Angina Pectoris: Symptoms, Causes, Diagnosis, and Treatment

Quick answer

What Is Angina Pectoris?

Angina pectoris is chest pain or discomfort that occurs when the heart muscle does not get enough oxygen-rich blood, usually because the coronary arteries have narrowed. Angina is a symptom, not a disease in itself, so a doctor needs to check its cause.

Sources

Signs That Need Urgent Help

Chest pain that does not ease after a few minutes of rest
New, severe chest pain, or angina that is becoming more frequent and more severe
Chest pain at rest or chest pain that wakes you from sleep
Chest pain with cold sweat, nausea, or severe shortness of breath
Fainting, nearly fainting, or a very irregular heartbeat

If these signs appear, go to the nearest emergency department right away or call Heart Attack Center 1500 258.

Urgency note: Angina means the heart muscle is not getting enough blood, so its cause needs to be found and treated to lower the risk of a heart attack. Chest pain that is new, becoming more frequent or more severe, or occurring at rest needs to be checked in the emergency room right away.

01 / Understanding the condition

About Angina Pectoris

Angina pectoris is pain, pressure, or discomfort in the chest that occurs when the heart muscle does not get enough oxygen-rich blood. This shortage of blood flow is called ischemia. Angina is not a disease in itself, but a sign of a problem with the heart's blood vessels. A common cause is coronary artery disease, covered on the Coronary Artery Disease page.

How Angina Happens

The heart muscle receives blood from the coronary arteries, the vessels that wrap around the surface of the heart. When you walk quickly, climb stairs, or feel strong emotion, your heart works harder and needs more oxygen. If the coronary arteries are narrowed by fatty plaque (atherosclerosis), tighten briefly because of a spasm, or the heart's small blood vessels cannot widen properly, the blood supply cannot keep up with that demand. The result is pain. When the heart's workload eases or blood flow returns, the pain usually subsides within a few minutes.

Types of Angina

Doctors classify angina by its pattern and cause. Stable angina appears in a predictable pattern, usually during activity, and eases with rest. Unstable angina is chest pain that is new, becoming more frequent or more severe, or occurring at rest. This condition is part of acute coronary syndrome and needs urgent care. Variant or vasospastic angina is caused by spasm of the coronary arteries and often occurs at rest at night or in the early morning. Microvascular angina is caused by a problem in the very small blood vessels of the heart muscle, so the large coronary arteries may look normal on testing. Each type is covered in more detail on its own page.

Symptoms Are Not Always Pain

Some people, especially women, older adults, and people with diabetes, feel angina as shortness of breath, unusual tiredness, nausea, or discomfort in the upper abdomen. These symptoms are easily mistaken for catching a chill or a stomach problem, when the source may in fact be the heart.

Why Angina Needs to Be Checked

Angina is a signal that the heart is not getting enough blood. With the right tests, your doctor can look for the cause, assess your risk of a heart attack, and plan treatment that relieves symptoms while protecting your blood vessels. Many people with angina can keep working and living an active life once treatment is underway.

02 / Understanding the condition

Types and Related Conditions

The following conditions belong to the Angina Pectoris group. Open each one for a full explanation.

Microvascular Angina Stable Angina Unstable Angina Vasospastic Angina

03 / Understanding the condition

Symptoms to Recognize.

Common Symptoms

Pain, pressure, heaviness, or a squeezing feeling in the chest
Pain spreading to the arm, shoulder, neck, jaw, or back
Symptoms that come on with physical activity or emotion and ease with rest
Symptoms that last a few minutes, not just a few seconds
Shortness of breath, especially during activity
Discomfort in the upper abdomen that feels like a stomach ache
Cold sweat or nausea when the pain appears

Symptoms in Adult Women

Chest pain is still the main symptom, but women more often have the following accompanying symptoms.

Shortness of breath that comes with or replaces chest pain
Nausea or discomfort in the upper abdomen
Unusual tiredness during light activity
Pain in the upper back, neck, or jaw
Chest pain that is more often triggered by emotional stress

Symptoms in Older Adults

In older age, angina is sometimes not felt as chest pain.

Shortness of breath during light activity
Tiring quickly or a reduced ability to be active
Vague discomfort in the chest or upper abdomen
Dizziness or feeling faint during activity

Not everyone has the same symptoms. If symptoms keep coming back or get worse, get checked.

04 / Understanding the condition

What Causes This Condition?

Narrowing of the coronary arteries by fatty plaque (atherosclerosis), covered on the Atherosclerosis page.
A plaque that ruptures and triggers a blood clot, suddenly reducing blood flow
Spasm of the coronary arteries that temporarily narrows the vessel
A problem with the heart's small blood vessels, which cannot widen as needed
Increased oxygen demand of the heart, for example with thickened heart muscle or a narrowed aortic valve
Reduced oxygen supply, for example with severe anemia or a very fast heart rate

05 / Understanding the condition

Who Is at Higher Risk?

