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HEART SERVICES

Diagnosis & Treatment

Angina

Find an angina specialist

How is Angina Diagnosed?

Diagnosis

Angina diagnosis will begin with a medical examination where a doctor will ask questions about a family history of heart conditions and possible genetically related heart concerns.

A blood test will confirm the presence of certain enzymes indicative of heart muscle damage or possible heart attack. Additional tests used for angina diagnosis can include:

  • Electrocardiogram (ECG or EKG) - This non-invasive, painless test uses electrodes attached to your chest, arms, and legs to measure the electrical activity of your heart. An ECG or EKG can detect rhythm abnormalities in your heart and any signs of strain from decreased blood flow to the arteries. From these results, a blockage that could result in angina can be diagnosed.
  • Chest X-ray – Chest X-rays can show signs of an enlarged heart which could be connected to coronary artery disease. Conditions relating to the lungs can be visualized through chest X-rays.
  • Blood tests - A cardiac enzyme blood test can reveal the presence of enzymes associated with heart damage or a heart attack.
  • Stress tests - Angina can be brought about by exercise. Doctors may have patients walk a treadmill or ride a stationary bicycle while monitoring their heart activity. If a patient cannot exercise, medications are available that can imitate the body’s response to exercise.
  • Echocardiogram - This imaging test uses ultrasound waves to create detailed images of the heart and surrounding organs. These images can determine if blood is flowing properly to the heart.
  • Nuclear stress test - A dye called a radioactive tracer is injected into a person’s bloodstream before beginning a stress test. A special monitor shows how the tracer flows through the arteries. Areas with little or no visible tracer at stress indicate poor blood flow.
  • Cardiac computerized tomography (CT) - This X-ray imaging device scans the body from different angles, collecting images of the heart and chest. These images are then processed through a computer to create detailed 3-D images of the cross-sections of bones, blood vessels, and soft tissue inside the body.
  • Cardiac magnetic resonance imaging (MRI) - Magnetic fields and radio waves are combined to produce in depth views of the heart and blood vessels.
  • Coronary angiography - This procedure, also called a coronary angiogram, is part of a group of catheterizations. X-rays produce images of the heart’s blood vessels, and if a blockage is identified, it can potentially be fixed with a stent, if appropriate, at the same time.

How is Angina Treated?

Treatment

Angina is the result of a heart condition. Often the treatment for the original heart condition will also treat angina.

Treatment for angina is designed to reduce the frequency of the episodes, decrease the severity of pain and discomfort associated with angina, and lower the risk of a heart attack.

If you have unstable angina and suddenly experience severe pain unlike any pain before, call 911 for immediate medical attention. Angina is sometimes the warning sign for a heart attack.

Other options available to treat angina include:

Lifestyle changes

Eating healthier, adding an exercise routine, and learning stress management techniques can improve heart health.

  • Don’t smoke
  • Exercise and maintain a healthy weight
  • Eat healthy foods low in salt, fat, and sugar and rich in fruits, vegetables, whole grains, low-fat dairy, and little or no red meat
  • Manage other health issues such as diabetes, high blood pressure, and high cholesterol, all which increase the risk of angina
  • Manage emotional stress by practicing mindfulness and connecting with others through support groups
  • Avoid or moderate alcohol consumption

Medications

Medications are available to treat angina and the pain associated with it.

  • Nitrates treat angina by relaxing and widening the blood vessels so more blood can flow to the heart
  • Aspirin reduces blood clotting, making blood flow easier through narrowed arteries
  • Anti-clotting drugs prevent platelets from sticking together, avoiding blood clots
  • Beta blockers cause the heart to beat slower, using less pressure and lowering blood pressure. These medications are designed to relax blood vessels, allowing for better blood flow.
  • Statins are used to lower cholesterol, a factor in heart disease and angina. Statins also prevent blockages from occurring in the blood vessels and stabilize existing plaque.
  • Calcium channel blockers relax and widen the blood vessels to enable better blood flow
  • Blood pressure medications can prevent heart attacks and heart disease. Doctors may prescribe angiotensin-converting enzyme inhibitors (ACE) or angiotensin II receptor blockers (ARBs) to manage blood pressure.
  • Ranolazine (Ranexa) is usually prescribed for chronic stable angina when other medications have not proven to be effective. Sometimes this medication is taken alone or with other angina medications.

Surgery

  • Surgery or catheterization procedures may have positive outcomes if other means to control angina have not been successful.
  • Angioplasty with stenting. This procedure uses a tiny balloon inserted through a catheter in the groin, then guided to the blocked coronary artery, where it is expanded to improve blood flow.
  • Open-heart surgery (coronary artery bypass surgery). Bypass surgery uses a vein or artery from somewhere else in the body to bypass the blocked or narrowed artery. This effective option is used for stable and unstable angina treatment when other treatments have not worked.

Therapies

Another option for treating angina involves using enhanced external counterpulsation (EECP). This non-drug treatment places blood pressure-type cuffs on the calves, thighs, and pelvis. Multiple sessions are usually needed. This treatment has been useful in treating people with uncontrolled angina (refractory angina).

Cardiac rehabilitation centers include supervised programs for people needing help with exercise, lifestyle changes, heart health education, and emotional support.

FAQs

FAQs

Angina is described as feeling like a heavy weight is on your chest. The pain is said to feel like pressure, a tight sensation in the chest, or a squeezing feeling in your chest.

Angina usually lasts about 5 minutes but rarely longer than 15 minutes.

To correctly diagnose angina, your doctor must perform a physical exam and ask questions relating to a family history of heart disease or complaints about the pain you are experiencing. After your initial physical exam, imaging and blood tests will be done to attain a positive diagnosis for angina.

Get Care

Trust NewYork-Presbyterian for Angina Treatment

Know the signs and symptoms of angina. Call NewYork-Presbyterian for an appointment for a consultation with one of our expert cardiologists, who are dedicated to our patients when preventing further heart complications and improving their quality of life. Learn about the treatment options available at NewYork-Presbyterian for angina and other cardiovascular care services.