Sandeep Das, M.D., M.P.H. Answers Questions On: General Cardiology
What causes angina?
Angina pectoris is chest pain that originates in the heart and arises when part of the heart can't get enough oxygen to function properly – when the demand for oxygen exceeds the available supply.
Angina is often caused by blockages in the coronary arteries that supply blood – and therefore oxygen – to the heart muscle. It typically occurs in the left chest or below the sternum, is brought on by physical exertion or emotional stress, and is relieved with rest or by nitroglycerin tablets under the tongue.
That said, angina isn't always "typical” – for example, people can experience it as chest pressure or shortness of breath – and distinguishing angina from the many other possible causes of chest pain (some serious, some not) can be challenging and require careful evaluation and possibly diagnostic testing.
People who experience chest pain during physical exertion, particularly if it limits how much they can exert themselves, should probably be evaluated for angina. Pain is less likely to be angina if it is very brief (a few seconds to a few minutes) or lasts for many hours (or even days); is worsened with deep breathing; or is reproducible by changing positions or pressing on the chest. But I’d still recommend anyone who has concerning chest pain discuss that with their doctor.
Do people sometimes get the wrong information about the best treatment for angina?
Coronary artery stenting in patients with stable angina is a good example of how people can become confused by information overload. Stenting is a procedure in which catheters and balloons are used to open a blocked artery, and a metal support is placed to keep the artery open. While it can be very good for relieving chest pain, research shows that stenting a partially blocked, but stable, coronary artery doesn't prevent future heart attacks or extend life. Yet many patients believe stents will do both of these things.
The bottom line is that patients should spend time talking with their doctors – and be sure they understand the proven benefits and risks associated with their possible treatment options before making decisions.