Chest Pain with a Difference: The Different Types of Angina

Author: Nnenna Chiloli, MBBS, MPH

Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Angina is chest pain or discomfort that occurs due to reduced flow of oxygen-rich blood to the heart.
• Different types include stable, unstable, variant, microvascular, and refractory angina.
• Symptoms include chest pain, shortness of breath, fatigue, etc.
• Risk factors include family history, smoking, high blood pressure, high cholesterol, and diabetes.
• ECG, Cardiac enzyme tests, echocardiogram, and stress tests help confirm angina.
• Medications, lifestyle changes, and surgical procedures can manage angina.
• Untreated symptoms increase the risk of a heart attack.

Introduction

You are climbing stairs at work when you feel a tightness across your chest that makes you pause. But it goes off after a few minutes of relaxation. Is it heartburn, stress, or something more serious?.

Not every chest pain is a heart attack, but some types of chest discomfort should never be ignored. This is especially true for angina, a specific kind of chest pain that signals your heart isn’t getting enough oxygen-rich blood[1]. Understanding the different types of angina can help you recognise signs early and take steps to protect your heart health.

In this article, you will discover what angina is, the main types, and how they differ, along with actionable preventive measures, and know when it’s time to consult a healthcare professional.

What Is Angina?

Angina, also known as angina pectoris, is not a disease; it is a symptom, a warning signal from your heart. Angina is chest pain or discomfort that occurs when your heart muscle doesn’t receive enough oxygen because blood flow through the coronary arteries (the vessels that supply your heart) is reduced [1,2]. 

It affects more than 100 million people globally. It often feels like pressure, tightness, burning, heaviness, or squeezing in the chest. In some cases, discomfort may occur in the shoulders, arms, neck, jaw, or back [3].

Why Does Angina Happen?

Your heart is like a pump that works very hard and always needs fresh blood with oxygen so that it can work well. When you run or walk up the stairs, or when you are stressed, your heart is pumping harder but needs more oxygen.

If the arteries that supply blood to your heart are narrowed or blocked, they can’t deliver enough blood to meet this increased demand, and that’s what causes angina symptoms [2].

Angina can occur for several reasons;

• Atherosclerosis: the buildup of fatty deposits, called plaques, inside your coronary arteries, which narrows them and restricts blood flow. This is the most common cause of angina.
• Coronary artery spasm: This is the sudden tightening or contraction of the muscular walls of the blood vessels that supply your heart, temporarily reducing blood flow even when there’s no significant blockage.
• Small vessel problems (microvascular dysfunction): The tiny blood vessels in your heart may not function properly, limiting oxygen delivery to the heart muscle even when the large coronary arteries appear normal.

Common Symptoms of Angina

Chest pain is the most common symptom, but its intensity varies among individuals.

Typical symptoms 

• A feeling of weight, tightness, or a squeeze in the middle or left part of the chest.
• Pain that moves to the shoulders, arms (most often the left arm), neck, jaw, or back.
• Shortness of breath or finding it hard to breathe, mostly when you move around.
• Unusual tiredness or very worn out
• Sweating, feeling sick, or feeling dizzy with chest pain.

Atypical Symptoms 

Not everyone has the usual chest pain. This is very important for some groups of people to know, especially women and people with diabetes.

• Women

Women, especially those with microvascular angina or ischaemia with non-obstructive coronary artery disease (INOCA), often present with less typical symptoms such as:

• Shortness of breath as the main sign, not chest pain.
• Unusual fatigue that doesn’t improve with rest.
• Pain in the neck, upper back, jaw, or throat, but not the chest.
• Feeling sick, throwing up, or experiencing symptoms such as heartburn.
• Dizziness or lightheadedness

• People with Diabetes

People with diabetes may experience angina differently due to nerve damage (diabetic neuropathy). They may have less obvious symptoms like:

• Reduced or absent chest pain sensation
• Shortness of breath
• Tiredness
• Vague discomfort

Types of Angina and How They Differ

Knowing the differences between types can help you understand what you are experiencing and guide you toward the right medical care.

• Stable Angina

Stable angina is the most common type of angina. It typically occurs when your heart is working harder than usual, such as during exercise, climbing stairs, after a heavy meal, or during emotional stress. 

You experience chest discomfort during these activities, which typically subsides with rest or medication [4]. The discomfort typically lasts a few minutes (usually 2 to 5 minutes).

 It feels like:

• Pressure, squeezing, heaviness, or tightness in the center of the chest.
• Discomfort that may spread to the shoulders, arms, neck, jaw, or back.
• A sensation similar to indigestion.

• Unstable Angina

Unstable angina is a medical emergency. It represents a sudden change in your angina pattern, either new chest pain that you have never experienced before, or stable angina that has become more frequent, more severe, lasts longer, or occurs at rest.  

Unstable angina is not predictable. It can strike when you are resting, sleeping, or doing very light activity [5]. 

Features include:

• Chest pain that occurs at rest or with minimal exertion.
• Pain that is more intense pr lasts longer than your usual angina.
• Pain that doesn’t respond well to res or your usual medication.

Unstable angina is a serious condition that can quickly progress to a heart attack and requires immediate medical care.

• Variant Angina (Prinzmetal’s Angina)

Variant angina is caused by a sudden spasm(temporary tightening) of a coronary artery, which temporarily blocks flow to part of your heart. It presents as,

• Severe chest pain that typically occurs at rest or during sleep.
• Often happens at night or early morning hours.