Lifestyle

Smoking, inactivity, a diet high in saturated fat and salt, and excess weight speed up plaque buildup in the coronary arteries.

Medical

High blood pressure, high LDL cholesterol, diabetes, and chronic kidney disease damage the inner lining of blood vessels and raise the risk of angina.

Genetic

Early coronary artery disease in an immediate family member, meaning in a man before age 55 or a woman before age 65, as well as inherited high cholesterol, raises the risk.

Age

Risk increases with age, especially in men over 45 and in women after menopause.

Other

Long-term stress, pauses in breathing during sleep (sleep apnea), air pollution, and chronic inflammatory diseases such as lupus are also linked to a higher risk.

Groups at Higher Risk

People with Diabetes: Diabetes speeds up atherosclerosis and can dull the sense of pain, so angina is sometimes felt only as shortness of breath or tiredness.
Active and Passive Smokers: Substances in cigarette smoke damage the inner lining of blood vessels, speed up plaque formation, and can trigger coronary artery spasm.
People with Hypertension and High Cholesterol: Years of high blood pressure and high LDL cholesterol damage the walls of the coronary arteries and speed up their narrowing.
Postmenopausal Women: After menopause, the risk of coronary artery disease increases, and angina caused by problems in the small blood vessels is found more often in women.

Having a risk factor does not mean a person will definitely develop this condition.

06 / Understanding the condition

How Is It Diagnosed?

Your doctor starts by asking about your symptoms: what they feel like, where they are, what triggers them, how long they last, and what relieves them. The doctor then checks your blood pressure, pulse, heart, and lungs. An ECG and blood tests are done to look for signs of ischemia, heart muscle damage, and risk factors.

If the pain is happening now or has just happened, repeated ECGs and a troponin test in the emergency room help tell unstable angina apart from a heart attack. For stable symptoms, the doctor chooses further tests based on how likely coronary disease is. CT coronary angiography can show plaque and narrowing. Stress testing with imaging, such as stress echocardiography, myocardial perfusion imaging, or cardiac MRI, shows whether the heart muscle lacks blood when it works hard.

Coronary angiography with a catheter is done if test results show high risk or symptoms remain severe despite treatment. If the large arteries look normal but the symptoms are real, the doctor may assess the function of the small blood vessels and the tendency to spasm.

Electrocardiogram (ECG)
Records the heart's electrical activity at rest or during pain to look for signs of ischemia, a heart attack, or a rhythm disorder.
Cardiac Troponin Test
Used for new or ongoing chest pain to confirm or rule out heart muscle damage.
CT Coronary Angiography
Shows plaque and narrowing in the coronary arteries without a catheter, useful for stable symptoms when the likelihood of coronary disease is low to moderate.
Stress Echocardiography
Assesses heart wall motion under stress to see whether any part of the heart muscle lacks blood.
Coronary Angiography
Takes images of the coronary arteries using a catheter and contrast dye to see the location and severity of narrowing, and to decide whether a procedure is needed.
Laboratory Tests
Blood fats, blood sugar or HbA1c, kidney function, and hemoglobin to assess risk factors and other causes.

07 / Understanding the condition

Treatment Options.

Treatment is decided by a doctor after an assessment. The categories below can help you follow the conversation with your doctor.

Lifestyle Changes

Quitting smoking, a heart-healthy diet, regular physical activity as advised by your doctor, and maintaining a healthy weight are the foundation of all angina treatment.

Medicines to Relieve and Prevent Angina

Fast-acting nitrates relieve attacks. Beta blockers, calcium channel blockers, or long-acting nitrates prevent attacks. Your doctor decides the type and dose based on the type of angina.

Medicines That Protect the Blood Vessels

Antiplatelets such as aspirin and cholesterol-lowering statins reduce the risk of a heart attack in angina caused by coronary disease.

Risk Factor Control

Blood pressure, LDL cholesterol, and blood sugar are controlled to the targets set by your doctor, with regular follow-up checks.

Coronary Revascularization

Stent placement through a catheter or bypass surgery is considered if the narrowing is severe, the risk is high, or symptoms remain troublesome despite treatment.

Urgent Hospital Treatment

Unstable angina is treated in the hospital with medicines that prevent clots and, in many patients, coronary angiography. Covered on the Unstable Angina page.

Whether a test or therapy is suitable and available needs to be confirmed with your care team.

08 / Understanding the condition

Complications to Watch For.

