, burning, heavy sensation, and it frequently radiates from the chest into other parts of the body, such as the neck, back, arms, jaw and abdomen. In women, angina may be experienced as abdominal pain. Typical episodes of angina can last anywhere from two to 15 minutes.
About 9.1 million Americans suffer from angina, according to the American Heart Association. In the United States, angina afflicts an estimated 3.9 percent of white women, 4.3 percent of black women, 3.3 percent of Mexican-American women, 4.8 percent of white men, 3.4 percent of black men and 2.3 percent of Mexican-American men.
 Angina occurs when the heart is temporarily deprived of oxygen, a condition called cardiac ischemia. The most common cause of cardiac ischemia is coronary artery disease, a condition in which oxygen-rich blood cannot travel freely through coronary arteries that are severely hardened and narrowed (atherosclerotic) from plaque buildup and calcification.
If the angina occurs at predictable times, usually after exercise or exertion, it is called stable angina. If the angina occurs at unpredictable times, including at rest, and lasts longer than typical angina episodes, it is known as unstable angina. Unstable angina may signal an impending heart attack. People experiencing unstable angina should seek medical attention immediately.
Besides coronary artery disease, other causes of cardiac ischemia and angina include problems with:
- The heart’s aortic valve, such as regurgitation (leaking) or stenosis (narrowing).
- The heart muscle, as in hypertrophic subaortic stenosis (also known as hypertrophic cardiomyopathy).
- The capillaries, which could lead to a diagnosis of microvascular angina or cardiac syndrome X.
- Coronary artery spasms, which could lead to a diagnosis of variant or Prinzmetal angina. This type of angina is rare, and may be considered a form of unstable angina. It almost always occurs when patients are at rest, typically between midnight and early morning. It is common for these patients to have “active” periods of variant angina, with frequent anginal episodes over a period of months. Two-thirds of people with variant angina have severe blockage in at least one major vessel. There is also a greater risk of developing abnormal heart rhythms (arrhythmias), such as ventricular tachycardia and ventricular fibrillation.
Cardiac ischemia can also lead to dangerous problems if underlying conditions are left untreated:
- Arrhythmias, which can lead to either syncope (fainting) or sudden cardiac death.
- Heart disease patients whose episodes are triggered by stress (e.g., frustration, hostility) are more likely to die from their heart condition.
- Severe or lengthy episodes can trigger a heart attack.
- The small effects of minor episodes can eventually lead to permanent weakening of the heart muscle (cardiomyopathy).
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