Angina Management

Angina Management


What is Angina?

Angina (angina pectoris) is chest pain. It is sometimes described as “pressure” or ‘discomfort” rather than pain; it may also radiate to the throat, jaw, back, or arms.

Pain generally occurs at about the same point. The pain usually comes with activity and/or emotional stress and goes away with rest and/or nitroglycerin tablets or spray; with the symptoms usually going away within three to five minutes. Angina is a warning signal. It is the heart muscle’s way of telling the body that it is being forced to work too hard and needs to slow down.

What patient can feel?

  • Tightness, pressure, squeezing and/or aching feeling in the chest or arm(s).
  • Feeling of indigestion (that is persistent).
  • Sharp, burning or cramping pain.
  • An ache that starts in, or spreads to, the neck, jaw, throat, shoulder, back, or arm(s).
  • Discomfort in the neck or upper back, particularly between the shoulder blades.
  • Some people feel breathless, weak or sweaty from angina but don’t have any of the above symptoms.

Reasons for Angina

Two conditions can prevent the heart from getting enough oxygen and blood. The first condition is known as atherosclerosis, which is a buildup of fatty deposits that reduces the diameter of the coronary artery. The other condition is known as a coronary spasm or sudden squeezing of the coronary artery.


Over time, the walls of the coronary arteries sometimes develop a fatty build up called plaque, which makes them thick and stiff. This is commonly referred to as hardening of the arteries or coronary artery disease (CAD). Your doctor will call it atherosclerosis.

When atherosclerosis narrows the diameter of an artery, less blood can get through to the heart muscle. This results in less oxygen being delivered to the heart muscle, which causes the symptom of angina.

Why angina can start?

When a coronary artery has a spasm it temporarily squeezes together. This cuts off the blood flow to the heart muscle for a few moments, causing angina.

Spasms can occur in arteries with or without fatty build (atherosclerosis).

Risk Factors for Atherosclerosis

Certain conditions or risk factors seen to be associated with this narrowing of the arteries. Some of these are beyond our control. The risk factors mentioned below can be controlled if we actively work on it.

Non-Controllable Risk Factors

  • Age – males over 55; females after menopause.
  • Family history of heart disease.

Controllable Risk Factors

  • Smoking or exposure to second-hand smoke
  • Uncontrolled high blood pressure
  • High cholesterol
  • Lack of physical activity
  • Diabetes
  • High fat diet

Stress, both physical and emotional, is also thought by some doctors to play a role.

What is the immediate treatment for Angina?

Nitroglycerin is the most common medication prescribed by doctors for angina. It works quickly to relax blood vessels and lower blood pressure, which relieves the discomfort of the angina attack. To prevent angina, the nitroglycerin tablet or spray can be used just before physical activity. Your doctor may prescribe a nitroglycerin patch to limit the angina on an ongoing basis. Remember to always follow your doctor’s directions when using any medication.

How to Use Nitroglycerin

  • Keep a supply with you all the times
  • Make sure that someone else knows where your spare supply is kept
  • Fast Acting Nitroglycerin Tablets:
  • Once the seal of the bottle is broken, replace the medicine after three months.
  • Keep the tablets in a dark glass bottle or jar.
  • Remove the cotton from the bottle once you’ve opened it.
  • Place tablet under tongue and let it dissolve.
  • Fast Acting Nitroglycerin Spray:
  • Can last up to two years (check the expiry date).
  • Keep spray away from high temperature areas.
  • Spray nitroglycerin directly under your tongue.

If the pain does not go away after a minute or two of rest:

  • Take your first dose of nitroglycerin. Spray or place tablet under your tongue.
  • If the pain doesn’t go away after five minutes, take a second dose.
  • If your angina is still there after five or more minutes (total of 10 minutes), take a third dose.
  • If your angina does not go away five minutes after the third dose (total of 15 minutes), you have to ACT QUICKLY and go to the nearest EMERGENCY DEPARTMENT.
  • Do not yourself. Call someone to help and be with you.

Other Medication for Angina?

Some more medications used to treat angina are:

  • Beta blocking drugs (e.g. metoprolol, atenolol), which make the heart beat more slowly and reduces its need for blood.
  • Calcium channel blocking drugs (e.g. diltiazem, verapamil, amlodipine), which relax the arteries and prevent spasms.
  • Aspirin (ASA), which thins the blood and makes blood clots less likely to form.

Do not use any medication without first talking with your doctor.


Contact your doctor if you notice any of the following changes in your angina symptoms:

  • Symptoms occur more frequently
  • More doses of medication are needed to relieve the discomfort
  • Pain is brought on by a lower level of activity, or while you are at rest
  • Symptoms are waking you from your sleep.

A change in your medication or further investigations and treatments may be needed to prevent heart damage.


Here are some things you can do to develop a heart healthy lifestyle that will help you cope with angina.

The pace at which you live your life has a lot to do with angina. The heart needs more oxygen when you are in a hurry, very active or upset.

If you change those habits which make your heart work harder, you may have fewer episodes of angina. You should always REST if you develop symptoms of angina.


Identify your risk factors for heart disease and take action to control the ones you can.

  • Stop smoking and avoid exposure to second-hand smoke
  • Lose weight if you are overweight
  • Reduce the total amount of fat in your diet
  • Keep your blood pressure under control by taking your medication as directed
  • Recognize stress in your life and deal with it in a healthy manner
  • Regular physical activity as advised by your doctor
  • Control blood sugar if you have diabetes
  • Get enough rest
  • Get good sleep
  • Be regular about your follow ups with your doctor

By making lifestyle changes and following your doctor’s directions, you will feel better and you may reduce angina attacks and decrease your chances of having a heart attack.