Angina - Diagnosis and treatment (2023)

Diagnosis

To diagnose angina, your health care provider will do a physical exam and ask questions about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

Tests used to diagnose and confirm angina include:

  • Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too fast, too slow or not at all. Your health care provider also can look for patterns in the heart rhythm to see if blood flow through the heart has been slowed or interrupted.
  • Chest X-ray. A chest X-ray shows the condition of the heart and lungs. A chest X-ray may be done to determine if other conditions are causing chest pain symptoms and to see if the heart is enlarged.
  • Blood tests. Certain heart enzymes enter the bloodstream when the heart muscle is damaged, such as from a heart attack. A cardiac enzyme blood test can help detect these substances.
  • Stress test. Sometimes angina is easier to diagnose when the heart is working harder. A stress test typically involves walking on a treadmill or riding a stationary bike while the heart is monitored. Other tests may be done at the same time as a stress test. If you can't exercise, you may be given drugs that mimic the effect of exercise on the heart.
  • Echocardiogram. An echocardiogram uses sound waves to create images of the heart in motion. These images can show how blood flows through the heart. An echocardiogram may be done during a stress test.
  • Nuclear stress test. A nuclear stress test helps measure blood flow to the heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive tracer is injected into the bloodstream. A special scanner shows how the tracer moves through the heart arteries. Areas that have little or no amounts of the tracer suggest poor blood flow.
  • Cardiac computerized tomography (CT). For this test, you typically lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around the body and collects images of the heart and chest. A cardiac CT scan can show if the heart is enlarged or if any heart's arteries are narrowed.
  • Cardiac magnetic resonance imaging (MRI). This test uses magnetic fields and radio waves to create detailed images of the heart. You typically lie on a table inside a long, tubelike machine that produces detailed images of the heart's structure and blood vessels.
  • Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of the heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization.

    A health care provider threads a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart and injects dye through the catheter. The dye makes the heart arteries show up more clearly on an X-ray. Your health care provider might call this type of X-ray an angiogram.

More Information

  • Chest X-rays
  • Coronary angiogram
  • CT scan
  • Echocardiogram
  • Electrocardiogram (ECG or EKG)
  • Nuclear stress test
  • Stress test
(Video) Angina - Causes, Symptoms, Treatments & More…

Treatment

Options for angina treatment include:

  • Lifestyle changes
  • Medications
  • Angioplasty and stenting
  • Open-heart surgery (coronary bypass surgery)

The goals of angina treatment are to reduce the frequency and severity of the symptoms and to lower the risk of a heart attack and death.

You will need immediate treatment if you have unstable angina or angina pain that's different from what you usually have.

Medications

If lifestyle changes — such as eating healthy and exercising — don't improve heart health and relieve angina pain, medications may be needed. Medications to treat angina may include:

  • Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen the blood vessels so more blood flows to the heart. The most common form of nitrate used to treat angina is nitroglycerin. The nitroglycerin pill is placed under the tongue. Your health care provider might recommend taking a nitrate before activities that typically trigger angina (such as exercise) or on a long-term preventive basis.
  • Aspirin. Aspirin reduces blood clotting, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can reduce the risk of a heart attack. Don't start taking a daily aspirin without talking to your health care provider first.
  • Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) make blood platelets less likely to stick together, so blood doesn't clot. One of these medications may be recommended if you can't take aspirin.
  • Beta blockers. Beta blockers cause the heart to beat more slowly and with less force, which lowers blood pressure. These medicines also relax blood vessels, which improves blood flow.
  • Statins. Statins are drugs used to lower blood cholesterol. High cholesterol is a risk factor for heart disease and angina. Statins block a substance that the body needs to make cholesterol. They help prevent blockages in the blood vessels.
  • Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels to improve blood flow.
  • Other blood pressure medications. Other drugs to lower blood pressure include angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your health care provider may prescribe one of these types of medications.
  • Ranolazine (Ranexa). This medication may be prescribed for chronic stable angina that doesn't get better with other medications. It may be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.

