What Causes Severe Chest Pain or Pressure?
Angina (chest pain or pressure) develops when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed or blocked by fatty plaque deposits. This restricts blood flow to the heart. When the heart's demand for oxygen exceeds the restricted blood supply, it can trigger pain and discomfort. There are two main types of angina:
- Stable Angina
With stable angina, chest pain and discomfort consistently occur during periods of increased exertion or stress (when the heart's demand for oxygen rises). Activities like exercise, climbing stairs, or experiencing strong emotions can trigger angina symptoms. However, the discomfort is predictable and reversible. It typically subsides within 5 minutes of resting or taking angina medication.
Stable angina pain often feels like a pressure, squeezing, tightness, or aching sensation in the chest. It can sometimes radiate to the jaw, neck, shoulders, arms, or back. The location and intensity are generally consistent with each episode. While not immediately life-threatening, stable angina indicates underlying coronary artery disease is restricting blood supply to the heart muscle.
- Unstable Angina
Unstable angina is characterized by sudden, unexpected chest pain and discomfort occurring even at rest. Unlike stable angina, it can occur with minimal exertion or stress. Unstable angina can wake a person from sleep and tends to be more severe and prolonged than stable angina pain.
Unstable angina indicates significant blockages in the blood vessels supplying the heart - often from a fresh blood clot forming over a plaque deposit in an artery or significant narrowing of the plaque. It signifies a high risk that a heart attack is imminent if treatment is not sought promptly. Unstable angina requires emergency medical care.
The unpredictable, intense nature of the pain differentiates unstable angina. Its emergence at rest is a warning sign of impending heart attack. Unstable angina is considered a medical emergency requiring rapid treatment to restore adequate blood flow and prevent heart muscle damage.
The symptoms of angina typically come on when the heart is working harder than usual, such as during physical activity or emotional stress. They may also be brought on by cold weather, eating a large meal, or smoking and can vary from person to person.
Symptoms of Angina
- Chest pain
This is the most common symptom of angina. The pain is usually described as a squeezing, pressure, or fullness in the chest. It may also radiate to the arms, neck, jaw, or back.
- Shortness of breath
This can occur with or without chest pain.
Some people with angina may feel nauseated or vomit.
This can occur if the heart is not getting enough oxygen.
This is a serious symptom of angina and requires immediate medical attention.
Testing & Diagnosis for Angina
The patient's medical history is an important part of the diagnostic process for angina. The doctor will ask about the patient's past medical problems, medications, and family history of heart disease. The doctor may also listen to the patient's heart and lungs for any abnormalities.
To confirm the diagnosis of angina and/or to rule out other possible causes of the symptoms, other diagnostic tests may be conducted. These tests may include:
- Electrocardiogram (EKG)
This test measures the electrical activity of the heart. An abnormal EKG can be a sign of angina.
- Chest X-ray
This test can show the size and shape of the heart, as well as any fluid buildup in the lungs.
This test uses sound waves to create images of the heart. An echocardiogram can show any damage to the heart muscle or valves.
- Stress test
This test is used to see how the heart responds to physical activity. The patient will walk on a treadmill or ride a stationary bike while the doctor monitors their heart rate, blood pressure, and EKG.
- Coronary angiogram
This test is used to see the inside of the coronary arteries. A thin tube is inserted into a blood vessel in the arm or leg and threaded up to the heart. A dye is injected into the tube and the doctor uses X-rays to see the blood flow through the arteries.
Treatments for Angina
The treatment for angina depends on the severity of the condition and the patient's overall health. In some cases, lifestyle changes may be enough to control angina. In other cases, medications, and procedures such as angioplasty or surgery may be necessary. With proper treatment, most people with angina can live a normal, active life.
- Lifestyle changes
Making lifestyle changes, such as losing weight, eating a healthy diet, exercising regularly, cutting back on alcohol, and quitting smoking, can help reduce the risk of angina and improve overall heart health.
There are a number of medications that can help control angina, including nitroglycerin, beta-blockers, and calcium channel blockers.
Angioplasty is a procedure that uses a balloon to widen a narrowed coronary artery. A thin tube is inserted into a blood vessel in the arm or leg and threaded up to the heart. A balloon is inflated at the narrowed area of the artery to widen it.
- Coronary artery bypass grafting (CABG)
Coronary artery bypass grafting is a surgery that creates a new path for blood to flow to the heart. This is done by taking a blood vessel from another part of the body and grafting it onto the coronary artery.