Angina - Diagnosis and Treatment

Diagnosis

Doctors start by listening to the patient’s symptoms, such as chest discomfort or pain during activity.

They ask about personal and family medical history, including risk factors like high blood pressure, diabetes, or smoking.

Doctors also check if anyone in the family had heart disease at a young age.
This helps them understand the patient’s risk.

Methods to Find the Cause

Doctors use several tools to see if someone has angina and what type it is.
These methods help tell the difference between stable angina, unstable angina, variant angina (Prinzmetal angina), and microvascular angina.

Each type has its own features, but all involve problems with blood flow to the heart.

Diagnostic Tools

Doctors use a range of tests to check the heart’s function and blood flow.

Test Name	Purpose	What It Detects
Electrocardiogram (ECG/EKG)	Measures heart’s electrical activity.	Abnormal heart rhythms, ischemia
Chest X-ray	Looks at heart and lungs.	Heart size, lung disease
Blood Tests	Finds heart damage markers.	Cardiac enzymes, heart attack
Stress Test	Checks heart under exercise.	Angina symptoms, abnormal rhythms
Echocardiogram	Uses sound waves to make heart images.	Heart motion, blood flow, valves
Nuclear Stress Test	Traces blood supply with a small amount of safe radioactive material.	Blood flow, blockages
Cardiac CT/MRI	Makes detailed pictures of the heart and blood vessels.	Heart structure, past damage
Coronary Angiogram	X-rays blood vessels after dye injection.	Blocked or narrowed arteries

Electrocardiogram (ECG or EKG)
Doctors place small patches (electrodes) on the chest and sometimes the limbs. The test records the heart’s electrical activity and helps doctors find abnormal rhythms, signs of a heart attack, or poor blood flow.

Chest X-ray
Doctors use chest X-rays to look at the heart and nearby areas.
They use these images to rule out other causes of discomfort, like lung problems, and to see if the heart is larger than normal.

Blood Tests
Doctors take blood samples to check for proteins that appear after heart muscle damage. Finding these proteins can suggest a recent heart attack, which sometimes happens with unstable angina.

Exercise and Pharmacologic Stress Testing
Doctors check how the heart works under stress with a stress test.
Patients may walk on a treadmill or ride a stationary bike, or get medicines that make the heart work harder if they cannot exercise.

Doctors may combine the stress test with imaging, such as an echocardiogram.

Echocardiogram
Doctors use sound waves to make moving images of the heart.
This test helps show how blood moves through the heart and how well the heart walls and valves work.

Nuclear Stress Test
Doctors inject a small amount of safe radioactive material into the bloodstream. A special camera tracks how the material moves in the heart’s blood vessels at rest and during exercise.

Areas with less blood supply appear different from healthy areas, which helps doctors find blockages.

Heart Imaging – Cardiac CT and MRI
Doctors use cardiac CT scans and MRIs for detailed views of the heart and blood vessels. A cardiac CT scan uses X-rays, while a cardiac MRI uses magnets and radio waves.

These tests show the heart’s structure and can reveal old injuries, enlargement, and artery problems.

Coronary Angiogram
Doctors use a coronary angiogram to see inside the coronary arteries.
They thread a long, thin tube called a catheter through a blood vessel to the heart and release dye to show narrowed or blocked arteries on X-ray images.

Doctors use these tools and the patient’s symptoms to confirm angina, identify the type, and find problems in the coronary arteries.

Treatment

Medicines to Help With Angina

Doctors often prescribe medicines to control angina symptoms and lower the risk of heart attack or stroke.
Several types of drugs help in different ways:

Medicine Type	How It Works
Nitrates	Widens blood vessels
Low-Dose Aspirin	Reduces blood clotting
Antiplatelet Agents	Stops platelets from clumping
Beta-Blockers	Lowers heart rate and blood pressure
Statins	Lowers cholesterol
Calcium Channel Blockers	Relaxes blood vessels
ACE Inhibitors/ARBs	Lowers blood pressure, used for heart/kidney protection
Anti-Anginal Agents	Helps with chest pain not relieved by other drugs

Nitrates

These medications relax and widen blood vessels, improving blood flow to the heart muscle. Short-acting forms can provide quick relief during an angina episode, while long-acting types may be used for prevention.

Antiplatelet Agents

These help prevent blood clots by stopping platelets from clumping together. Low-dose aspirin is one example commonly recommended to lower the risk of heart attack, but it may not be suitable for everyone.

Alternatives may be prescribed if aspirin isn’t appropriate. Patients should ask their doctor if aspirin is right for them.

Beta-Blockers

Beta-blockers slow the heart and lower blood pressure by relaxing blood vessels. This reduces the heart’s workload and its need for oxygen.

Cholesterol-Lowering Agents (Statins)

These medications reduce low-density lipoprotein (LDL) cholesterol levels, helping to prevent artery blockages and slow the progression of coronary artery disease.

Calcium Channel Blockers

These drugs help dilate blood vessels and lower blood pressure, improving oxygen supply to the heart muscle. They may be used alone or with other medications to prevent angina.

