Angina and Acute Coronary Syndrome

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Angina Pectoris Symptoms & Diagnosis

Angina pectoris is the term used to describe the disorder associated with chest pain or chest discomfort. It is due to an imbalance of oxygen supply and demand to the heart muscle and is often the first sign of coronary disease. The need for oxygen may increase, as it does with exercise, excitement, eating a heavy meal or exposure to cold. The amount of oxygen available in the bloodstream can be reduced due to the narrowed vessels supplying the heart muscle with blood and oxygen.

Angina can occur suddenly or gradually and usually lasts for a short time (5 to 15 minutes). The discomfort usually occurs in the mid-chest area and can radiate to the back, neck, arms, jaws, shoulders and upper abdominal area. The discomfort is frequently described as vague “aches,” “sensations,” or “feelings.” It has also been described as “pressure,” “burning,” “squeezing,” heaviness,” “smothering,” “tightness” and “indigestion.” Other symptoms associated with angina are shortness of breath, sweating, nausea, belching and apprehension.

Management of this disorder is directed toward correcting the imbalance of oxygen supply and demand. If you are engaging in some activity, you should stop the activity and rest, which may relieve the discomfort. Drugs can be used to increase blood flow and oxygen to the heart muscle.

Nitroglycerin tablets are commonly used for anginal discomfort. After you sit or lie down, place the tablet under your tongue for immediate absorption and relief. If there is no relief after five minutes, a second nitro tablet is placed under the tongue. If you get no relief after another five-minute interval, place a third tablet under your tongue. If you still get no relief with this sequence of three nitroglycerin tablets, call 911 immediately and go to the nearest Emergency Room. Nitroglycerin tablets can cause you to experience a headache and a “flushed” feeling. You should carry the nitroglycerin with you at all times. It should be kept in the original dark bottle and should be replaced when it has expired. Other medications known to treat angina are: calcium channel blockers, beta blockers and long-lasting nitrates. When predictable angina becomes unpredictable in its course, it is called unstable angina. This disorder requires more aggressive therapy. You should notify your primary care physician or our office if your symptoms occur more frequently or the pattern changes.


  1. Pain or discomfort in the shoulders, arms, chest, neck, jaw, back, or between the shoulder blades
  2. Short of breath or fatigued
  3. Nauseous
  4. Angina pain may also feel like indigestion

The symptoms of angina can vary from person to person.

Treatments & Investigations

  • Echocardiography
  • Implantable Cardiac Monitor (ICM)
  • Treadmill stress testing
  • Transoesophageal echocardiogram (TOE)
  • Pacemaker checks
  • Electrophysiology (EP) Study
  • Holter monitoring

Useful info and health tips


Angina occurs when the heart doesn’t get all of the oxygen-rich blood it needs to work properly. This often happens when one or more of the arteries that feed the heart—the coronary arteries—are narrowed or blocked.


Angina is not a disease.  It’s a symptom of an underlying heart condition. Often this condition is coronary heart disease (CHD), which occurs when plaque builds up in the heart’s arteries. Angina can also signal coronary microvascular disease: damage to the walls and lining of the blood vessels branching off from the arteries that provide blood to the heart.

Other conditions that can cause chest pain include:

  • Pulmonary embolism (a blockage in a lung artery)
  • Cardiomyopathy (diseases of the heart muscle)
  • Aortic dissection (a tear in the aorta)
  • Aortic stenosis (narrowing of the aortic valve)
  • Pericarditis (inflammation of the heart’s surrounding tissue)
  • Lung infection
  • Gastroesophageal disease (GERD)


Your doctor will first want to determine whether the angina is stable (a regular pattern of the heart overworking) or unstable (unexpected chest pain, that does not follow an expected pattern). Because unstable angina can signal a heart attack, your doctor may order the following tests:

  • Blood tests
  • Chest X-rays
  • Computed tomography (CT) angiography
  • Electrocardiogram (EKG)
  • Stress testing
  • Echocardiogram


Treatment for angina depends on the type and underlying cause. Lifestyle changes, medication and cardiac rehab may be used to treat stable angina and decrease your risk for heart attack.

If you have unstable angina, your doctor will first need to find the blocked parts of the coronary arteries by performing a cardiac catheterization. Depending on the extent of the blockages, you may need surgery.

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