A short story: what would you do?
Follow Mario to learn the warning signs and what to do. Turn on your sound for the narration.
What causes angina
Most angina is caused by fatty plaque that narrows the coronary arteries, which feed the heart muscle. At rest, enough blood gets through. During effort, the heart needs more oxygen than the narrowed arteries can deliver, and angina starts. Resting lets the heart catch up. [Ref: AHA Angina] [Ref: ESC 2024 CCS]
Some people have angina even though their large heart arteries are not blocked. This can come from problems in the tiny blood vessels of the heart, or from arteries that tighten in spasm. Special tests can look for these causes. [Ref: ESC 2024 CCS]
What raises your risk: smoking, high blood pressure, high cholesterol, diabetes, being overweight, not being active, older age and a family history of heart disease. [Ref: AHA/ACC 2023 CCD] [Ref: ESC 2024 CCS]
What angina feels like
Pressure or squeezingA tight, heavy feeling in the chest rather than a sharp pain.
Spreading discomfortTo the shoulders, arms, neck, jaw, back or upper belly.
Less typical signsSome people feel an upset stomach, or only shortness of breath or tiredness.
Common triggersWalking fast, climbing stairs or other effort, and sometimes a heavy meal. It usually eases quickly with rest.
[Ref: AHA Angina]
Stable vs. unstable angina
| Type | What it is like | What to do |
|---|---|---|
| Stable angina | Comes on with a similar amount of effort each time. Goes away within minutes with rest or your angina medicine. | Book a clinic visit |
| Unstable angina | New, happening at rest, coming more often, lasting longer or not easing with your usual medicine. | Go to the ER now |
Unstable angina can lead to a heart attack and needs emergency care. [Ref: AHA Angina] [Ref: ESC 2023 ACS]
What happens at your check-up
Only your doctor can tell whether chest discomfort is angina. Your check-up starts with your symptoms, an examination, an ECG, blood tests and usually a heart ultrasound. Your doctor then decides whether you need more tests, such as these. [Ref: ESC 2024 CCS]
CT coronary angiogram
A CT scan with dye that shows plaque and narrowing in the heart arteries. It is a good first test to rule out blockages. [Ref: ESC 2024 CCS]
Stress test with imaging
Shows whether part of the heart muscle runs short of blood during exercise or medicine-induced stress. [Ref: ESC 2024 CCS]
Coronary angiogram
A thin tube and dye show the arteries directly. Your doctor may recommend it if other tests suggest serious narrowing. [Ref: ESC 2024 CCS]
Your doctor decides which tests you need and explains what the results mean for you.
Chest discomfort with effort? Get your heart checked.
Only an examination and the right tests can tell whether your chest discomfort is angina and how it should be treated. Dr. Aaron Christopher P. Novales sees patients with angina and heart artery disease.
Chest discomfort at rest, or lasting more than a few minutes? Do not wait for a clinic visit. Go to the emergency room now →
How angina is treated
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
Treatment has two goals: relieve the chest discomfort, and lower the risk of a heart attack. [Ref: AHA Angina] [Ref: ESC 2024 CCS]
Healthy habits
Stop smoking, eat a heart-healthy diet, sit less and stay active with exercise your doctor approves. Fish oil and vitamin supplements do not prevent heart attacks. [Ref: AHA/ACC 2023 CCD]
Medicines
- To relieve angina: medicines that ease the heart's workload, chosen by your doctor. Your doctor may also prescribe a fast-acting medicine for attacks and explain exactly when and how to use it. [Ref: AHA/ACC 2023 CCD] [Ref: AHA Angina]
- To prevent a heart attack: a medicine that helps prevent clots and a medicine that lowers cholesterol, both prescribed by your doctor. [Ref: ESC 2024 CCS] [Ref: AHA/ACC 2023 CCD]
- For some people: some newer diabetes medicines can also protect the heart. Ask your doctor if they are right for you. [Ref: AHA/ACC 2023 CCD]
If your usual angina does not go away with rest or your medicine within a few minutes, go to the emergency room now. [Ref: AHA Heart Attack Warning Signs]
Cardiac rehabilitation
A supervised exercise and education program that improves symptoms and lowers the risk of future heart problems. [Ref: AHA/ACC 2023 CCD]
Stents or bypass surgery
A stent (PCI) or bypass surgery is offered when angina still limits your life despite medicines, or when tests show a high-risk pattern of blockages. [Ref: AHA/ACC 2023 CCD] [Ref: ESC 2024 CCS]
Your doctor will discuss whether a stent or bypass would help you, based on your symptoms and test results. [Ref: ESC 2024 CCS] [Ref: AHA/ACC 2023 CCD]
Talk to your doctor about
Bring these questions to your visit.
- Is my chest discomfort stable angina?
- Which test is right for me?
- What should I do if an attack starts?
- Would a stent or bypass help me, or are medicines enough?
- Can I join a cardiac rehabilitation program?
Related conditions
Guideline sources for this page
- ESC 2024 CCS: Vrints C, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024.
- AHA/ACC 2023 CCD: Virani SS, et al. 2023 AHA/ACC multisociety guideline for the management of chronic coronary disease. J Am Coll Cardiol 2023.
- ESC 2023 ACS: Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023.
- AHA Angina: American Heart Association. Angina (chest pain).
- AHA Heart Attack Warning Signs: American Heart Association. Warning signs of a heart attack.