angina treatment options overview

Overview

Angina is a type of chest pain or discomfort that happens when the heart muscle doesn't get enough oxygen-rich blood. It is usually a symptom of heart disease, not a disease itself. The pain often feels like pressure, squeezing, heaviness, or tightness in the chest, and it may spread to the shoulders, arms, neck, jaw, or back.

Angina is fairly common. It affects millions of people around the world, and the number of cases has been rising as populations age and risk factors like obesity and diabetes become more common.

Angina is most common in older adults, especially people over age 50. Men often develop it earlier than women, but women's risk rises after menopause. People with high blood pressure, high cholesterol, diabetes, or a family history of heart disease are also more likely to have angina.

Symptoms

Common symptoms

• Chest pain or discomfort – often described as pressure, squeezing, heaviness, or tightness
• Pain that spreads to the shoulders, arms, neck, jaw, or back
• Shortness of breath
• Feeling tired or weak during activity
• Indigestion-like feeling in the chest or stomach

Causes

Main causes

• Narrowing of the coronary arteries due to a fatty substance called plaque (atherosclerosis)
• A spasm (sudden squeezing) of the coronary arteries
• The heart needing more oxygen than the arteries can supply, such as during exercise, stress, or illness
• Coronary microvascular disease – problems with the tiny blood vessels of the heart

Risk factors

• High blood pressure
• High cholesterol
• Smoking or tobacco use
• Diabetes
• Physical inactivity
• An unhealthy diet high in salt, saturated fat, and processed foods
• Being overweight or obese
• High levels of stress
• A family history of early heart disease

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe chest pain that lasts more than a few minutes
• If you have chest pain with sweating, nausea, or feeling like you might faint
• If you have been diagnosed with angina and your usual pattern changes, or your pain does not improve with rest

Book a routine appointment if:

• If you have any chest pain or discomfort that comes and goes, especially during physical activity
• If you have unexplained shortness of breath, indigestion-like pain, or extreme tiredness with activity

Diagnosis

A healthcare provider will ask about your symptoms, medical history, and risk factors. They will listen to your heart, check your blood pressure, and may order tests to see how well your heart is working and whether your heart arteries are narrowed.

Tests that may be done

• Blood tests – to check cholesterol, blood sugar, and signs of heart muscle strain
• Electrocardiogram (ECG or EKG) – a quick, painless test of the heart's electrical activity
• Exercise stress test – walking on a treadmill while your heart is monitored
• Echocardiogram – an ultrasound picture of the heart's structure and function
• Coronary angiography or cardiac catheterization – a dye test that looks inside the heart's arteries
• CT scan or MRI of the heart – detailed images to look for blockages

What to expect at your appointment

Testing can feel a little daunting, but most tests are safe and well tolerated. You may be asked not to eat or drink for a few hours before some procedures. Your healthcare team will explain what each test involves and what the results mean, and they will be with you throughout the process.

Treatment

Treatment for angina aims to relieve symptoms, slow or reduce the buildup of plaque, and lower the risk of heart attack and stroke. Your plan will depend on the type and severity of your angina, your overall health, and your personal preferences. It will likely include lifestyle changes, medicines, and possibly a procedure to improve blood flow to the heart.

Self-care at home

• Stop smoking and avoid second-hand smoke
• Eat a heart-healthy diet rich in vegetables, fruits, whole grains, and lean proteins
• Get regular physical activity, as advised by your healthcare provider
• Reach and maintain a healthy weight
• Take all prescribed medicines exactly as directed
• Learn to manage stress with relaxation techniques or mindfulness
• Track your symptoms and know what to do when they occur

Medical treatments

Medicines are often the first line of treatment for angina. They may include tablets or sprays to help widen blood vessels and ease an attack, medicines to lower heart rate or blood pressure, medicines to reduce cholesterol, and medicines to prevent blood clots. Some are taken every day, while others are used only when symptoms occur. Your healthcare provider or pharmacist will explain how to use them properly. Do not change your dose or stop a medicine without talking to them.

When is surgery considered?

If medicines and lifestyle changes are not enough, a heart specialist may recommend a procedure to improve blood flow. This can be angioplasty – using a small balloon with a support tube called a stent to open a narrowed artery – or open-heart surgery called coronary artery bypass graft (CABG). These options are discussed in detail with your cardiologist and heart team.

Living with this condition

Living with angina means learning your patterns and triggers. You can still do many of the things you enjoy by pacing yourself, resting when needed, and keeping your medicine with you. Tell your family and close friends about your condition and how they can help in an emergency.

Lifestyle tips

• Follow a heart-healthy, balanced diet
• Include moderate exercise like walking, cycling, or swimming, but check with your provider first
• Get enough sleep – aim for 7 to 9 hours a night
• Keep blood pressure, cholesterol, and blood sugar in a healthy range
• Limit alcohol
• Maintain a healthy weight
• Reduce stress with hobbies, breathing exercises, or talking to friends

Diet and exercise

A diet for angina emphasizes vegetables, fruits, whole grains, fish, and healthy fats like olive oil and nuts. Limit red and processed meats, fried foods, foods high in sugar, and excess salt. Exercise helps your heart work more efficiently and can improve symptoms. Start slowly, and always talk to your doctor before starting a new activity. If an activity causes chest pain, stop and rest.

Mental health and emotional wellbeing

Angina can cause worry, anxiety, or low mood. It is normal to feel this way after a diagnosis. Your emotional health matters as much as your physical health. Talk to your healthcare team about how you are feeling. You can also reach out to family, friends, or a mental health professional. If you are having thoughts of self-harm, seek help immediately by calling your local emergency number or a crisis line.

Prevention

You can lower your chances of developing angina by controlling the risk factors that lead to heart disease. Even if you already have angina, these steps can slow its progression and prevent it from getting worse.

Vaccines

There is no vaccine for angina itself, but it is important to stay up to date with recommended vaccines such as the flu and COVID-19 vaccines. Infections can put stress on the heart, so preventing them is good for your heart health. Talk to your healthcare provider about which vaccines are right for you.

Screening programmes

There is no routine screening test for angina in all adults. However, you can have your blood pressure, cholesterol, blood sugar, and other risk factors checked at regular health visits. Your provider may recommend heart tests if you have symptoms or a strong family history of heart disease.

Complications

If left untreated

• Heart attack – damage to a part of the heart muscle
• Abnormal heart rhythms (arrhythmias)
• Heart failure – a weakened heart that doesn't pump blood effectively
• Sudden cardiac arrest – a medical emergency where the heart stops beating

Long-term outlook

With the right treatment and self-care, most people with angina can enjoy a good quality of life. Angina is often a warning sign that encourages positive changes. Acting now can make a big difference. Your healthcare team is there to help you reduce your risks and feel your best.

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