Therapies

Sometimes, a nondrug option called enhanced external counterpulsation (EECP) may be recommended to increase blood flow to the heart. With EECP, blood pressure-type cuffs are placed around the calves, thighs and pelvis. EECP requires multiple treatment sessions. EECP may help reduce symptoms in people with frequent, uncontrolled angina (refractory angina).

Surgery and procedures

If lifestyle changes, medications or other therapies don't reduce angina pain, a catheter procedure or open-heart surgery may be needed.

(Video) What is Angina Pectoris? Causes, signs and symptoms, Diagnosis and treatment.

Surgeries and procedures used to treat angina and coronary artery disease include:

  • Angioplasty with stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into the 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.

    Angioplasty with stenting improves blood flow in the heart, reducing or eliminating angina. Angioplasty with stenting may be a good treatment option for those with unstable angina or if lifestyle changes and medications don't effectively treat chronic, stable angina.

  • Open-heart surgery (coronary artery bypass surgery). During coronary artery bypass surgery, a vein or artery from somewhere else in the body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to the heart. It's a treatment option for both unstable angina and stable angina that has not responded to other treatments.

More Information

  • Coronary artery bypass surgery

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(Video) Angina pectoris (stable, unstable, prinzmetal, vasospastic) - symptoms & pathology

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Heart disease is often the cause of angina. Making lifestyle changes to keep the heart healthy is an important part of angina treatment. Try these strategies:

  • Don't smoke and avoid exposure to secondhand smoke. If you need help quitting, talk to your health care provider about smoking cessation treatment.
  • Exercise and manage weight. As a general goal, aim to get at least 30 minutes of moderate physical activity every day. If you're overweight, talk to your health care provider about safe weight-loss options. Ask your health care provider what weight is best for you.
  • Eat a healthy diet low in salt and saturated and trans fats and rich in whole grains, fruits and vegetables.
  • Manage other health conditions. Diabetes, high blood pressure and high blood cholesterol can lead to angina.
  • Practice stress relief. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce emotional stress.
  • Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Preparing for your appointment

If you have sudden chest pain (unstable angina), call 911 or your local emergency number immediately.

If you have a strong family history of heart disease, make an appointment with your health care provider.

Appointments can be brief, and there's often a lot to discuss. So it's a good idea to take steps to prepare for your appointment. Here's some information to help you get ready and what to expect from your health care provider.

(Video) What is Angina And How it Works? | Types, Causes, Symptoms and treatment (3D Animation)

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. For example, you may need to avoid eating or drinking for a period of time for a cholesterol blood test.
  • Write down any symptoms you're having, 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, and the dosages.
  • 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, talk to your health care provider about any challenges you might face in getting started.
  • Write down questions to ask your health care provider.

Your time with your health care provider 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 health care provider include:

  • What's the most likely cause of my chest pain symptoms?
  • What kinds of tests will I need? How do I need to prepare for these tests?
  • What treatments do you recommend and why?
  • What's the safest type and amount of physical activity for me?
  • 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?
  • Are there any brochures or other printed materials that I can take home with me?
  • What websites do you recommend visiting?

Don't hesitate to ask any other questions that you may have during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may save time to go over any information you want to spend more time on. Your health care provider may ask:

  • When did you first begin having symptoms?
  • How would you describe the chest pain?
  • Where is the pain located?
  • Does the pain spread to other parts of the body, such as the neck and arms?
  • How and when did the pain start?
  • Did something specific seem to trigger the chest pain?
  • Does the pain start gradually or suddenly?
  • How long does the pain last?
  • What makes the chest pain worse?
  • What makes it feel better?
  • Do you have other symptoms with the pain, such as nausea or dizziness?
  • Do you have trouble swallowing?
  • Do you have a history of 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. Try these steps:

  • Quit smoking.
  • Eat healthy foods.
  • Get more exercise.

By Mayo Clinic Staff

(Video) Angina: Stable, Unstable, Microvascular and Prinzmetal, Animation

FAQs

How is angina diagnosed? ›

A chest X-ray may be done to determine if other conditions are causing chest pain symptoms and to see if the heart is enlarged. Blood tests. Certain heart enzymes enter the bloodstream when the heart muscle is damaged, such as from a heart attack. A cardiac enzyme blood test can help detect these substances.

