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Angina: Types, Differential Diagnoses & Alarming factors

Chest pain can be due to many reasons, some of which may be of cardiac origin. In this article, you can read more about the causes of chest pain, other factors that may lead to it, and how to differentiate between these types. Cardiac causes of chest pain include heart disease and other conditions like pericardial disease.


Ischemic heart disease is a condition that happens when the coronary artery and its branches that supply the blood with oxygen to the heart muscles become clogged due to the buildup of plaque. This plaque is formed due to a variety of factors, foremost of which include inflammation and deposition of fat. This is otherwise known as atherosclerosis of the coronary arteries. Another situation encountered in ischemic heart disease, when the coronary vessel is contracted, is known as coronary vasospasm. A combination of these factors leads to a sudden reduction in the amount of oxygen available to the heart. A specific kind of chest pain occurs when the heart suffers from a lack of oxygen. This is known as angina.


When you are doing exercise for demanding tasks, the necessity of the heart to pump more blood also increases its requirement for oxygen. Hence, exercise and challenging tasks can trigger angina. On the other hand, when angina is only triggered due to exercise or increased activity, it is known as stable angina.


In some cases, even without plaque deposition in the coronary arteries,  the coronary arteries may contract vigorously, reducing the available blood for the heart tissue. This is known as vasospastic angina and is unrelated to coronavirus atherosclerosis.

Types of angina:


Angina is generally divided into four types:


  • Stable angina - As discussed above, this type of angina occurs when the heart works harder than usual, and the available blood supply does not meet the oxygen demand through the coronary arteries. Rest or medication may relieve the symptoms, but the person may experience recurring symptoms for months or years.


  • Unstable angina - This type of angina does not have a routine. It occurs even at rest and is most commonly due to atherosclerosis or deposition of plaque within the coronary arteries leading to less blood reaching the heart muscles. If you have unstable angina, you should seek medical care.


  • Microvascular angina - This particular type of angina occurs when the minor branches of the coronavirus artery are affected by Coronary microvascular disease or MVD. The person may also experience fatigue, low energy sleep problems, and shortness of breath. Microvascular angina usually lasts longer than stable angina and lasts between 10 and 30 minutes in each episode.


  • Variant angina - Also known as vasospastic angina or Prinzmetal angina, this occurs when the coronary arteries contract and go into spasm due to triggers such as cold, dress, medication, or drug use such as cocaine. It usually occurs around midnight or early morning.


  • Refractory angina refers to episodes of angina that keep coming back even after medication and Lifestyle changes.

Symptoms you may experience if you have angina include:


  • Squeezing, pressure, heaviness, burning, or a tightening sensation in the chest
  • Symptoms of indigestion
  • General weakness
  • Shortness of breath
  • Sweating
  • Nausea or feeling like vomiting


Women may experience slightly different symptoms, dominated by nausea and vomiting, abdominal pain, weakness, dyspnea, or shortness of breath. 


Stable angina may be triggered by physical exertion and stress at low temperatures.

When should you seek medical care?


Angina is a severe condition and should not be ignored. The most dangerous type is unstable angina, and you should visit the emergency department if you are experiencing chest pain. Other types of angina are severe and can be managed with medication, care, and lifestyle changes. Chest pain may also occur due to a variety of reasons. So, getting it checked and diagnosed is essential before getting anxious about it.


You can read more about ischemic heart disease,  its causes, symptoms, risk factors,  diagnosis, and treatment in our articles here and here.

DR. Alkesh Jain
Cardiac Care
Meet The Doctor
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