By Carmela Sangalang
UBC 4th-Year Pharmacy Student
“I feel a tight pressure in my chest, like my heart feels trapped. It makes me so tired, and I can’t catch my breath!”
What Exactly is Angina?
Angina pectoris, or chest pain, is a feeling that occurs in patients whose heart is working harder to pump blood to the rest of their body. Just like you, your heart needs oxygen to survive! It receives oxygen from your blood, but it starts to struggle when there is not enough blood flow to supply it. This commonly occurs in patients who have heart conditions, such as coronary artery disease (CAD) because the arteries supplying the heart contain blockages. Think of it as a warning sign that the heart is getting tired because it’s not receiving enough oxygen. If left untreated, it can result in a heart attack, which can ultimately reduce blood flow to the rest of the body and lead to death.
Types of anginas:
There are two main types of anginas that you should know about.
- Stable Angina: This is predictable and usually occurs with increased activity.
- Unstable Angina: This is unpredictable, occurs even at rest, and needs urgent care.
How does angina happen?
The arteries supplying your heart muscle are called coronary arteries. For patients who have CAD, these arteries get blocked due to build up of a sticky plaque, usually made up of cholesterol, fats and blood cells, on the blood vessel walls. This plaque can narrow the coronary arteries and reduce blood flow to the heart. If the plaque is unmanaged, it can also burst and trigger a blood clot that can completely block the arteries, leading to a heart attack or stroke.
What Angina Might Feel Like
Most patients with angina will experience pain behind or below the sternum (breastbone) that can radiate to their jaw, neck, shoulder, or arm. This pain will more likely occur on the left side of the body. The quality of pain is usually described as a:
- Dull discomfort
- Aching feeling
- Heaviness/pressure
- Tightness/squeezing/suffocating sensation
- Sharp or stabbing pain (rarely)
Other non-pain symptoms of angina include unusual tiredness, shortness of breath, and abdominal pain. All these symptoms can be provoked by physical exertion, intense emotions, or stress. For those who have stable angina, the duration of pain should only last less than 10 minutes. Anything longer would be considered unstable and requires immediate medical attention (call 911).
Much Ado about Angina
Fortunately, angina is manageable with the right care. There are many treatment options available.
Medications
The following medications are used to relieve symptoms of stable angina. Remember, unstable angina requires emergency interventions!
| Symptom Relief | |||
| Instant Relief (works within minutes) | Long-Term Relief (prevention) | ||
| Nitroglycerin Sublingual Spray
(Do not inhale) |
Use 1 spray under the tongue at onset of chest pain. | Nitroglycerin Patches
Helps dilate the blood vessels, increasing blood flow to heart. |
Apply 1 patch once daily (on for 12 hours and off for another 12 hours). |
| Nitroglycerin Sublingual Tablets
(Do not chew) |
Dissolve 1-2 tablets under the tongue at onset of chest pain. | Beta-Blockers (e.g. bisoprolol, metoprolol, carvedilol)ORCalcium Channel Blockers (e.g. amlodipine, felodipine, diltiazem, verapamil) |
Take one tablet once daily.
Both classes help reduce strain on the heart by reducing heart rate and blood pressure. |
| Both help dilate the blood vessels QUICKLY, increasing blood flow to the heart.
If no relief within 5 minutes, call 911. You can take another dose after 5 minutes, to a maximum of 3 doses total while waiting for help to arrive. |
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Other prescription medications that help prevent stroke and heart attacks but do not provide symptomatic relief:
- “Blood thinners” (e.g., Aspirin, clopidogrel, rivaroxaban, apixaban): prevent blood clots from forming. Note: These do not actually thin your blood.
- Cholesterol-lowering medications or “statins” (e.g., rosuvastatin, atorvastatin, simvastatin): lower “bad cholesterol” that contributes to plaque buildup in blood vessels.
These medications work best if they are taken every day. The goal is to lower your risk of cardiovascular complications and prevent death.
Lifestyle Changes
Making changes to your lifestyle can significantly reduce your risk of angina, let alone heart attacks or stroke. Here are some tips you can follow to improve your heart health!
- Eat a healthy, well-balanced diet. This does not mean eating less, but be mindful of what you put in your body! Some examples of a healthy diet include:
- Increase lean protein intake (e.g., fish, poultry, low-fat dairy)
- Eat high-fiber foods (e.g., grains, leafy vegetables, fruits)
- Limit foods with high sodium and unhealthy fats (e.g., processed meats, salted butter, canned soups)
- Cut back on simple sugars. Instead of canned pop, try drinking fruit smoothies instead!
- Exercise, exercise, exercise! Aim for at least 150 minutes of activity per week.
- Going on 30-minute walks every day can work wonders.
- Aerobic exercises such as running, swimming and biking can strengthen your heart muscles. However, do NOT over-exert yourself.
- Resistance training. Lift weights that your body can handle!
- Quit smoking.
- Smoking increases risk of clots and fatty deposits from forming.
- Go to your nearest pharmacy to learn more about options that will help you quit smoking.
- Limit alcohol intake.
- Alcohol can increase your blood pressure and heart rate, which can put further stress on your heart.
- Avoid stressful situations.
- Like alcohol, stress can also increase your blood pressure and narrow your blood vessels!
Angina can be scary, but it’s just your body’s way of sending you a signal to take action. It’s important to know your limits and recognize when you need to call for medical attention. If you’re unsure, you can still call 911! It’s better to be safe and be proactive about your heart health.
References:
Angina. Heart and Stroke Foundation of Canada. (n.d.). https://www.heartandstroke.ca/heart-disease/conditions/angina
Angina Treatment. RxFiles. (2025). Rxfiles.ca. https://www.rxfiles.ca/RxFiles/uploads/documents/members/Cht-angina.pdf
Heart disease in Canada. (n.d.). https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/heart-disease-fact-sheet/heart-disease-factsheet-eng.pdf
Watanabe, T., Fan, J. (2025). Atherosclerosis Is a Global No. 1 Killer. In: Atherosclerosis. Springer, Singapore. https://doi.org/10.1007/978-981-96-3675-4_1