What is angina pectoris?

Angina pectoris occurs when the heart needs more oxygen to function properly but can’t get enough. It may develop during exercise, when you experience stress, in cold environments or in other situations.

In most people, coronary artery disease is the cause of angina pectoris. This form of cardiovascular disease occurs when a sticky substance called plaque builds up in the arteries, reducing blood flow to the heart.

Less often, other medical conditions cause stable angina. These less common causes include:

• Problems with heart valves
• Abnormal heart rhythms
• Anemia
• Overactive thyroid
• Heart failure
• Coronary spasm
  

Because angina pectoris develops in response to certain triggers, symptoms are predictable and resolve with a few minutes of rest or after taking angina medication. Symptoms include:

• Chest pain, which may feel like burning, pressure, squeezing or indigestion
• Pain that radiates to the jaw, back, neck, shoulders or arms
• Shortness of breath
• Nausea in atypical presentation
• Fatigue with low level of activity
• Dizziness with exertion

Diagnosis of stable angina usually begins with a medical exam and an evaluation of your symptoms and health history. In addition, your healthcare provider will likely order tests,
such as:

• Blood tests
  
• An electrocardiogram (EKG) test that tracks the electrical activity of the heart
• A stress test, which evaluates how well the heart functions while under strain. This could be an exercise stress test with nuclear/echo, an exercise stress test alone or a medication-induced/chemical stress test.
• A coronary angiogram test that involves inserting a thin tube into a blood vessel in the leg or arm to assess coronary artery circulation/blockages and heart function as well as pressures in heart chambers
• Coronary CT angiogram
• Echocardiogram to check heart function, valves and chamber size
• Imaging tests, such as a CT scan, MRI or chest X-ray

For most people, treatment for angina pectoris involves following a treatment plan for heart disease, which may include resting and/or taking medications when chest pain occurs. When stable angina occurs due to another health condition, treatment generally focuses on treating the underlying cause, such as thyroid disease or arrhythmia.

1. Treatment for chest pain: For some people, rest is enough to alleviate stable angina symptoms. Others benefit from taking nitroglycerin, a prescription medication that works quickly to relax the blood vessels. This increases blood flow to the heart, allowing it to get the oxygen it needs.

When chest pain persists for long periods, healthcare providers may prescribe the medication ranolazine or isosorbide to prevent symptoms from occurring. These are long-acting medications and should not be taken for acute episodes of chest pain where nitroglycerin works better and faster.

Enhanced external counterpulsation (EECP) is another potential treatment for long-term angina pectoris. This therapy involves placing pressure cuffs around the pelvis and legs to increase blood flow to the heart. However, cardiology trials have not shown significant benefits so far. This should only be prescribed by a cardiologist after a discussion of benefits and alternatives.

2. Treatment for coronary artery disease: When angina pectoris arises due to coronary heart disease, healthcare providers will usually develop a treatment plan to manage the disease. Treatments may include:

• Medications: Blood pressure medications, nitrates and other drugs may be prescribed to treat heart disease. When angina persists despite treatment, healthcare providers may prescribe the drug ranolazine.
• Angioplasty with stenting: This surgical procedure involves inserting a wire mesh coil called a stent into an artery to keep it open and improve blood flow to the heart.
• Coronary artery bypass grafting (CABG): Another surgical procedure, CABG, involves grafting a blood vessel from another part of the body onto the heart in order to divert blood flow around a blocked artery.

3. Lifestyle changes: If you have coronary artery disease, your healthcare provider will likely recommend that you make lifestyle changes, such as:

• Eating a diet rich in fruits, vegetables, whole grains and lean proteins
• Reducing your intake of alcohol, added sugars, sodium, and trans and saturated fats
• Exercising regularly
• Quitting smoking
• Reaching or maintaining a healthy weight
• Managing stress
• Getting enough sleep

Although there is no cure for coronary artery disease, lifestyle changes and medical treatments can support heart health, ease angina and reduce your risk of experiencing heart disease complications, such as a heart attack.

Updated August 2024.