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 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.
Options for angina treatment include:
- Lifestyle changes
- 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.
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.
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
Surgeries and procedures used to treat angina and coronary artery disease include:
- Angioplasty with stenting
- Open-heart surgery (coronary artery bypass surgery)
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
- Exercise and manage weight
- Eat a healthy diet
- Manage other health conditions
- Practice stress relief
- Avoid or limit alcohol