Last updated on January 7, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on January 7, 2022
Have you experienced chest pain before? Maybe as a result of acid reflux or heartburn or even sometimes as a result of muscle soreness after a chest workout. While these are common types of chest pain we may experience in our day to day lives, sometimes, people may experience pain particularly in the left side of their chest. Since this is where the heart is located, it is important to take pain in the left side of the chest seriously.
Angina is a type of chest pain that happens because there isn’t enough blood flow to any part of the heart. This can happen because there is something that is blocking the arteries of your heart or there is low blood flow in the arteries that bring oxygen-rich blood to your heart. Angina can translate into pain in the left side of the chest so by itself is not a disease but can be indicative of serious heart disorder. Angina can sometimes go away quickly but stil,l it should not be ignored. Consulting a doctor and getting tests done to find out the underlying cause is essential to prevent angina from developing into a complication.
There are different types of angina and most of them can be improved using medications, lifestyle changes and surgery, in extreme cases. Read on to find out about angina, how it occurs in Indian patients, its causes and management to help you be better prepared in case of an emergency.
Have you experienced chest pain before? Maybe as a result of acid reflux or heartburn or even sometimes as a result of muscle soreness after a chest workout. While these are common types of chest pain we may experience in our day to day lives, sometimes, people may experience pain particularly in the left side of their chest. Since this is where the heart is located, it is important to take pain in the left side of the chest seriously.
Angina is a type of chest pain that happens because there isn’t enough blood flow to any part of the heart. This can happen because there is something that is blocking the arteries of your heart or there is low blood flow in the arteries that bring oxygen-rich blood to your heart. Angina can translate into pain in the left side of the chest so by itself is not a disease but can be indicative of serious heart disorder. Angina can sometimes go away quickly but stil,l it should not be ignored. Consulting a doctor and getting tests done to find out the underlying cause is essential to prevent angina from developing into a complication.
There are different types of angina and most of them can be improved using medications, lifestyle changes and surgery, in extreme cases. Read on to find out about angina, how it occurs in Indian patients, its causes and management to help you be better prepared in case of an emergency.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
Angina is a kind of chest pain that happens because of reduced blood flow to the heart. Angina is not an illness by itself but a symptom of many underlying heart disorders. It is often a symptom of coronary artery disease. Angina is primarily associated with left side chest pain. This health issue is also known as angina pectoris.
Generally, men above the age of 45 years and women above the age of 55 years are at greater risk of developing angina. Young people rarely experience left side chest pain due to angina pectoris. The prevalence of angina among the Indian population has decreased from 27.8% to 11.2% over the last few years. Nevertheless, it’s always better to be wary about the condition.
Angina often causes a tight feeling in the chest. It can also create pressure or heaviness in the chest. People often describe angina as something heavy is placed on their chest or squeezing on their chest. Sometimes symptoms of angina can be a kind of recurring pain that usually goes away with proper treatment. Angina is quite common but it can also be hard to distinguish it from other types of chest pain. If you are suffering from unexplained left side chest pain, it’s best to seek medical attention at the earliest and rule out your diagnosis.
There are different types of angina, including stable, unstable, variant and microvascular angina. It is important to be able to understand the different types of angina to understand the complications associated with it. Angina is associated with an increased risk of heart attack and other heart disorders. Any type of angina can cause discomfort or pain in the chest as oxygen-rich blood does not reach the heart. The discomfort can slowly reach your shoulders, neck, arms, back and jaw. Pain associated with angina sometimes can be confused as indigestion.
Sudden left side chest pain can also be indicative of a heart attack. It can also suggest other medical issues such as lung disorder or inflammation. It’s advised to seek immediate medical attention if your chest pain eventually reaches other areas of your body, such as your arms, back and neck and also especially if the chest pain is accompanied by nausea, fatigue and vomiting.
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Angina is a type of chest pain that causes tightness, pain and heaviness in the chest. Before we look into what causes this kind of chest pain, let’s briefly explore the various types of angina.
Stable Angina – The signs and symptoms of stable angina involve a person feeling brief episodes of pain, pressure, squeezing and a tight feeling in the chest. In the case of stable angina, the signs and symptoms can be aggravated while doing moderate physical activities. The stable angina symptoms usually disappear with a little rest. The pain may radiate to the shoulders, back and arms.