Heart Attack

A ruptured plaque can trigger a clot that completely blocks a coronary artery, damaging part of the heart muscle. Covered on the Myocardial Infarction / Heart Attack page.

Heart Rhythm Disorders

Heart muscle that lacks blood can trigger irregular rhythms, ranging from mild ones to those that need urgent treatment.

Heart Failure

Repeated ischemia or scarring from a heart attack can weaken the heart's pumping, causing shortness of breath and swelling in the legs.

Activity Limitations

Frequent pain leads people to limit work, exercise, and social activities, and can trigger anxiety.

09 / Understanding the condition

What Can You Do?

Quit smoking and avoid other people's cigarette smoke
Stay active, for example brisk walking for about 150 minutes per week, as advised by your doctor
Choose a diet rich in vegetables, fruit, whole grains, fish, and nuts; limit salt and saturated fat
Keep your weight and waist size within a healthy range
Have your blood pressure, cholesterol, and blood sugar checked regularly
Take your heart medicines as prescribed and do not stop them without talking to your doctor
Manage stress and get enough sleep

10 / Understanding the condition

When Should You See a Doctor?

See a cardiologist if you have ever felt pain or discomfort in your chest, even if it went away on its own. Getting checked early gives a chance to find the cause and lower the risk of a heart attack. If chest pain is happening now and does not ease with rest, or your angina pattern changes to become more frequent and more severe, do not wait for your next appointment: go to a nearby emergency room right away and do not drive yourself.

Pain, pressure, or heaviness in the chest during activity or emotion.
Shortness of breath or unusual tiredness during activities that used to feel easy.
Discomfort in the upper abdomen during activity that does not improve with stomach medicine.
You have diabetes, hypertension, high cholesterol, or a family history of heart disease and are starting to feel chest symptoms.

Don't Wait in an Emergency.

If symptoms are severe or come on suddenly, go to the nearest emergency department right away or call Heart Attack Center 1500 258, rather than waiting for an appointment.

11 / Common questions

Questions You May Have.

Frequently asked questions about angina pectoris.

Is angina the same as a heart attack?

No, they are different. In angina, blood flow to the heart muscle is reduced temporarily without damaging the heart muscle. In a heart attack, an artery stays blocked long enough that part of the heart muscle is damaged. At home, however, the two are hard to tell apart. Chest pain that does not ease with rest, or severe chest pain you are feeling for the first time, needs to be checked in the emergency room right away.

Is angin duduk the same as angina pectoris?

In everyday Indonesian, the folk term angin duduk is often used for chest pain that is actually angina or a heart attack. The symptom is not caused by wind inside the body, but by reduced blood flow to the heart muscle. That is why chest pain thought to be a chill (masuk angin) should be checked by a doctor, not just treated with coin rubbing (kerokan) or remedies for a chill.

How can you tell angina from stomach pain or muscle pain?

Angina usually feels like pressure or heaviness, is triggered by activity or emotion, lasts a few minutes, and eases with rest. Muscle pain is usually sharp and gets worse when pressed or when you move. Stomach pain is often related to eating. These features often overlap, so your doctor still needs an ECG and other tests to confirm the source.

Can people with angina exercise?

Yes, and it is generally recommended once your doctor has assessed your condition. Regular exercise at a suitable intensity helps the heart work more efficiently and improves risk factors. A cardiac rehabilitation program can help determine a safe amount of exercise. Stop exercising and rest if chest pain appears, then tell your doctor at your next checkup.

Can angina be cured?

The underlying cause, such as coronary artery disease, usually needs long-term management. However, angina symptoms can be controlled, and many people have attacks only rarely, or not at all, after receiving medicines, lifestyle changes, and, if needed, a procedure to open the blood vessels. Regular checkups help your doctor adjust treatment if your symptoms change.

What should you do when an angina attack occurs?

Stop what you are doing, then sit or lie down comfortably. If your doctor has prescribed a fast-acting nitrate, use it as instructed. If the pain does not ease within a few minutes, feels more severe than usual, or this is your first chest pain, call emergency services right away or ask someone to take you to a nearby emergency room.

Sources and Medical Review

Translated from the Indonesian edition medically reviewed by Dr. dr. Jajang Sinardja, Sp.JP(K).

Sources as cited in the Indonesian edition.

Next step

Discuss Your Symptoms with a Doctor.

Start with a consultation to understand your condition and the treatment options that suit you.

Book an Appointment for This Condition Ask on WhatsApp

Visit topic: Angina Pectoris

The information on this page is for educational purposes and does not replace medical consultation, diagnosis, or treatment. For any health concerns, please consult a doctor directly.

Back to All Conditions

Angina Pectoris