Can be triggered by:

• Smoking
• Exposure to cold
• Emotional stress
• Use of certain medications that constrict blood vessels
• In rare cases, allergic reactions (Kounis syndrome)

Severe spasms can lead to heart attacks, fainting, or even sudden heart death in some cases.

• Microvascular Angina

Microvascular angina occurs when the tiny blood vessels in your heart don’t work properly, even though your large coronary arteries appear normal on standard tests.

The features are:

• Chest pain that may occur with exertion, mental stress, or without apparent cause.
• It can be similar to stable angina, but may also feel different.
• Often comes with feelings of tiredness and shortness of breath.
• More common in women 
• Microvascular angina raises the risk of heart problems later on.

• Refractory Angina

This is long–term, persistent chest pain lasting 3 months or more, and it's not relieved by normal treatments. It significantly affects the quality of life and requires special management.

What Are The Risk Factors for Angina?

Factors that  increase the risk of angina include:

• Family history of heart disease
• Older age
• Male sex. However, microvascular angina is more common in women
• Overweight and obesity
• Smoking or exposure to tobacco smoke
• High blood pressure
• High blood cholesterol
• Diabetes
• Chronic stress
• Sedentary lifestyle
• Excessive alcohol intake
• Air pollution exposure
• High-stress occupation or long working hours

What To Do When Angina Occurs

If you experience any chest discomfort that you think may be angina:

• Stop all activity and sit down(rest)
• Take nitroglycerin if prescribed
• Call emergency services immediately if symptoms don’t improve within minutes

When To Seek Emergency Help

Call for help right away if you have:

• Chest pain at rest that doesn’t go away after a few minutes
• Chest pain that’s new, worse, or lasts longer or is different from your usual angina
• Chest pain with:

• Difficulty breathing
• Sweating, feeling sick, or vomiting
• Dizziness or fainting
• Pain that moves to your jaw, neck, shoulders, arms, or back
• A feeling of fear

• Angina symptoms that do not get better with rest or your medicine

These may be signs of unstable angina or a heart attack.

When To Schedule an Appointment With Your Doctor

Schedule an appointment with your doctor if you have:

• New chest discomfort that occurs with exertion and goes away with rest
• Changes in your stable angina pattern, such as occurring more frequently or with less exertion
• Persistent chest discomfort or shortness of breath that you can’t explain, even if it seems mild
• Ongoing symptoms despite normal test results. You may need specialised testing for microvascular or vasospastic angina.

How is Angina Diagnosed?

Common tests include;

• Electrocardiogram (ECG)
• Cardiac enzyme tests, e.g, troponin
• Echocardiogram
• Stress test
• Coronary CT angiogram
• Coronary flow reserve testing for microvascular dysfunction

Preventing Angina And Protecting Your  Heart

You can reduce your risk of developing angina, prevent it from worsening, and improve your overall quality of life by:

• Controlling key risk factors.

• Stop smoking. Smoking damages your blood vessels, promotes plaque buildup, and can trigger coronary artery spasm.
• Control your blood pressure. High blood pressure forces your heart to work harder and damages artery walls over time.
• Manage your cholesterol. High levels of bad cholesterol (LDL) contribute to the buildup of plaque in your arteries
• Control blood sugar if you have diabetes
• Maintain a healthy weight

• Embracing healthy lifestyle habits.

Small changes can make a big difference in your heart health.

• Eat healthy foods, including fruits, vegetables, whole grains, lean proteins (mainly fish), and healthy fats like olive oil and nuts.
• Maintain regular physical activity (exercise).
• Control stress by deep breathing, relaxation, meditation, etc
• Sleep well. Have 7 to 9 hours of good sleep at night.

• Take your medications as prescribed.

Your doctor may prescribe drugs that,

• Help prevent blood clots (antiplatelets) such as aspirin or clopidogrel.
• Lower cholesterol and stabilise plaques (Statins).
• Slow your heart rate and reduce your heart’s oxygen demand ( Beta blockers)
• Help control blood pressure and protect your heart (Angiotensin Converting Enzyme inhibitors)
• Relax blood vessels, and are especially important for treating variant and microvascular angina (Calcium channel blockers)
• Relieve angina symptoms by widening blood vessels( Nitrates)

Long-term Outlook

With proper lifestyle changes, medication, and follow-up care, many people with angina live full, healthy lives. However, untreated angina, especially unstable or microvascular types, can lead to a heart attack or long-term heart damage. Early recognition and management are crucial.

Conclusion

Angina is not only chest pain. It's your heart telling you that it needs help. By understanding the various types of angina, the symptoms of angina, healthy habits, and knowing when to consult your doctor. You are actively engaging in the safeguarding of your heart and avoiding severe consequences. 

References

1. Alam K, Mahal A. The economic burden of angina on households in South Asia. BMC Public Health [Internet]. 2014 Dec [cited 2025 Nov 19];14(1):179. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-179

2. Ford TJ, Berry C. Angina: contemporary diagnosis and management. Heart [Internet]. 2020 Mar [cited 2025 Nov 9];106(5):387–98. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035719/

3. Manolis AJ, Collins P, López-Sendón J. Diagnosing and treating stable angina: a contemporary approach for practicing physicians. Future Cardiol [Internet]. [cited 2025 Nov 9];21(5):291–303. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980508/

4. Gillen C, Goyal A. Stable angina. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559016/

5. Goyal A, Singh B, Ahmed I, Zeltser R. Unstable angina. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK442000/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published November 24, 2025