What is angina (angina pectoris) and what are its symptoms?
Angina pectoris (or angina) is chest pain caused by transient myocardial ischemia—the heart muscle temporarily receives insufficient oxygen due to narrowing of the coronary arteries. It is a cardiovascular warning sign that requires cardiological follow-up: any new, prolonged, or resting chest pain constitutes a medical emergency (call 15). Medical treatments and lifestyle changes form the basis of management—natural approaches are used only as a supplement. Check out our cholesterol and cardiolipid disorder formulas, as well as our pages on high blood pressure and atherosclerosis.
- Pathophysiology: Angina results from an imbalance between the myocardium’s oxygen demand and the supply from the coronary arteries—atherosclerosis (deposition of lipid plaques on arterial walls) is the primary cause (>90% of cases) — the plaque narrows the arterial lumen → insufficient coronary blood flow during exertion or stress → ischemia → pain
- Typical symptoms: retrosternal pain or tightness (behind the sternum)—often described as pressure, a vice-like sensation, a burning sensation, or heaviness—may radiate to the left arm, shoulder, jaw, neck, or back—duration: a few minutes (3–15 min) — triggered by physical exertion, cold, emotions, or heavy meals — relieved by rest and/or nitroglycerin
- Stable angina vs. unstable angina: stable angina—recurs at the same level of exertion, is quickly relieved by rest or nitroglycerin, stable frequency and intensity → scheduled cardiology follow-up — unstable angina — occurs at rest or with less exertion than usual, lasts longer, does not respond well to nitroglycerin → cardiac emergency (call 15 — risk of imminent heart attack)
- Diagnosis: Resting ECG (often normal between episodes) — Exercise ECG (stress test) — echocardiography — myocardial scintigraphy — coronary angiography (gold standard — direct visualization of the coronary arteries) — troponin levels (if myocardial infarction is suspected)
- Cardiovascular risk factors: high blood pressure — dyslipidemia (high LDL + low HDL) — diabetes — smoking — obesity (BMI > 30) — physical inactivity — family history of cardiovascular disease — age (men > 45 years, women > 55 years)
Medication and interventional treatment
- Nitrate derivatives (sublingual nitroglycerin): first-line treatment for an angina attack — coronary vasodilators (dilate the coronary arteries → increased blood flow) — sublingual nitroglycerin (spray or tablet) to be taken at the first signs of an attack — takes effect in 1–3 minutes — if there is no relief after 2 doses taken 5 minutes apart → call 15 immediately
- Beta-blockers: long-term treatment for stable angina — reduce heart rate and myocardial oxygen consumption — decrease the frequency of attacks — must never be stopped abruptly (rebound effect)
- Statins: reduce LDL cholesterol and stabilize atherosclerotic plaques — essential for preventing cardiovascular events in patients with angina — require a doctor’s prescription
- Calcium channel blockers + ivabradine + aspirin/anticoagulants: adjunctive treatments based on patient profile (type of angina, heart rate, comorbidities) — tailored by the cardiologist
- Coronary revascularization: coronary angioplasty (artery dilation + stent placement) — aorto-coronary bypass (cardiac surgery—bypassing the blockage)—indicated if medical treatment is insufficient or if coronary anatomy warrants it—multidisciplinary cardiology decision
Lifestyle, heart-healthy diet, and natural supplements
- Heart-healthy Mediterranean diet: reduce saturated fats (fatty meats, processed meats, full-fat cheeses) and trans fats — increase omega-3s (fatty fish 2–3 times a week) — vegetables and fruits (antioxidants + fiber) — legumes + whole grains — extra-virgin olive oil — walnuts and almonds — check out our formulas for cholesterol and cardiolipid disorders
- Omega-3 EPA and DHA: reduce triglycerides, vascular inflammation, and platelet aggregation — antiarrhythmic properties — studies showing a reduction in cardiovascular mortality — 1–2 g EPA+DHA/day — consult your cardiologist (possible interactions with high-dose anticoagulants)
- CoQ10 (ubiquinol): mitochondrial antioxidant — cardiac production of CoQ10 is significantly reduced in patients with angina and those taking statins (statins block CoQ10 synthesis) — 100–300 mg/day of ubiquinol (reduced form, better absorbed) — several studies show improved exercise tolerance and ventricular function — inform your cardiologist
- Magnesium: cofactor for > 300 cardiac enzymes — common deficiency in cardiovascular patients — coronary antispasmodic (reduces arterial spasms) + moderate antihypertensive + antiarrhythmic — magnesium bisglycinate 300–400 mg/evening
- Smoking cessation and appropriate physical activity: Quitting smoking reduces the risk of heart attack by 50% within the first year — regular and appropriate physical activity (after approval from a cardiologist) — a cardiac rehabilitation program is recommended after angioplasty or a heart attack — brisk walking for 30 minutes per day — never resume physical activity without consulting a cardiologist after an episode of unstable angina
Stress management, monitoring, and resources
- Stress and angina: Stress activates the sympathetic nervous system → release of catecholamines → tachycardia + coronary vasoconstriction + hypertension → triggering of angina attacks — Stress management is an integral part of cardiovascular treatment — Cardiac coherence (365, 3 times a day — improves heart rate variability) — mindfulness meditation (MBSR) — gentle yoga
- Home monitoring: always carry nitroglycerin with you — be aware of warning signs that require calling 15 (chest pain lasting > 15 min + not relieved by nitroglycerin + radiating pain) — monitor your blood pressure regularly — visit our high blood pressure page
- Vitamin D3: Deficiency has been associated with an increased cardiovascular risk in epidemiological studies — role in blood pressure regulation, prevention of atherosclerosis, and cardiac function — 1,000–2,000 IU/day — 25-OH-D3 testing recommended
- Important contraindications: Never stop taking heart medications (statins, beta-blockers, antiplatelet agents) without medical advice — Never consider natural supplements as alternatives to antianginal medications — Always inform your cardiologist of any supplementation (possible interactions)
- Resources in France: treating cardiologist — consultation at a cardiac rehabilitation center (list available at sfcardio.fr) — French Federation of Cardiology (fedecardio.org) — information on heart attacks and angina — primary care physician for monitoring risk factors — 15 (SAMU) for any prolonged or unusual chest pain
