To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.
There are several tests your doctor may order to help confirm whether you have angina:
- Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack.
- Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. Your blood pressure and ECG readings are monitored as you exercise. Other tests also may be done at the same time as a stress test. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising followed by an imaging test.
- Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including heart muscle damage due to poor blood flow. An echocardiogram can be given during a stress test, and this can show if there are areas of your heart that are not getting enough blood.
Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream.
This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — shows how the substance moves with the blood in your heart muscle. Poor blood flow to any part of your heart can be seen on the images because not as much of the radioactive substance is getting there.
- Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
- Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization.
During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.
- Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
- Cardiac MRI. In a cardiac MRI, you lie on a table inside a long, tubelike machine that produces detailed images of your heart's structure and its blood vessels.
There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of a heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:
- Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. The most common form of nitrate used to treat angina is nitroglycerin tablets, which you put under your tongue.
- Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.
- Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can't take aspirin.
- Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
- Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
- Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
- Blood pressure-lowering medications. If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to lower your blood pressure. There are two main classes of drugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.
Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.
This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.
- Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.
- External counterpulsation (ECP). With ECP, blood pressure-type cuffs are placed around the calves, thighs and pelvis to increase blood flow to the heart. ECP requires multiple treatment sessions. The American College of Cardiology, American Heart Association and other heart organizations say ECP may help reduce symptoms in people with refractory angina.
Lifestyle and home remedies
Because heart disease is often the cause of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Making lifestyle changes is the most important step you can take.
- If you smoke, stop smoking. Avoid exposure to secondhand smoke.
- If you're overweight, talk to your doctor about weight-loss options.
- Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
- Talk to your doctor about starting a safe exercise plan.
- Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
- Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
- Avoid large meals that make you feel overly full.
- Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
- Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
Preparing for your appointment
If you're having sudden chest pain (unstable angina), call 911 or your local emergency number right away.
If you think you may have recurring angina because your symptoms are brief and only occur during exercise, or you're worried about your angina risk because of a strong family history, make an appointment with your primary care doctor. If angina is found early, your treatment may be easier and more effective.
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. For a blood test to check your cholesterol or other indicators of heart disease, for example, you may need to fast for a period of time beforehand.
- Write down any symptoms you're experiencing, including any that may seem unrelated to angina.
- Write down key personal information, including any family history of angina, chest pain, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. For angina, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- What kinds of tests will I need? How do I need to prepare for these tests?
- What treatments are available, and what do you recommend?
- What foods should I eat or avoid?
- What's an appropriate level of physical activity?
- I have other health conditions. How can I best manage these conditions together?
- How often do I need to follow up with you about my angina?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Is it pain? Discomfort? Tightness? Pressure? Sharp? Stabbing?
- Where is the pain located? Is it in a specific area or more generalized?
- Does the pain spread to your neck and arms? How and when did the pain start? Did something specific seem to trigger the pain? Does it start gradually and build up or start suddenly?
- How long does it last?
- What makes it worse? Activity? Breathing? Body movement?
- What makes it feel better? Rest? Deep breath? Sitting up?
- Do you have other symptoms with the pain, such as nausea or dizziness?
- Do you have trouble swallowing?
- Do you often have heartburn? (Heartburn can mimic the feeling of angina.)
What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against angina and its complications, including a heart attack and stroke.