Blood Pressure-Lowering Drugs

ACE inhibitors and ARBs help people with high blood pressure, diabetes, heart failure symptoms, or chronic kidney disease.

Anti-Anginal Agents

When other medications do not adequately control chronic stable angina, doctors may prescribe drugs that help the heart use oxygen more efficiently. These are typically reserved for specific cases after evaluating other treatment options.

Doctors may combine these medicines to manage blood pressure, cholesterol, diabetes, and other risks.

Nondrug Options and Supportive Therapies

Doctors may suggest extra help if medicines do not control angina.
One option is enhanced external counterpulsation (EECP), where special cuffs are placed around the legs and hips.

These cuffs inflate and deflate with the heartbeat to help push more blood back to the heart. EECP does not need surgery or needles, but it does require several sessions.

This therapy can lower the number and intensity of angina attacks for some people.

Surgical and Procedure-Based Options for Angina

If medicines and other therapies do not work, doctors may recommend procedures or surgery to restore better blood flow.

Angioplasty and stenting (Percutaneous Coronary Intervention, PCI): In this procedure, a doctor inserts a thin tube (catheter) into a blocked heart artery. A small balloon at the end of the tube is inflated to widen the artery, and a wire mesh tube called a stent is placed to keep the artery open.

Doctors often use angioplasty and stenting for people with unstable angina or those whose symptoms do not respond to medicines. These procedures can quickly improve blood flow and reduce chest pain.

Coronary artery bypass grafting (CABG): In this surgery, doctors use a vein or artery from another part of the body to bypass a blocked heart artery. CABG is often chosen if a person has several blockages or ongoing angina despite medicine.

Doctors usually select these procedures after careful testing and advice from a cardiologist.

Daily Habits for Managing Angina at Home

Managing angina also means adopting healthy habits to support heart health and lower the risk of angina attacks.

Here are key steps:

Habit	Benefit
No tobacco	Better heart health
Regular exercise	Controls weight, reduces symptoms
Healthy eating	Lowers cholesterol
Manage stress	Reduces attacks, lowers risk
Good sleep	Prevents fatigue

Stop Tobacco Use: Quitting smoking and avoiding all tobacco helps protect the heart. Staying away from secondhand smoke is important too.
Stay Physically Active: Aim for regular activity, like brisk walking or cycling, for about 30 minutes most days. Talk to a health provider before starting new exercises, especially if you have heart problems.
Reach and Keep a Healthy Weight: Extra weight strains the heart and raises the risk of high blood pressure, diabetes, and high cholesterol. Work with healthcare professionals to set and reach healthy weight goals.
Eat Nutritious Foods: A heart-friendly diet includes fruits, vegetables, whole grains, and lean proteins. Limit foods high in saturated fats, trans fats, sugar, and salt.
Handle Other Health Issues: Monitor and control blood pressure, cholesterol, and blood sugar to prevent complications.
Reduce Emotional Stress: Too much stress can trigger angina attacks. Manage stress with exercise, mindfulness, or support from others.
Be Careful With Alcohol: Limit alcohol to lower heart risks. Women should have no more than one drink a day, and men no more than two.
Practice Healthy Sleep Habits: Aim for 7–9 hours of sleep each night. Keep a steady sleep schedule, even on weekends.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Plan ahead to make your appointment more helpful.

Here are things you can do before seeing the doctor:

Ask about pre-visit instructions. When you set up the appointment, ask if you need to follow any special rules, such as not eating before certain tests like cholesterol checks.
Write down your symptoms. List all your symptoms, even those that seem unrelated to chest pain. Note when they began and what you were doing at the time.
Collect family and personal health details. Make a list of relatives with heart problems, chest pain, stroke, diabetes, or high blood pressure. Think about recent stresses or big changes in your life.
Make a list of everything you take. Write down all medicines, vitamins, and supplements, even those bought without a prescription. Include exact dosages.
Bring support. If possible, invite someone to come with you. This person can help you remember what the doctor says.
Be ready to talk about your habits. Be prepared to discuss your diet and exercise. If you have concerns about activity or eating habits, mention them.
Prepare your questions. Write down what you want to ask. Having your questions ready can help you remember everything.

Sample Questions to Ask:

Topic	Example Questions
Symptoms	What could be causing my chest pain?
Testing	What tests will I need and how do I get ready for them?
Treatment	What options do you suggest and why?
Activity	What exercise is safe for me?
Other Conditions	How can I manage my other health problems together with angina?
Follow-up	How often should we meet to check on my angina?

Ask as many questions as you need. Bring up any concern during the visit.

Questions Your Healthcare Provider May Ask

Doctors need to learn about your symptoms and background. Being ready for these questions can help your appointment go smoothly.

Common Questions From Your Care Team:

When did your symptoms first start?
How would you describe your pain?
Where do you feel the pain most?
Does the pain move to other places like your neck or arms?
Did anything set off the pain?
Does the pain come on fast or slow?
How long does each episode last?
What makes the pain worse or better?
Are you also feeling dizzy or sick?
Is swallowing hard for you?
Do you ever have heartburn?

The doctor may also ask about your daily life and stress. Honest answers help your care team give better advice.

Angina – Diagnosis and Treatment