Angina

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. It occurs when the heart muscle does not receive enough oxygen-rich blood, resulting in discomfort, pressure, or squeezing in the chest. Angina is not a disease but a symptom of an underlying heart condition, typically coronary artery disease (CAD). While angina itself is not immediately life-threatening, it indicates an increased risk of heart attack, cardiac arrest, or sudden cardiac death.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG) | MRCP (UK) | MMed (Internal Med) (SG) | FAMS (Cardiology, SG)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Angina

Angina can cause a range of symptoms, with varying degrees of intensity and how they appear in each individual.

Chest Pain or Discomfort

The most common symptom is a feeling of pressure, tightness, or squeezing sensation in the chest, often described as heaviness or burning. This discomfort may radiate to the shoulders, arms, neck, jaw, or back.
Shortness of Breath

Some patients experience difficulty breathing during an angina episode. This occurs when the heart struggles to pump efficiently due to reduced oxygen supply.
Fatigue

Unexplained tiredness, especially during physical activities that were previously manageable. The heart’s reduced efficiency can lead to general fatigue as the body receives less oxygenated blood.
Dizziness or Lightheadedness

Insufficient blood flow to the brain may lead to feelings of dizziness or a sense of faintness.
Nausea and Indigestion

Some individuals, particularly women, may mistake angina for digestive discomfort. Upper abdominal pain or nausea can sometimes accompany chest discomfort.
Sweating

Cold sweat may occur during an angina attack, as the body responds to cardiac stress through the autonomic nervous system reaction.

Causes and Risk Factors

Angina develops as a result of specific cardiovascular issues, typically caused by a combination of risk factors.

Coronary Artery Disease

The most common cause of angina is atherosclerosis, where fatty deposits (plaque) build up in the coronary arteries. These deposits narrow the arteries, restricting blood flow to the heart muscle.

Coronary Microvascular Disease

This condition affects the heart’s smallest arteries, causing angina even when the larger coronary arteries appear normal. It may not be detected through standard diagnostic tests.

Age

The risk of angina increases with age due to the progressive vascular changes that occur over time.

Family History

A genetic predisposition to heart disease increases angina risk. First-degree relatives with premature coronary artery disease significantly raises personal risk.

Hypertension

High blood pressure damages the arteries and accelerates atherosclerosis. Chronic hypertension forces the heart to work harder, increasing oxygen demand while simultaneously reducing supply.

Hyperlipidaemia

Elevated cholesterol levels, particularly high levels of LDL (“bad”) cholesterol, contribute to arterial plaque formation. This directly impacts coronary artery health and function.

Diabetes

People with diabetes have an increased risk of coronary artery disease. Diabetes accelerates atherosclerosis and often leads to more severe and widespread blockages in the coronary arteries.

Tobacco Use

Smoking damages blood vessels, increases blood pressure, and reduces oxygen in the blood. All these factors significantly increase the risk of angina.

Obesity

Excess weight places additional stress on the heart and increases the likelihood of developing other risk factors like diabetes and hypertension.

Diagnostic Methods

Medical History and Physical Examination

Diagnosis begins with a detailed review of symptoms, personal and family medical history, and a physical examination. Risk factors, pain patterns, and physical signs of cardiovascular disease are assessed to determine if further testing is necessary.
Electrocardiogram (ECG)

An ECG records the heart’s electrical activity and can detect abnormalities at rest or during an angina episode. It provides insight into heart rhythm, past heart attacks, and current ischaemia (reduced blood flow). However, a normal result does not rule out coronary artery disease, especially if symptoms are not present at the time of testing.
Exercise Stress Test

This test monitors heart activity during physical exertion, usually on a treadmill or stationary bike. As exercise increases oxygen demand, the test can reveal abnormalities not evident at rest. It evaluates changes in ECG, blood pressure response, and the development of symptoms, which helps assess functional capacity and detect ischaemia.
Cardiac Imaging

Various imaging techniques provide detailed views of the heart’s structure and function. Echocardiography uses sound waves to create moving images of the heart, while nuclear stress tests use radioactive tracers to evaluate blood flow. Cardiac MRI and CT scans offer detailed anatomical information about the heart and coronary arteries, identifying areas of reduced perfusion or structural abnormalities.
Coronary Angiography

This is the most definitive test for diagnosing coronary artery disease. It involves injecting a contrast dye into the coronary arteries and capturing X-ray images to identify the location and severity of arterial narrowing or blockages. This procedure is essential in guiding treatment decisions, particularly for revascularisation procedures.

Treatment Options

Management of angina requires a comprehensive approach that is tailored to each patient’s specific condition, risk factors, and overall health.