What is the best treatment for angina? ›

Nitrates or beta blockers are usually preferred for initial treatment of angina, and calcium channel blockers may be added if needed. The number and type of medications used are often tailored to how frequently angina occurs in an average week.

What is first line treatment for angina? ›

Beta-blockers are an appropriate first-line medical treatment to relieve the symptoms of angina. Calcium channel blockers or long-acting nitrates may be appropriate for those who do not tolerate or who have contraindications to beta-blockers.

Will angina show up on EKG? ›

Your doctor can suspect a diagnosis of angina based on your description of your symptoms, when they appear and your risk factors for coronary artery disease. Your doctor will likely first do an electrocardiogram (ECG) to help determine what additional testing is needed to confirm the diagnosis.

How do I know if my chest pain is angina? ›

Angina pain is often described as squeezing, pressure, heaviness, tightness or pain in the chest. It may feel like a heavy weight lying on the chest. Angina may be a new pain that needs to be checked by a health care provider, or recurring pain that goes away with treatment.

What triggers angina? ›

Anything that causes your heart muscle to need more blood or oxygen supply can result in angina. Risk factors include physical activity, emotional stress, extreme cold and heat, heavy meals, drinking excessive alcohol, and cigarette smoking.

What should you avoid if you have angina? ›

Avoid foods that contain high levels of sodium (salt). Read food labels. Avoid foods that contain saturated fat and partially hydrogenated or hydrogenated fats. These are unhealthy fats that are often found in fried foods, processed foods, and baked goods.

Does angina show in blood tests? ›

Blood tests check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks.

Can angina go away on its own? ›

If it's angina, your symptoms usually ease or go away after a few minutes' rest, or after taking the medicines your doctor or nurse has prescribed for you, such as glyceryl trinitrate medicine (GTN). If you're having a heart attack, your symptoms are less likely to ease or go away after resting or taking medicines.

Does aspirin help angina? ›

As secondary prevention, aspirin is believed to be effective in acute coronary syndrome, stable angina, revascularization, stroke, TIA, and atrial fibrillation.

Which beta blocker is best for angina? ›

A cardioselective beta-blocker such as bisoprolol or metoprolol succinate will provide the maximum effect with the minimum amount of adverse effects. Beta-blockers that reduce resting heart rate less than others (due to ISA) tend not to be used for angina, e.g. celiprolol and pindolol.

Does drinking water help angina? ›

Angina pectoris tends to be accompanied by thrombosis [18]. Therefore, drinking an adequate amount of water may help reduce blood coagulation and result in a lower OR for angina pectoris.

Should I go to ER for angina? ›

The main symptoms of coronary artery disease are chest pain and angina. Angina causes a crushing or squeezing feeling in your chest. It also causes chest pain that can spread to your arms, neck, and jaw. Go to the ER immediately if you experience these symptoms.

Is angina hard to diagnose? ›

If the heart is working harder, such as when exercising, it requires more blood flow. And if the coronary arteries cannot meet this demand for any reason, angina will occur. Angina can be surprisingly difficult to diagnose.

Can you have angina without blocked arteries? ›

Microvascular angina.

This used to be called Syndrome X. It causes chest pain with no coronary artery blockage. The pain is caused by from poor function of tiny blood vessels that lead to the heart, arms, and legs. It is more common in women.

Is angina caused by stress? ›

Doctors have long known that mental or psychological stress can lead to angina (chest pain or discomfort caused by inadequate blood to the heart). Now, new research reveals a direct correlation between angina and stress-related activity in the brain's frontal lobe.

What does mild angina feel like? ›

Angina is chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, abdomen or back. Angina pain may even feel like indigestion.

How long does a bout of angina last? ›

Usually lasts 5 minutes; rarely more than 15 minutes. Triggered by physical activity, emotional stress, heavy meals, extreme cold or hot weather. Relieved within 5 minutes by rest, nitroglycerin or both. Pain in the chest that may spread to the jaw, neck, arms, back or other areas.