Unstable Angina – Unstable angina symptoms can be felt without doing any strenuous activity. Even while resting, the symptoms of unstable angina can be felt. The cause of unstable angina symptoms is primarily blood clots blocking an artery. Blood clots are formed and can also get dissolved partially. Unstable angina symptoms are severe pain and discomfort that last longer than symptoms of stable angina. The patient should be given immediate medical care as this may lead to a heart attack if left untreated.
Prinzmetal Angina – Prinzmetal angina is a condition where there is a sudden spasm in the coronary artery. This as a result leads to artery narrowing. Once the artery narrows it reduces the blood flow to the heart and can cause acute pain in the chest. It may also cause a feeling of the heart being squeezed. Rare type of angina that occurs almost always during midnight or early morning. Pain is severe and usually occurs in cycles that come and go. Immediate treatment by an expert can be very helpful.
Microvascular Angina – This type of angina is usually a symptom of coronary microvascular disease (MVD). MVD is a heart disease that affects the tiny coronary arteries (blood vessels that supply oxygenated blood to the heart) that branch off from the larger coronary arteries. The pain may be more severe than other types of angina and it usually lasts longer than 10 minutes. Symptoms of microvascular angina include shortness of breath, fatigue, troubled sleep and lack of energy. The treatment depends on the underlying cause, but dietary changes and lifestyle modifications can help a great deal in long term management along with prescribed treatment.
Chest pain should not be ignored. It can be caused by many underlying conditions. In most cases, it is related to the heart. However, it is worth noting that chest pain may also be caused by problems in your lungs, oesophagus, muscles, ribs or nerves. Some of these conditions can even be life-threatening, while others are not. If you have unexplained chest pain, it is important you consult your doctor at the earliest to identify its cause.
Listing down some causes of left side chest pain:
Coronary heart disease
Coronary heart diseases cause a plaque buildup in arteries responsible for supplying blood to the heart. It is often responsible for high blood pressure and chest tightness. This is the commonest cause of angina.
Ischemia
It is a condition in which some parts of the body, such as the heart or brain, do not get an adequate supply of blood. It is a leading cause of chest tightness symptoms.
Atherosclerosis
It leads to a buildup of plaque (sticky, fatty substance) in the arteries. As the arteries become narrow and hard, blood flow is restricted, causing high blood pressure and chest tightness. Atherosclerosis prevention involves adopting lifestyle changes like quitting smoking, staying physically active, managing stress and following the diet chart for heart patients.
Panic Attack
Panic attacks can cause overwhelming sensations of impending fear and high anxiety. It is often associated with chest discomfort or pain along with fast breathing, sweating, nausea and a racing heart.
Pericarditis
Angina pectoris may also be caused by inflammation of the pericardium leading to pericarditis. The pericardium is a sac-like structure consisting of thin layers of tissue surrounding the heart. The heart is held in place and made to work with the help of the pericardium. Pericarditis treatment usually involes taking certain medications or undergoing surgerical procedures like pericardiocentesis and pericardiectomy.
Cardiomyopathy
A condition affecting the muscular structure of the heart makes it difficult for the heart to contract and relax in order to pump blood efficiently. It is often a reason behind heart failure and immense pain on the left side of the chest. A few types of cardiomyopathy include dilated hypertrophic and restrictive cardiomyopathy. Cardiomyopathy treatment may involve taking medications, undergoing non-surgical procedures like septal ablation, or surgical procedures like septal myectomy and heart transplant.
Heartburn acid reflux or GERD
Due to this Gastroesophageal Reflux Disease, stomach acid flows back to the oesophagus, which is a tube-like structure that connects the mouth to the stomach. It can often create sensations of heartburn and cramping feelings in the chest. This is often confused with the symptoms of angina.
Hiatal Hernia
In the case of a hiatal hernia, the stomach bulges through an opening in the diaphragm. It can happen to people irrespective of their gender and age. One of the major symptoms of a hiatal hernia is pain on the left side of the chest.
Chest Wall Injuries
Having an injury in the chest walls such as a fractured sternum, fractured ribs and bruising to the lungs can result in chest pain.
Pulmonary hypertension
Left side chest pain can also be experienced due to pulmonary hypertension. Pulmonary hypertension should be given immediate medical attention to avoid complications.
