Angina pectoris (literally "chest tightness") usually refers to attacks of pain occurring in the chest. The reason for this lies in a reduced perfusion of the coronary arteries. These are, for example, blocked or narrowed by plaques in the case of coronary heart disease and thus can not be properly supplied with blood.
This results in a deficiency supply of the underlying heart muscle area. This so-called ischemia (undersupply of oxygen and other nutrients) can cause pain.


Angina attacks often indicate coronary heart disease. However, it may also have other causes, such as spasms (sudden brief contraction) of the coronary arteries.
Often, angina pectoris is triggered by exposure to cold, stress or physical exertion. In such situations, the oxygen requirement of the body increases. Therefore, more blood must be pumped from the heart into the circulation than is the case at rest. This extra work of the heart also requires a greater circulation of the heart muscles. If this is not ensured, for example, because of coronary heart disease, the above-mentioned undersupply of the heart muscle occurs, which can lead to angina pectoris attacks.
Such a seizure usually lasts between one and five minutes. By administering nitroglycerin (often called "nitrospray") the symptoms can be eased quickly.

Angina pectoris can be divided into different stages.

  • At stage 0, there are no complaints despite any ischemia that occurs.
  • Stage I is characterized by chest pain associated with severe exercise.
  • If there is a slight angina pectoris during normal exercise, this is called stage II.
  • In contrast, stage III causes significant chest pain at comparable exercise levels.
  • Stage IV is when angina pectoris starts to appear at low stress or complete rest. In such cases, it is usually an unstable angina pectoris, in which the underlying disease (usually coronary heart disease) is progressive.

Those who suffer from unstable angina have a significantly increased risk of having a heart attack. In stable angina, however, the symptoms stagnate, which means that the complaints do not worsen. Although this indicates a stenosis (constriction) of the coronary vessels, but at the same time means that the bottleneck does not expand further.


The pain in the area of ​​the jaw can also occur weeks to months before the actual form of angina pectoris. However, these symptoms are very nonspecific and should be well monitored. The pain in the jaw do not have to persist permanently, but they can also occur intermittently.

There may be other harbingers, such as a general feeling of weakness and fatigue. Often, these symptoms are perceived as a kind of influenza infection.
Before severe angina occurs, pain in the left arm is very common, especially in males. Especially people who know of a family history should go to a doctor when this symptom occurs.
Since the harbingers are even more unspecific in women, the early detection is accordingly heavier.

At the moment, men are more affected than women. One of the reasons for this is that smoking is a risk factor for calcification of the coronary arteries and a heart attack.
Since men used to smoke more than women, angina pectoris is more common in men than in women. However, since just as many women as men smoke today, an approximation is to be expected soon.

Symptoms of angina pectoris

Pain behind the sternum

Pain behind the sternum is the typical symptom of angina pectoris.
Many suffer from pain throughout the chest, however, the pain is often perceived most often immediately behind the breastbone. Usually the pain is described as dull, piercing or boring. This is usually accompanied by a strong feeling of chest tightness or pressure in the chest. Many sufferers feel as though they have been given a heavy sack on the chest.
In addition to the pain behind the breastbone often results in respiratory distress, which comes about through the pressure feeling.

Pain in the left arm

Pain radiating to the left arm is typical of heart disease of all kinds.
Particularly associated with pain are the heart attack and angina pectoris. Both diseases are due to coronary heart disease, in which the coronary arteries are constricted or blocked and therefore the heart muscle can not be sufficiently supplied with oxygen and nutrients.
This mechanism causes pain.

The direction of the sensation of pain from the heart to the brain takes place via nerve fibers. These are bundled with many other nerve fibers from different parts of the body and thus run together part of the way to the brain together.
Because of this bundled nerve course, in some cases the brain can not distinguish which part of the body the pain originates from and falsely perceives it in the area of ​​the left arm.

Basically, a perception of pain in the right arm is possible, but such complaints occur much less frequently. The reason for this lies in the anatomy of the human body: the heart is on the left side of the chest, so the associated nerve fibers are usually bundled with the other fibers of the left half of the body.

Shortness of breath as a symptom

Angina pectoris usually manifests itself in the form of chest pain. In addition, there is a feeling of tightness or pressure on the chest. This leads to respiratory distress in many sufferers.
In addition, shortness of breath and angina pectoris complaints are often associated with each other, as they both occur during exercise.

Those who are physically active consume more oxygen and therefore have to breathe more often. In addition, especially the muscles must be supplied with more blood, which is why the heart must do an increased pumping work. Heart disease such as coronary heart disease also causes a lack of oxygen in the heart, which causes angina pectoris complaints.

Pain in the upper abdomen

Angina pectoris is usually due to coronary heart disease. Due to the deficiency of the heart tissue, pain is created, which is usually felt in the chest area. However, they can also radiate to other parts of the body. This is especially common in neighboring organs.