Can anxiety bring on angina? ›

It can be challenging to distinguish between angina and an anxiety attack, especially because emotional distress can also increase the amount of oxygen the heart requires and trigger angina.

Do angina attacks damage the heart? ›

Coronary heart disease occurs when there's narrowing of the coronary arteries supplying blood to the heart muscles, due to a build-up of a fatty substance in the arteries (plaque). Angina is not the same as a heart attack. Unlike a heart attack, angina does not cause permanent damage to the heart muscle.

What age does angina occur? ›

Angina is rare in people under 35 years of age unless that person has other health problems which make angina more common – such as diabetes or smoking tobacco. Besides age, smoking, and diabetes, risk factors include a history of hypertension or high cholesterol.

Does walking help angina? ›

Regular exercise improves your body's ability to take in and use oxygen, which means you can do daily activities more easily and feel less tired. It can also help reduce your angina symptoms (like chest pain and shortness of breath) by encouraging your body to use a network of tiny blood vessels that supply your heart.

What vitamin is good for angina? ›

Our study has suggested beneficial effect of Vitamin D supplementation in chronic stable angina patients who have low Vitamin D levels, which is independent of changes in BP and /or heart rate.

Does angina show up on a chest xray? ›

A chest x-ray doesn't diagnose angina but may rule out other causes of chest pain. Blood tests. Blood tests look for risk factors for heart disease. CT scans.

What happens if you leave angina untreated? ›

An attack of unstable angina is an emergency and you should seek immediate medical treatment. If left untreated, unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heart rhythms). These can be life-threatening conditions.

Is angina always serious? ›

Stable angina (angina pectoris) is the most common type, and it's caused by coronary artery disease. Rest and medication can ease your angina and improve your quality of life. Severe or unexpected angina signals a heart attack and needs immediate medical care.

Can you live a long life with angina? ›

If your symptoms are well controlled and you make healthy lifestyle changes, you can usually have a normal life with angina.

Does Tylenol stop angina? ›

Tylenol is a good choice for those needing relief from the physical pain caused by osteoarthritis in the joints or from headache pain and who also have heart troubles such as high blood pressure, heart failure, heart attacks, chest pain due to narrowed coronary arteries (angina), or stroke.

Does metoprolol stop angina? ›

Metoprolol is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, metoprolol is used to treat patients with heart failure. This medicine is a beta-blocker.

Does metoprolol cure angina? ›

Metoprolol controls high blood pressure and angina but does not cure them. Metoprolol extended-release tablets control heart failure but does not cure it. It may take a few weeks before you feel the full benefit of metoprolol. Continue to take metoprolol even if you feel well.

What are the dangers of taking metoprolol? ›

Metoprolol has not been associated with drug abuse, dependency, or withdrawal. However, taking too much metoprolol can cause serious problems including heart failure, heart attack, and death. Symptoms of an overdose include slowed heart rate, low blood pressure, and wheezing.

What do you feel if you have angina? ›

The main symptom of angina is chest pain. Chest pain caused by angina usually: feels tight, dull or heavy – it may spread to your arms, neck, jaw or back. is triggered by physical exertion or stress.

What is the gold standard in diagnosing angina? ›

Angina pectoris, a clinical syndrome characterized by discomfort typically located in the chest, neck, or left arm, is one of several clinical manifestations of CAD. The gold standard for diagnosing and evaluating CAD is coronary angiography.

What happens if angina goes untreated? ›

An attack of unstable angina is an emergency and you should seek immediate medical treatment. If left untreated, unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heart rhythms). These can be life-threatening conditions.

Can bloodwork detect angina? ›

Blood tests check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.

Does angina always mean blockage? ›

Angina is a symptom triggered by a lack of blood supply to the heart. Usually, doctors look at angina in terms of finding blockages in the main heart arteries, followed by treatments including drugs, stents or bypass surgery. However, nearly half of all coronary angiograms do not reveal any blockages in blood vessels.

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