Angina (angina pectoris)

Angina, also known as angina pectoris or stenocardia, refers to a sudden attack of sharp pain in the area of the heart (cardiac region). The pain may occur, for example, during physical exertion or stress. A common cause of this pain is the narrowing of one or more arteries in the heart. As a result, some of the heart muscle receive an inadequate supply of blood and oxygen.

At a glance

  • Angina is usually due to coronary heart disease.
  • With this condition, arteries in the heart are often narrowed, producing sharp pains in the chest.
  • A surgical procedure may be necessary, depending on the severity of the symptoms. 

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Angina pectoris: old man sitting on a bed looking tired and clutching his chest.

What is angina?

The Latin term “angina pectoris” means “tight chest”. Angina pectoris, often referred to simply as angina, may develop if one or more cardiac arteries become narrowed due to vascular calcification (arteriosclerosis).

It may be triggered by physical exertion or stress. The heart muscle no longer receives an adequate supply of blood and oxygen, resulting in sudden, sharp pains in the area of the heart.

Important: Chest pain may also indicate a heart attack. In this case, immediate medical assistance is essential! If in doubt, anyone suffering from angina at night, for instance, should not wait until the next morning for assistance. Instead, they should dial emergency services on 112 (NOT the General Practitioners’ emergency on-call service) and request that an ambulance be sent immediately.

What are the signs of angina?

The are a number of ways in which angina may manifest. There may be mild chest pains only, for example when climbing the stairs. However, it can also lead to sudden, severe pain in the cardiac region. These may radiate outwards into the left arm, lower jaw, upper abdomen, or back.

In most cases, these pains only last during the period of exertion, and fade after a few minutes. With advanced heart disease, the pain may also last for longer or begin again as soon as the sufferer moves.

What causes angina?

Angina is often the first tangible indication of coronary heart disease. When the blood vessels that supply the cardiac muscle (i.e., the cardiac arteries) become “calcified”, narrow sections occur that hinder the flow of blood to the area.

In most cases, this only becomes evident when the heart needs increased blood and oxygen – for example, during physical exertion. This is why the pains and feelings of tightness in the chest subside when the body is at rest. This condition is referred to as “stable angina”.

If chest pain occurs while a person is still at rest, i.e., without any prior stress, this is referred to as “unstable angina”. In most cases, this indicates that a blood clot has formed and the blood vessel is almost entirely blocked. This condition can cause damage to the cardiac muscle.

If a coronary artery becomes completely blocked, this results in a heart attack. In this case, immediate treatment is essential to prevent part of the heart muscle from dying.

What are the risk factors for angina?

Risk factors for angina are smoking, being severely overweight, high cholesterol levels, high blood pressure and type 2 diabetes.

The main risk factors for angina are smoking, being heavily overweight, an elevated cholesterol level, high blood pressure, and type 2 diabetes. The risk of disease increases with age.

Why is high blood pressure dangerous?

The video below explains what happens in the body in the event of high blood pressure. What consequences can high blood pressure have and how can it be lowered?

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How does angina progress?

Doctors use a grading system for angina, with four classes to indicate varying degrees of severity:

Grade 1

Chest pain during sudden mental or physical strain but not during everyday activities like walking or climbing the stairs

Grade 2

Chest pain during heavy exertion, such as running at speed, walking uphill and walking upstairs after meals – also in conjunction with cold or mental stress

Grade 3

Chest pain during light physical exertion, such as regular walking or getting dressed

Grade 4

Chest pain while at rest or during tasks involving minimal physical exertion

Severity of angina pectoris: grade 1 “mild” to 4 “severe”.

Important: The severity of the angina does not necessarily depend on the blood supply to the cardiac muscle. As a general rule, however, someone suffering from angina is also more likely to suffer a heart attack or other consequences of coronary heart disease.

What can be done to prevent angina?

Anything that can be done to maintain a healthy cardiovascular system is also a suitable means of preventing this condition:

It has yet to be established whether vitamins and dietary supplements help prevent heart disease.

How is angina diagnosed?

Chest pain has many potential causes, including problems with the muscle and bones in this area. 

The main method used to detect angina is an electrocardiogram (ECG). An ECG records the electrical signals in the heart at rest or under stress.

Tests that produce images of the heart, e.g., via ultrasound (echocardiogram), are also possible. In certain cases, additional tests may be required. The determining factors are age, the type of symptoms involved, and the presence or absence of additional diseases.

Angina occurs as a result of coronary heart disease. Therefore, the risk of developing further complications is also investigated. To enable precise treatment planning, doctors will perform another battery of tests, including: 

  • blood pressure measurement
  • thorough physical examination
  • test for metabolic disorders (e.g., type 2 diabetes)
  • identification of risk factors

What screening options are available?

In Germany, people over 35 with health insurance are entitled to a health check by a doctor once every three years. The screening examination is intended, in particular, to detect indications of cardiovascular disease, diabetes, and kidney diseases. The check includes a blood and urine test and a measurement of blood pressure. 

How can angina be treated?

With stable angina, medication, such as beta blockers, calcium channel blockers, and nitrates, can relieve everyday symptoms and improve quality of life. If treatment with these medications is insufficient, a procedure can be attempted to widen the constricted coronary artery using a cardiac catheter.

A bypass operation is possible if an artery is significantly constricted or if several arteries are affected. In this surgical procedure, an artery is taken from elsewhere in the body and used to “divert” blood around the blocked artery.

Treating angina can also help prevent the development of complications such as a heart attack or cardiac insufficiency – for example, by ensuring a healthy diet and sufficient exercise. Smokers are advised to quit. Various medicines are also available to at least prevent the development of secondary diseases.

For more detailed information about angina and which medications are available, visit gesundheitsinformation.de.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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