While men often focus on chest pain or chest tightness, women often complain of stomach or upper abdominal pain. In some cases, upper abdominal pain is even the only symptom of angina pectoris. Often, abdominal pain is accompanied by nausea and vomiting.

Upper abdominal pain - These are the most common causes.

Nausea and vomiting as a symptom

Angina pectoris seizures are often not only expressed by pain in the chest area. In many cases, the pain radiates to other parts of the body.

Especially in women, the upper abdomen and the stomach are often affected. This not only pain in the stomach region occur, in addition, it often comes to nausea and vomiting.
Since some people with coronary heart disease are only suffering from nausea, vomiting, and stomach pain without chest pain or other heart-specific symptoms, more common episodes of ailments should include angina pectoris.

pain in the back

Back pain in general is a folk disease and usually due to bad posture of the body while sitting.
However, if the back pain occurs in the form of a dull, stinging or piercing pain, heart disease may be behind the discomfort. Especially back pain, which is located in the area of ​​the thoracic spine, should also be examined with regard to heart disease.

Many sufferers experience a kind of belt-shaped pain that surrounds the chest. Thus, a combination of back and chest pain occurs, which is particularly typical of angina pectoris complaints. While men often report very specific backbone pain, the symptoms in women are much more diverse and nonspecific, so diagnosing angina pectoris can often take longer.
If a person suffers from seizure-like back pain, specific attention should be given to coronary heart disease. This causes angina pectoris seizures in many sufferers, which are usually perceived as chest pain, but often also as back pain.

Pain on the tooth and jaw

Jaw and toothache initially suggest an actual problem in the dental field. However, straight jaw pain can also be an expression for many other diseases.

In the case of angina pectoris, it is possible that the chest pain radiates into the area of ​​the jaw and the teeth. Sometimes the jaw / tooth pain may be present even without the occurrence of chest pain.
The jaw pain can also be caused by a general tension in the body. Especially angina pectoris attacks put the body in a stressful situation. In addition, the seizures are often associated with anxiety or panic. This can, among other things, cause an increased tension of the jaw musculature ("clenching teeth").

Pain in the neck area

Sore throats, such as those associated with colds and cough, are more of an atypical symptom of angina pectoris.
However, the sensation of pain, which is usually localized in the chest area, can also be perceived at other parts of the body. Thus, the chest pain is typically described as piercing, boring or dull. If such a pain sensation occurs in the neck area, it can also be a sign of angina pectoris

A possible explanation for the development of this pain lies in the common connection of the competent pain-conducting nerve fibers. As a result, the brain can no longer distinguish whether the origin of the pain in the neck or chest is located.

Pain in the neck area

Neck pain is rare in angina pectoris but may still occur. They are triggered by the pain radiating from the chest and back to the neck.
A possible explanation for this is that the brain does not have many painful nerve fibers in the area of ​​the internal organs. Thus, the pain can not be perceived at a specific point. Rather, the feeling of pain arises in a larger body area. In some people, therefore, the pain area of ​​the heart is extended to the neck. Therefore, the pain from the heart can also be perceived in the neck.

In addition, an anginal attack is accompanied by a stress reaction of the body and can thus lead to a reflex tension of the neck muscles. This results in a tension in the neck, which in turn can trigger pain.

Fear and panic as a symptom

In connection with an anginal attack, there is often a feeling of anxiety / panic and inner restlessness.
With increased physical stress, there is a shortage of heart muscle. On the one hand, this causes the chest pain referred to as angina pectoris, on the other hand it also leads to a feeling of tightness in the chest.
The tightness or pressure on the chest alone can cause anxiety or panic. It also makes it difficult to breathe, thereby triggering the feeling of being breathless, which in turn can increase panic. Because of these mechanisms, the notion of "heart anxiety" has emerged describing anxiety and panic in an anginal attack or a heart attack.

Sweat stigma as a symptom

People with angina pectoris complaints suffer from heart disease. As a result, they often get out of breath faster during physical exertion and start sweating earlier.
An acute attack of angina pectoris can also lead to sudden outbreaks of sweating. These are triggered by chest pain
In addition, such an attack can also cause anxiety or panic, which leads to an activation of sweat production in the body.

Symptoms in diabetics

In diabetics, the symptoms of angina pectoris are often less pronounced. As with other people affected, the angina usually comes in the form of chest pain, these can radiate into the back, left arm and jaw. Also stomach pains as well as nausea and vomiting can occur.

The increased blood sugar level in diabetics inter alia attacks nerve fibers, so that pain stimuli can only be transmitted to the brain to a lesser extent. Because of this, the pain that occurs with angina is less pronounced by diabetics.
Due to the loss of nerve fibers, diabetics more often suffer a dumb heart attack, in which a heart attack occurs, but no pain is perceived.


