Angina: A Guide to Diagnosis & Treatment Options

Angina is a common heart condition that causes chest pain or discomfort. It occurs when the heart muscle does not receive enough blood and oxygen. In this article, we’ll explore what angina is, its causes, symptoms, diagnosis, and treatment options.

For a more general discussion on the various causes of chest pain, see our article here.


What is angina?

Angina is characterized by a distinct type of chest pain or discomfort that arises when the heart muscle encounters an inadequate supply of blood and oxygen. This condition often emerges as a consequence of the narrowing or obstruction of the coronary arteries – the crucial blood vessels responsible for delivering nourishing blood to the heart muscle.

The chest pain associated with angina can vary in intensity and sensation. It’s frequently described as a tightness, pressure, squeezing, or burning sensation in the chest. Sometimes, this discomfort might also radiate to the arms, neck, jaw, shoulders, or back. Angina’s onset can be provoked by physical exertion, emotional stress, or even extreme temperatures. When the heart’s demand for oxygen increases, such as during exercise, and the supply is restricted due to narrowed arteries, angina can occur as a warning sign.

It’s important to recognize that angina is not a standalone condition but rather a symptom that signifies an underlying heart issue. One of the most common root causes of angina is coronary artery disease (CAD). In CAD, the coronary arteries that should be supplying the heart muscle with a steady flow of oxygen-rich blood become narrowed or blocked by the buildup of cholesterol and fatty deposits called plaques. These plaques restrict blood flow, which in turn triggers the discomfort characteristic of angina.


Causes of angina

Recognizing the underlying cause of angina is vital for determining the appropriate treatment and management strategies. If you experience chest pain or discomfort resembling angina symptoms, seeking medical attention promptly is crucial. A healthcare provider will conduct a comprehensive assessment with a medical history review, physical examination, and diagnostic tests like electrocardiograms (ECGs), stress tests, CT scans or angiograms to pinpoint the precise cause and determine the best course of action.

In essence, angina serves as an essential warning signal from your body that your heart might not be receiving the blood and oxygen it requires. Understanding its nature and underlying causes empowers individuals to take proactive steps toward heart health, adopt appropriate lifestyle changes, adhere to medical recommendations, and seek timely medical assistance when needed.

The most common cause of this is a buildup of plaque, which is a fatty substance that accumulates inside the artery walls. Other causes of angina may include:

  • Coronary artery spasm: A sudden contraction of the coronary artery that can temporarily reduce blood flow to the heart muscle.
  • Anemia: A low red blood cell count that reduces the amount of oxygen in the blood.
  • Heart valve problems: Certain heart valve problems, such as aortic stenosis, can reduce blood flow to the heart muscle.
  • Hypertension: High blood pressure can increase the workload on the heart and reduce blood flow to the heart muscle.

For a more general discussion on the various causes of chest pain, see our article here.


Symptoms of angina

At the core of angina’s symptoms lies chest pain or discomfort. This sensation is frequently described as a tightness, pressure, squeezing, or burning feeling in the chest. However, it’s important to recognize that angina doesn’t solely restrict its expression to the chest. Other parts of the body can also be involved, including the arms, neck, jaw, shoulders, or back. This divergence in symptom location emphasizes the interconnectedness of the heart and its circulatory network.

Beyond Chest Pain: A Multifaceted Range of Symptoms

The breadth of angina symptoms extends beyond mere discomfort. Individuals may experience an assortment of sensations, each offering a glimpse into the intricacies of this condition. Alongside chest pain, these symptoms can include:

  • Pain or Discomfort: Radiating from the chest to the arms, neck, jaw, shoulder, or back, this pain provides an unmistakable signal of compromised blood flow affecting multiple areas.
  • Shortness of Breath: Oxygen demand can surpass supply during angina episodes, leading to breathlessness. This symptom can be particularly distressing, making even routine activities challenging.
  • Nausea or Vomiting: In response to the stress angina places on the body, feelings of nausea or even vomiting might occur.
  • Sweating: A sudden surge in perspiration, often cold and clammy, is a common response to the physiological stress of angina.
  • Fatigue: Angina can drain energy levels, leaving individuals feeling unusually fatigued and lethargic.
  • Dizziness or Lightheadedness: Diminished blood flow can affect blood pressure and oxygen delivery to the brain, causing sensations of dizziness or lightheadedness.

Diverse Triggers, Unified Experience

Angina’s triggers are as diverse as its symptoms. Episodes can occur during physical exertion, emotional stress, or even at rest. The body’s heightened need for oxygen, whether from a brisk walk or a surge of anxiety, can provoke angina symptoms. Notably, these symptoms are transient, usually lasting just a few minutes. Moreover, they tend to subside with rest or medication, reflecting the body’s resilience in adapting to temporary disruptions in blood flow.

In summary, the constellation of angina symptoms reflects the intricate dialogue between the heart, blood vessels, and the body’s demand for oxygen. By recognizing this diversity of expressions, individuals can take swift action when symptoms arise, seeking medical guidance to pinpoint the underlying cause and embark on an appropriate management journey. A comprehensive understanding of angina’s variegated symptoms empowers proactive heart care, fostering a healthier and more informed approach to overall well-being.


Diagnosis of angina

The Foundation: Clinical History and Risk Factors

Central to the diagnostic journey is the patient’s clinical history. A healthcare professional will engage in a thorough conversation to glean essential insights into the nature and frequency of symptoms. This exchange delves into the duration, intensity, and triggers of chest discomfort or other associated sensations. Any connections to physical activity, stressors, or resting periods are crucial for establishing patterns.

