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About Your Diagnosis Angina pectoris is heart-related pain. Pain may be felt in the chest or the upper arms or jaw. It occurs when the heart has an inadequate oxygen supply in the blood. Any condition that causes the heart to increase work increases its need for oxygen. If blood flow to the heart is decreased because of coronary artery disease from atherosclerosis (scarring and fatty deposits in the blood vessels) or from vessel spasm (contracting closed), angina may result. The coronary arteries are the vessels that supply blood to the heart muscle. Abnormal heart valves may decrease blood flow through the heart and to the coronary vessels. Abnormal heart rhythm (arrhythmias) may keep the heart from moving blood effectively. If the heart must work harder because of exercise, stress, or illness and blood flow does not meet demands, angina may result. A decrease in the number of oxygen-carrying cells (red blood cells) in the blood (anemia) makes it difficult for the heart to deliver oxygen. Damage to the heart muscle from disease or heart attack (myocardial infarction, which means a portion of the heart muscle dies because it does not have enough blood) causes the heart to pump less effectively. Angina pectoris may be a sign of more serious heart problems and requires immediate attention from a physician. The following persons are at risk for heart disease:
Angina is described in several ways. Some patients describe a smothering or crushing pain as if someone is sitting on their chest. The pain may be dull or sharp and may last several minutes or just a moment. The pain may be in the center of your chest or in your back, shoulder, or jaw. It may feel like heartburn. Sweating, dizziness, or shortness of breath may accompany it. If pain occurs with exercise or increased work for the heart, rest may help. Pain that occurs at rest is called unstable angina. Exercise can improve some patients' symptoms and their ability to work. Aerobic exercise such as swimming, bicycling, and walking or jogging is the best form of exercise for patients with heart disease who can tolerate exercise. Before an exercise program is begun, an exercise test must be conducted. A physician's clearance is necessary for strenuous activity. It is normal to have concerns about the effects on your heart of having sexual relations. Most people with heart disease or angina may engage in sexual activity safely with the same risk as those for moderate exercise. If you are concerned, speak to your doctor. TreatmentThe diagnosis of angina pectoris is made by a physician on the basis of the symptoms and examination findings. Tests may be performed to evaluate the heart. These may include electrocardiograms (ECGs), treadmill or exercise tests, or catheterization (checking the blood flow at the heart by means of inserting a device through a vein to the heart). Severe cases of angina pectoris may necessitate angioplasty (opening clogged blood vessels with a balloon-like device) or coronary artery bypass grafting. Laboratory tests may be performed to monitor for evidence of heart damage or other conditions, such as anemia, diabetes, hyperthyroidism, or high blood cholesterol levels. Chest pain is controlled with attempts to improve the blood flow to the working heart muscle or to decrease the work of the heart. Resting or decreasing activity is the first treatment you should try. Some patients can improve the blood flow to their hearts with nitrates such as nitroglycerin (a small pill placed under the tongue). Hypertension (high blood pressure) makes the heart work harder, so antihypertensive medicines such as beta-blockers or calcium channel blockers may be given. There are many different types of these medications, so a physician should review the side effects with you. Arrhythmias may be treated with antiarrhythmic medicines. High blood cholesterol should be treated. Underlying medical conditions that may be contributing to the angina or heart disease require careful management. Control of diabetes and hypertension is extremely important. Monitoring thyroid disease and high blood cholesterol are important. Anyone with angina or heart disease should take aspirin daily unless otherwise directed by a physician. The DOs
Living with Angina is a booklet available from the American Heart Association that is helpful for persons with this condition. Call 1-800-242-8721 and ask for the literature department. 
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