Angina (Chest Pain) Living With

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Angina is not the same as a heart attack, but it is a signal that you are at greater risk of having a heart attack. The risk is higher if you have unstable angina. Make sure that you receive follow-up care and understand your condition. Knowing when to get medical help can save your life.

You may need follow-up visits every 4 to 6 months for the first year after an angina diagnosis and every 6 to 12 months as long as your condition is stable. Your care plan may need to change if your angina worsens or becomes unstable. Unstable angina is a medical emergency. Your healthcare provider may prescribe cholesterol-lowering statin medicines as part of your long-term treatment, especially if you have had a heart attack.

• Ask your provider about when you can get back to normal physical activity, such as climbing stairs.
• Ask your provider whether sexual activity is safe for you. People who have unstable angina or angina that does not respond well to treatment should not engage in sexual activity until their heart condition and angina are stable and well managed.
• Talk to your provider about vaccinations to prevent the flu and pneumonia.

Angina is a symptom of heart disease. Your provider may talk to you about the following heart-healthy lifestyle changes to help you manage your angina:

• Choose heart-healthy foods. Following a healthy eating plan, including limiting alcohol, can prevent or lower high blood pressure and high blood cholesterol, helping to relieve your angina symptoms and maintain a healthy weight. You should avoid large meals and rich foods if heavy meals trigger your angina. If you have vasospastic angina, drinking alcohol can also be a trigger.
• Aim for a healthy weight. If you have overweight or obesity, work with your healthcare provider to create a reasonable weight-loss plan. Controlling your weight helps you manage the risk factors for angina.
• Be physically active. Before starting any exercise program, ask your healthcare provider about what level of physical activity is right for you. Slow down or take rest breaks if physical exertion triggers angina.
• Manage stress. If stress triggers your angina, try to avoid or limit situations that cause it.
• Quit smoking. Smoking can damage and tighten blood vessels, make angina worse, and raise the risk of life-threatening complications. Visit Smoking and Your Heart and NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
• Get enough good-quality sleep. Sleep helps heal and repair your heart and blood vessels. Over time, not getting enough quality sleep, called sleep deficiency, can raise your risk of heart disease, obesity, high blood pressure, diabetes, and stroke.

Your healthcare provider may talk to you about these heart-healthy lifestyle changes as part of a larger cardiac rehabilitation program that your providers oversee.

Stable angina usually occurs in a pattern. After several events, you will learn what causes the pain to occur, what it feels like, and how long it usually lasts. To help learn your angina’s pattern and triggers, keep a log of when you feel pain. Remembering when and how angina happens can be hard after a few days have passed, and a log can help you keep track. The log also helps your healthcare provider manage your medicines and determine your need for future treatments. When you know what triggers your angina, you can take steps to prevent or lessen the severity of events.

• Know when you need emergency medical attention. Ask your provider about what “normal” means for your angina and when you should call 9-1-1.
• Know the limits of your physical activity. Most people who have stable angina can continue their normal activities. These include work, hobbies, and sexual activity. Learn how much exertion triggers your angina so you can try to stop and rest before the chest pain starts.
• Learn how to lower and manage stress. Try to avoid or limit situations that cause anger, arguments, and worry. Exercise and relaxation can help relieve emotional stress. If stress is a problem for you, talk with your provider about getting help.
• Avoid very hot or cold conditions. Temperature extremes strain the heart.
• Eat smaller meals if large meals lead to chest pain.

Tell your healthcare provider right away if your pattern changes. Pattern changes may include angina that occurs more often, lasts longer, is more painful, occurs without physical exertion, or does not go away with rest or medicines. These changes may be a sign that your symptoms are getting worse or becoming unstable.

Not all angina improves with medicines or medical procedures. If your symptoms continue, your healthcare provider may change your medicines or therapies to help relieve your chest pain.

• Enhanced external counterpulsation (EECP) improves the flow of oxygen-rich blood to the heart muscle, which may help relieve angina. EECP uses large cuffs, similar to blood pressure cuffs, on your legs. The cuffs inflate and deflate in sync with your heartbeat. You typically get five 1-hour treatments per week for 7 weeks. Side effects may include back or neck pain and skin abrasions.
• Transmyocardial laser treatment stimulates growth of new blood vessels and improves blood flow in the heart muscle. It can relieve angina pain and increase your ability to exercise without discomfort. This laser-based treatment is done during open-heart surgery or through cardiac catheterization. In certain cases, you may need this treatment in combination with coronary artery bypass grafting.

You should know what medicines you are taking, what the purpose of each is, how and when to take them, and what the possible side effects are. Always take your medicines following your healthcare provider’s instructions. Learn exactly when and how to take nitroglycerin or other short-acting nitrates to relieve chest pain.

• Talk to your healthcare provider about any other medicines you are taking, including vitamins and nutritional supplements. Some medicines can cause serious or life-threatening problems if they are taken with nitrates or other angina medicines. For example, men who take nitrates for their angina, including nitroglycerin, should not take medicines for erectile dysfunction without checking with their provider first.
• Learn how to take short-acting nitrates safely. Watch for side effects, such as flushing or dizziness, and find a place to sit down or something to hold on to if you feel dizzy.
  • Call 9-1-1 if the pain continues after taking a second dose. This could be a symptom of unstable angina, which is a medical emergency.
• Tell your provider about any side effects. Do not stop taking your medicines without talking to your provider first.
• Learn how to store your medicines correctly and when to replace them.