Equally significant is the assessment of underlying risk factors. Conditions like hypertension, high cholesterol levels, diabetes, and a family history of heart disease can heighten the likelihood of angina. Lifestyle factors, including smoking, obesity, and a sedentary routine, further contribute to the overall risk profile. These risk factors, when considered collectively, provide a holistic view of an individual’s susceptibility to angina.

Diagnostic Tools: Beyond Symptoms and Risk Factors

While clinical history and risk assessment offer valuable initial insights, objective diagnostic tests play a pivotal role in confirming the presence of angina and its underlying causes. These tests provide a more concrete understanding of the heart’s functionality and the blood flow to its muscle.

  • Electrocardiogram (ECG): This fundamental test records the heart’s electrical activity, identifying any abnormal rhythms or patterns that could suggest angina.
  • Stress Electrocardiogram (Stress ECG): This test involves monitoring the heart’s electrical activity while the patient engages in physical exercise, usually walking on a treadmill or pedaling a stationary bike. As intensity escalates, the heart’s oxygen demand rises. A stress ECG highlights any irregularities in the heart’s rhythm or signs of inadequate blood flow, suggesting angina. Changes in the ECG’s pattern during exercise can point toward coronary artery disease.
  • Stress Echocardiogram (Stress Echo): Combining ultrasound imaging with exercise, a stress echo captures real-time images of the heart’s chambers and valves before and after exertion. This dynamic approach enables the assessment of blood flow and heart function, providing valuable information about the heart’s health and any areas with compromised blood supply.
  • Nuclear Stress Test: This advanced test integrates nuclear imaging to delve deeper into blood flow dynamics. A small amount of radioactive substance is injected into the bloodstream, allowing specialized cameras to trace blood flow to the heart. The images reveal areas with diminished blood supply, guiding diagnoses with remarkable precision. This test is particularly useful when traditional stress tests yield inconclusive results.
  • Coronary Angiography: This invasive procedure involves injecting a contrast dye into the coronary arteries to visualize blood flow. It can precisely identify blockages or narrowing in the arteries.
  • Echocardiogram: Using sound waves, an echocardiogram produces detailed images of the heart’s structure and function, aiding in evaluating heart health.
  • Blood tests: Measuring specific enzymes and proteins in the blood can indicate whether the heart muscle has suffered damage. Additionally, assessing blood levels of cholesterol and sugar holds significance, as does evaluating blood count and thyroid function.


The integration of clinical history, risk assessment, and diagnostic tests empowers healthcare professionals to make informed treatment decisions. A precise diagnosis addresses immediate concerns and guides the creation of a personalized plan, managing risks, symptoms, and promoting lasting heart health.


Angina: A Guide to Diagnosis & Treatment Options Heart Matters

Treatment of angina

The treatment of angina depends on the severity and frequency of symptoms. Treatment options for angina may include:

  • Lifestyle changes: Adopting a healthy lifestyle, including regular exercise, a balanced diet, and quitting smoking can help reduce the risk of angina and improve symptoms.
  • Medications: Certain medications, such as nitroglycerin or beta-blockers, can help relieve symptoms and improve blood flow to the heart muscle.
  • Procedures: Certain procedures, such as angioplasty or coronary artery bypass surgery, can help open blocked or narrowed arteries and improve blood flow to the heart muscle.


Prevention of angina

Though angina may not always be entirely avoidable, embracing a range of proactive strategies can significantly diminish the risk of its occurrence. These measures encompass lifestyle adjustments and mindful management of underlying health factors, working together to foster heart health and well-being.

Adopting a Healthy Lifestyle: A cornerstone of angina prevention lies in adopting a lifestyle that promotes heart health. Regular physical activity, encompassing exercises like brisk walking, swimming, or cycling, enhances cardiovascular fitness and blood circulation. Coupled with this, a balanced and nutrient-rich diet, rich in whole grains, lean proteins, and vegetables, supports heart function and maintains a healthy weight. Perhaps one of the most impactful actions is quitting smoking, as it drastically reduces the risk of arterial narrowing and plaque buildup.

Managing Underlying Medical Conditions: Tackling factors that contribute to angina risk is essential. Individuals with high blood pressure or elevated cholesterol levels should work closely with healthcare professionals to manage these conditions through medication, lifestyle modifications, or a combination of both. By addressing these contributing factors, the likelihood of developing angina can be notably curtailed. In essence, while the complete prevention of angina might not always be within reach, individuals possess the agency to proactively influence their heart health. By embracing a health-conscious lifestyle, actively managing underlying health conditions, and prioritizing stress reduction, individuals can significantly reduce the burden of angina.


Anemia and low iron levels often play a role in angina deterioration. Remember, a simple discussion with your doctor about these factors can make a significant impact on your angina management.



In conclusion, angina is a common heart condition that causes chest pain or discomfort due to reduced blood flow to the heart muscle. It is typically caused by a blockage or narrowing of the coronary arteries, which can be due to a buildup of plaque or other underlying medical conditions. Treatment options for angina may include lifestyle changes, medications, or procedures to improve blood flow to the heart muscle. While angina may not always be preventable, adopting a healthy lifestyle, managing underlying medical conditions, and reducing stress levels can help reduce the risk of developing the disease or experiencing symptoms. If you are experiencing symptoms of angina, it is vital to seek medical attention to receive an accurate diagnosis and appropriate treatment.

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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.