Different types of angina pectoris are distinguished from each other.
On the one hand there is stable angina pectoris and on the other hand unstable angina pectoris.

Stable angina pectoris is when the symptoms are similar for each occurrence and last for about the same amount of time. An example of stable angina pectoris is Prinzmetal's angina, which causes spasm of the vessels. Stable angina pectoris usually occurs without changes in the ECG. This form of angina pectoris is well treatable with nitroglycerine.

In the case of unstable angina pectoris, there is either a change in the symptoms or a new onset of angina pectoris. This form is usually based on a heart attack or coronary artery disease on the bottom of arteriosclerosis.
The occurrence of unstable angina pectoris is an emergency. In contrast to stable angina pectoris, the basis of unstable angina pectoris is usually visible on the ECG.

Symptoms of stable angina pectoris

The symptoms of stable angina pectoris are characterized in particular by the fact that they do not change over a longer period of time.

In general, the disorder is characterized by chest pain. These are often located directly behind the breastbone and occur like an attack. They usually last for one to five minutes and can be relieved by the administration of nitroglycerin (nitrospray).
However, the pain can also radiate to other parts of the body. This causes back, neck or jaw pain. Also pain in the left arm can be an indication of angina pectoris. Especially in women, more rarely in men, it also causes stomach and upper abdominal pain. This can be accompanied by nausea and vomiting.

In contrast to unstable angina pectoris, the symptoms of stable angina remain constant. Over a long period of time, therefore, the aforementioned complaints occur on a paroxysmal basis, the pain does not worsen. These symptoms suggest that stenosis (constriction) of the affected coronary vessel is present, but does not progress further.

Symptoms of unstable angina pectoris

The unstable angina pectoris refers to the typical pectanginous complaints.
These include chest pain, especially behind the sternum (sternum). In addition, the pain in the upper abdomen and stomach can radiate. Along with this, nausea and vomiting often occur. Also, a shift of pain in the left arm, the back or the jaw / teeth / neck is possible.
The underlying cause of the pain is coronary heart disease. So it is at least one of the coronary vessels with a plaque clogged or narrowed.

Characteristic of unstable angina pectoris is a worsening of symptoms. Over a period of time, multiple seizures occur and gradually increase.
From this one can conclude that the stenosis (constriction) of the affected coronary vessels continues to progress. Therefore, unstable angina pectoris is associated with a high risk of heart attack.

Also every first appearing Angina pectoris falls under the definition of an unstable Angina, since in this case a worsening of the symptoms of "no complaints" to "angina pectoris complaints" takes place.

Symptoms of Prinzmetal's angina

Prinzmetal's angina also refers to fits like chest pain. These are triggered by a spasm (sudden contraction) of the coronary arteries.
Similar to the coronary heart disease, this leads to a reduced blood flow to the vessels, so that the heart muscle behind the cramping vascular section is no longer adequately supplied with blood. This results in an undersupply of oxygen and other nutrients, resulting in chest pain.

These vascular spas occur like an attack and thereby also cause seizure-like pain in the chest area.

Emergency situations with angina pectoris Symptomatik

If angina pectoris symptoms recur, it is an emergency!

In this case, call an emergency physician immediately because it is a life-threatening situation. Until the arrival of the ambulance, it should be tried to calm the victim.
First, the symptoms of angina pectoris are treated and not the causative heart attack, so that the heart can be re-oxygenated. The hospital will then treat the heart attack itself.
But not every anginal attack is a heart attack! Especially in the case of stable angina pectoris, which occurs especially in stressful situations, there is no permanent low supply of the heart muscle. Once the exertion is over, the vessels are enough again to provide enough oxygen to the heart.
In contrast, unstable angina pectoris is more often a sign of an infarct.

differential diagnoses

When the symptoms of angina pectoris first appear, most people first think of a heart attack. However, it can also be a ruptured aortic dissection.

The main artery ( aorta ) consists of three layers. In particular, the innermost layer can loosen, resulting in a false cavity (so-called aortic dissection ). When this cavity, which is constantly filled by the constant flow of blood, breaks, one speaks of a ruptured aortic dissection.
Like cardiac infarct, it is a life-threatening condition that can trigger the symptoms of angina pectoris.

There is no life-threatening disease behind this type of symptomatology. In some patients, due to the close proximity of the heart and stomach, which are separated only by the diaphragm, an inflammation of the stomach (gastritis) causes symptoms of angina pectoris.
Important for all these causes is to examine the patient as thoroughly as possible in order to exclude a life-threatening illness.

Approach to angina pectoris

In angina pectoris attack, a so-called 12-channel electrocardiogram (12-lead ECG) is often written. In addition, patients usually get medications that reduce anxiety and pain, so that the stressed body can come to rest.

If the person concerned knows that his form of angina pectoris is the stable form, then the hospital does not have to be visited either, since the symptoms usually improve with a decrease in the burden on their own.

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