Non-Surgical Treatment

Medications: Various medications help alleviate angina symptoms and address underlying causes. Nitrates work by widening blood vessels, improving blood flow. Beta-blockers lower heart rate and blood pressure, reducing oxygen demand. Calcium channel blockers relax the coronary arteries, easing the heart’s workload. Anti-platelet agents help reduce the risk of blood clot formation. These may be used alone or in combination, depending on individual response and tolerance.
Lifestyle Modifications: Regular physical activity, a heart-healthy diet low in saturated fats and sodium, maintaining a healthy weight, and stress management all contribute to improved cardiac health. These changes help control risk factors such as hypertension, hyperlipidaemia, and diabetes while reducing the frequency and severity of angina episodes.
Cardiac Rehabilitation: Structured rehabilitation programmes provide supervised exercise, education, and psychological support for angina patients. These programmes help patients safely increase physical activity levels, gain a better understanding of their condition, and develop strategies for long-term management. Cardiac rehabilitation can help improve functional capacity, reduce hospital admissions, and enhance quality of life for many.

Surgical Treatment

Percutaneous Coronary Intervention (PCI): This minimally invasive procedure uses a catheter with a balloon tip to open narrowed coronary arteries. In most cases, a stent (small mesh tube) is placed to keep the artery open. PCI restores blood flow to the heart muscle, relieving angina symptoms in many patients. Drug-eluting stents reduce the risk of re-narrowing (restenosis) and improve long-term outcomes.
Coronary Artery Bypass Grafting (CABG): This procedure uses blood vessels from another part of the body to bypass blocked coronary arteries. CABG is typically recommended for patients with multiple blockages, left main coronary artery disease, or those with diabetes and complex coronary disease. The procedure provides significant symptom relief and may improve long-term survival for eligible candidates.
Enhanced External Counterpulsation (EECP): A non-invasive option for patients who cannot undergo invasive procedures or continue to have symptoms despite optimal medical therapy. EECP uses inflatable cuffs on the legs to increase blood flow to the heart and improve collateral circulation. This treatment requires multiple sessions over several weeks and can provide symptom relief for patients with refractory angina.

Are Your Symptoms
Affecting Your Quality Of Life?

Consult our MOH-accredited specialist for an accurate diagnosis & personalised treatment plan today.

Make an Enquiry

Prevention and Management

Managing angina focuses on controlling risk factors and supporting heart health. Regular exercise improves circulation and strengthens the heart, while a balanced diet helps manage weight and cholesterol. Regularly monitoring blood pressure and cholesterol enables early intervention, and managing diabetes through medication, diet, and glucose monitoring reduces complications. Quitting smoking benefits heart health immediately and long-term. Stress management techniques, such as mindfulness or yoga, help minimise triggers. Following prescribed medications and attending regular check-ups ensures ongoing assessment and treatment adjustments.

Frequently Asked Questions (FAQ)

How can angina be distinguished from a heart attack?

Angina usually improves with rest or nitroglycerine within minutes, whereas heart attack pain persists despite these measures. Heart attacks are often more intense and may also be accompanied by nausea, vomiting, or cold sweats. Any new, severe, or prolonged chest pain should be treated as a medical emergency and evaluated promptly to confirm the cause.

How does emotional stress trigger angina?

Emotional stress releases adrenaline, which increases both heart rate and blood pressure, raising the heart’s oxygen demand. For individuals with coronary artery disease, this can reduce blood flow to the heart muscle, potentially triggering angina. Managing stress through relaxation techniques, mindfulness, or breathing exercises may help reduce the frequency of angina episodes.

Can angina be cured?

Angina can often be well managed, but whether it resolves entirely depends on the underlying cause. Lifestyle changes and medical treatments can significantly reduce or eliminate symptoms. Revascularisation procedures may provide long-term relief, but ongoing management of cardiovascular risk factors remains necessary to prevent further disease progression.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG)|MRCP (UK)|MMed (Internal Med) (SG)|FAMS (Cardiology, SG)

A Senior Consultant Cardiologist specialising in interventional cardiology and serves as the Medical Director at Carrington Cardiology, located at Mount Elizabeth Medical Centre in Singapore.

Dr. Kua obtained his MBBS from the National University of Singapore. He furthered his medical education by earning an MRCP in the UK and an MMed in Internal Medicine from NUS. He completed advanced training in interventional cardiology at Hammersmith Hospital in London.
Dr. Kua’s international training at Hammersmith Hospital provided him with extensive experience in complex coronary interventions and exposure to advanced cardiovascular research. He served as an International Cardiology Fellow and Honorary Consultant during his tenure there.

Read Full Bio

Billing & Insurance