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Symptoms of an Angina attack are often confused with normal chest pain. Therefore, it is important to know the symptoms that indicate an angina attack in particular.
Heartburns
It revolves around a burning pain in the lower chest or the upper belly. Severe heartburn like symptoms can also be experienced during angina attacks.
Nausea and dizziness
If you experience sudden nausea and pain along with chest pain in the left side, it might be an indication of an angina attack.
Discomfort in the stomach
A feeling of discomfort in the stomach can be an indication of an angina attack. Angina may be caused after eating a heavy meal. This usually happens when the blood in the colon cannot flow freely and meet the energy needs of the internal organs in our body.
Shortness of breath
Another sign of angina is shortness of breath in individuals. As a result of decreased blood flow, people experience breathing trouble.
Panting and excessive sweating
Due to a decreased supply of blood, panting and excessive sweating can occur. These usually are initial signs of angina.
Heavy feeling in the chest
Any kind of heavy feeling in the chest is associated with an angina attack.
Pain radiating to arms, back and shoulders
Severe, excruciating, squeezing kind of pain in the chest
Unexplained weakness and lack of energy
After knowing what angina causes, it’s important to know when you’re having an angina attack so that the right steps can be taken to prevent complications.
The first thing to do while having an angina attack symptom is to stop whatever you were doing, take deep breaths and try to relax. Sometimes the attack can be a pain that is confused with symptoms of heartburn or just extreme stress and deep breathing can help relieve the pain. But never ignore an episode of left side chest pain, do not exert and call or visit a doctor immediately. Some sublingual tablets (prescribed by doctors to patients at risk) can help in calming angina signs and symptoms. However, it is advised to speak to your doctor before taking any medications to reduce the effects of chest pain.
Some angina attacks worsen at night or early in the morning. Therefore, it is necessary to opt for medications prescribed by your doctor to alleviate the symptoms that angina causes.
Supplement your treatment of angina with the right health care products.
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Angina is usually diagnosed based on the symptoms it presents. Other ways angina can be diagnosed are:
Circumstances that trigger or relieve the pain
Circumstances that trigger the chest pressure symptoms of angina include climbing stairs, exercising and walking. Sometimes even emotional stress can trigger angina pain. There are also several situations that can relieve the pain associated with angina. The methods of relieving pain associated with angina will depend on the type of angina you have.
Type of pain (choking, burning, pressing, squeezing, dull, bursting)
A person with angina can suffer from different kinds of pain. Sometimes the angina pain will feel like it’s choking you. In some cases, angina causes a burning sensation in the chest. It can also be a pressing or squeezing feeling on the chest. But the level of the pain can vary from dull to bursting pain.
Location and radiation of pain
Typical locations where angina pain can be felt include the arms, neck and shoulders. Even though the pain originates in the chest, it usually spreads to other areas in the upper part of the body.
Duration of pain
Stable angina pain can last for around five minutes. In rare cases, the pain can extend up to 15 minutes.
Persistent pain in the chest may indicate an underlying condition that is yet to be detected. If you have chest pain that is not going away, your doctor may recommend a few diagnostic tests such as:
Stress test
An angina diagnosis can be made with the help of stress tests that will usually require you to engage in physical activity. You might be asked to walk on a treadmill while an ECG will be recorded. It will help in evaluating if your heartbeat reached an appropriate rate during the time of the exercise.
2-D Echo Test
It is a non-invasive test that helps in evaluating the functioning of the heart. Sound waves are used to capture images of chambers, valves and the main blood vessels of the heart. This diagnostic test, which is used to identify the underlying cause of angina, can also help in detecting blood clots, abnormality of blood flow within the heart, different types of congenital heart diseases and tumours.
Blood tests
Some blood tests can help in stable angina diagnosis with the identification of certain enzymes in the body. Enzymes like troponin are leaked in the body after you suffer a major angina attack. Blood tests also help in checking the cardiac markers and if cholesterol, LDL and triglycerides are high, which are often a cause of chest pain.
ECG/EKG
An electrocardiogram is used to monitor the electrical activity of the heart. It can help in identifying heart abnormalities in a person and the root cause of chest pain.
MRI
Imaging tests like MRI can help in the diagnosis of angina. The evaluation of blood flow using imaging tests is often done twice. Once it is done while you are resting, another time it might be performed while making you do an activity that puts stress on your heart. Performing the test twice helps in understanding if the blood flow to the heart decreases only during strenuous activities. Imaging tests can also find if there are any scars in the heart muscle.
Coronary angiography
The test is helpful in the diagnosis of angina by evaluating the coronary vessels. The coronary vessels are responsible for supplying blood and oxygen to the heart. You can take coronary angiography to find out if your coronary vessels have narrowed without the use of a catheter (a thin flexible tube that is inserted inside the vessel). The narrowing of the coronary vessels is often caused due to plaque in the arteries.
Cardiac catheterization
In the case, of cardiac catheterization, a thin and long plastic tube is inserted into an artery in the hand or groin. A wire is used to guide the catheter inside the coronary artery for stable angina diagnosis. It helps in determining if the vessels have become narrow. It is possible to reopen the narrowed portion in the vessels with the help of stents or balloons.
Chest X-ray
A chest x-ray is a non-invasive method for the diagnosis of the causes of chest pain and the treatment that can be followed It can help in ruling out causes of chest pain such as pneumonia.
CT Scan of the chest
A CT scan of the chest is a little more advanced than a chest x-ray. Chest CT can help in identifying aortic diseases or clotting of blood in the vessels, which can suggest causes of chest pain and the potential treatment options for the same.
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There are several angina treatment options available. The treatment plan depends on the type of angina, underlying medical conditions and various other factors. Lifestyle changes, medications and surgeries can help in treating angina and improve the quality of life. However, you must consult your doctor to find the treatment plan that is most suited for you.
Many medications can help in improving the symptoms of angina by addressing the underlying cause. Lifestyle modifications alone may not help, your doctor will prescribe some medications and other precautions, e.g. less physical exertion for some cases.
If angina is found to be a symptom of a more complicated underlying issue, surgery may be employed to treat the root cause. The different surgical procedures for stable and unstable angina treatment depend on the underlying causes. They include:
Angioplasty
An angioplasty helps in increasing blood flow through the blood vessels. A tiny but inflated balloon is used to widen. the narrow arteries. This may usually be done in the case of coronary artery disease. Sometimes a small metal tube called a stent is inserted to prevent the artery from becoming narrow again. The surgical procedure for the treatment of angina pectoris takes around 30 minutes of time. An individual undergoing this surgery might be required to stay in the hospital for a night.
Coronary Artery Bypass Graft (CABG)
CABG is required for severe cases of stable angina pectoris. This is done when an artery is completely blocked and unable to supply blood to the heart. This procedure is based upon bypassing the narrowed artery using other blood vessels to restore the normal blood supply.
Coronary Artery Bypass Graft can help in improving blood supply to your heart and the survival rate also increases after undergoing bypass surgery.
Enhanced External Counterpulsation (EECP)
EECP is recommended for people whose angina does not show improvement with other forms of treatment. Large cuffs are wrapped around the legs as part of this therapy. The cuffs are inflated and deflated alternatively to push blood to the heart and help in increasing blood supply to the heart and significantly improving heart function. The treatment usually lasts for seven weeks. Five one-hour treatments are required each week.
In other cases, your doctor may recommend lifestyle changes and home remedies to aid stable and unstable angina treatment such as:
Maintain blood pressure, blood sugar and lipid profile in a healthy range
If you want to manage the causes of chest tightness, it is crucial to keep blood pressure, blood sugar and lipid profile under control.
Lower stress levels
Avoiding stress and finding ways to relax can help in reducing the risk of squeezing feelings in the chest. You can ask your doctor to recommend other stress reduction techniques.
Meditate to improve mental health
Emotional stress can trigger squeezing feelings in the chest of individuals. Therefore, it is important to think about your mental well-being along with your physical health. Meditation is a good technique for improving your mental health and calming your nerves.
Stick to a balanced and healthy diet
Eating well is key if you want to eliminate the causes of chest pressure and other heart diseases. Maintain a healthy diet that contains heart-healthy foods and make sure to limit trans fat, sugar, salt and saturated fats.
Regular checkups with your doctor
Going to regular checkups can help your doctor detect the causes of chest pressure. If you experience symptoms of angina, do not hide them from your doctor.
Exercise and stay active
Exercising and staying active will help in keeping your body weight in check. Being overweight often increases the risk of symptoms of angina pectoris. You can also try out some exercises for heart patients to stay physcially fit, without putting your heart under pressure.
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Unfortunately, angina, if left untreated or undiagnosed can lead to several heart-related complications – some that can be life-threatening and others that can cause significant damage to other parts of the body. Therefore, is it vital not to ignore any signs of left side chest pain or chest tightness in general and always get it checked to rule out any possible underlying condition that may have caused it.
Some common complications of angina include:
Heart attack
When the coronary arteries become too narrow, they completely cut off blood supply to the heart. It results in a buildup of cholesterol within the body. If a piece of this cholesterol breaks off, it can block the blood vessels. Due to deprivation of oxygen, the blood cells begin to die and cause heart attacks.
Heart failure
When the heart is unable to pump blood to the body, it is known as heart failure. The heart muscle might have trouble doing its job even though it is very strong. The heart tries to compensate by building more muscle, beating faster or stretching to accommodate more blood. This compensation can cause heart failure. The difference between heart attack and heart failure is heart attack occurs when the blood flow to the heart is suddenly cut off, while heart failure happens when the heart is unable to pump blood as efficiently as it should.
Chances of stroke
When the heart fails to perform effectively, blood clots form in the blood vessels. If one of these blood clots gets lodged in the brain and disrupts blood flow, a stroke can occur. Seeking immediate treatment for a stroke is necessary as it gradually leads to the death of too many brain cells.
Peripheral Artery Disease
It involves the narrowing of the vessels responsible for supplying blood to the arms and legs.
Atrial fibrillation
This results in the irregular beating of the upper chambers in the heart. The condition increases the risk of having a stroke or heart failure. Atrial fibrillation treatment usually involves taking certain medications, undergoing surgical procedures or cardioversion, which is a form of therapy used to reset heart rhythm.
If you think you have the symptoms of this condition, be sure to consult with a doctor immediately. Taking diagnosis tests will help you find the underlying causes immediately and get you on a treatment for a fast track recovery. Angina attack symptoms can crop at any moment so be sure that you take care and are observant about any changes that you may notice. There are various treatment options and tests that you can take up to ensure that you are on the right track to your treatment and recovery. Making those necessary lifestyle changes will benefit you during and post your treatment of angina. It is important to take care of yourself and it is a process but your health is your first priority so be sure to take no chances with that.
Manage the symptoms of angina with the right medicines!
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While angina itself may not be life-threatening, it is indicative of other underlying heart disorders which if not treated immediately can lead to life-threatening consequences. You will be at an increased risk of a heart attack or stroke if you suffer from angina. It is important to seek medical attention if you experience any signs and symptoms of different types of angina.
Pain associated with stable angina can disappear after resting for some time. The duration of the pain varies from time to time and depends on the type and cause of angina. The symptoms of feeling chest pressure remain stable for around two months. Some medications prescribed by your doctor can help in reducing the symptoms of angina a few minutes after taking it.
Angina can be managed with the help of proper treatment. Some sublingual tablets are mostly used for alleviating the pain associated with angina. Sometimes surgical methods like angioplasty are used to fix angina in patients. Lifestyle changes can also help in reducing the risk of angina.
Angina is caused when the arteries supplying blood to the heart become narrow. A buildup of fatty substances or clots in the vessels obstructs an adequate supply of blood to the heart muscles. Inadequate blood supply to the heart makes it difficult for it to function.
An ECG is often used to detect the causes of different types of angina in an individual. This test helps in evaluating the functioning of the heart. Angina may or may not be detected every time in ECG. In such a case your doctor may advise other tests like 2-D Echo, MRI or angioplasty for a better understanding of the condition.
Angina does not reduce life expectancy as it is a symptom instead of a disorder. However, the complications associated with angina can result in a low survival rate. Unstable angina symptoms are experienced even while resting. Therefore, it is important to seek treatment as soon as you experience the symptoms of angina. People who are treated for angina can live for long.
If you suspect you have angina, you should not exert at all and immediately go to your doctor. A doctor might ask you to undergo certain medical tests to become sure if you have angina. Unstable angina symptoms might not be persistent but seek immediate medical attention without delay will help you get better with the right treatment.
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