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Angina, stable

How do doctors diagnose stable angina?

To find out if you have angina, your doctor will ask you some questions about your chest discomfort or pain and your health. He or she will also examine you and will probably suggest some tests.

It isn't always easy to diagnose angina because there are so many other causes of chest pain. Here are some things your doctor might do to figure out if you have angina.

Questions your doctor might ask

Your doctor may ask you these questions.

How would you describe the discomfort or pain you feel?
What brings on this feeling?
How long does it last and what makes it go away?
Is there a regular pattern to it, and can you tell when it will happen?
How long have you had it, and is it getting any worse?
Do you smoke?
Does

heart disease
You get heart disease when your heart isn't able to pump blood as well as it should. This can happen for a variety of reasons.

heart disease run in your family?
Do you have

high blood pressure
Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."

high blood pressure?
Do you have

high cholesterol
If you've been told that you have high cholesterol it usually means that your total cholesterol level is 240mg/dL or higher. But doctors also look at the amount of good (HDL) and bad (LDL) cholesterol you have in your blood. Having high levels of bad cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.

high cholesterol?
Do you have

diabetes
Diabetes is a condition that causes too much sugar to circulate in your blood. It happens when your body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes).

diabetes?
What kind of work do you do?
What kinds of foods do you eat?

If there is any doubt about what is causing your discomfort or pain, your doctor will ask you more questions. For more, see Other causes of chest pain.

Physical exam

Your doctor will give you a physical exam to learn more about what could be causing your symptoms. Here are some things he or she may do.

Measure your

blood pressure
Blood pressure is the amount of force exerted by the blood on the walls of the vessels that carry it. You can think of it like the water pressure in your home: the more pressure you have, the faster and more forcefully the water flows out of the shower. Blood pressure is measured in millimeters of mercury (written as mm Hg). When your blood pressure is taken, the measurement is given as two numbers, for example 120/80 mm Hg. The first, higher, number is called the systolic pressure, and the second, lower, number is the diastolic pressure. The systolic number is the highest pressure that occurs while the heart is pushing blood into the arteries. The diastolic number is the lowest pressure that happens when the heart is relaxing and is not pushing the blood.

blood pressure and feel your

pulse rate
Your pulse rate is the number of times that your heart beats in one minute. A normal rate is between 60 and 100 beats per minute, but the heart can speed up under certain circumstances, such as when you exert yourself or when you have an infection.

pulse. Your pulse tells your doctor how fast your heart is beating and if your heartbeat is regular.
Listen to your heart, especially for any extra noises called murmurs. These may be a sign of a problem with your heart valves. Sometimes valve problems can cause angina.
Listen to the blood flowing though the

arteries
Arteries are the blood vessels that take blood that is rich in oxygen and food away from your heart. The arteries carry this blood to all the tissues in your body.

arteries in your neck to see if there are any extra noises. These noises could mean that your arteries are narrowed.
Look for bumps under your skin that are a sign of

high cholesterol
If you've been told that you have high cholesterol it usually means that your total cholesterol level is 240mg/dL or higher. But doctors also look at the amount of good (HDL) and bad (LDL) cholesterol you have in your blood. Having high levels of bad cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.

high cholesterol. For example, you might have firm white bumps around your eyes. High cholesterol can put you at risk for narrowing of your arteries.
Listen to your lungs for any extra noises while you breathe. These could be caused by lung disease or by

heart failure
When the heart loses its ability to push enough blood through the circulation, it is called heart failure.

heart failure. You can get heart failure if your heart is damaged so that it doesn't pump well.
Measure your height and weight to figure out if you are overweight. If you are overweight, this puts an extra strain on your heart.
Check for less common causes of angina. For example, your doctor will look for signs of

anemia
Anemia is when you have too few red blood cells. Anemia can make you get tired and breathless easily. It can also make you look pale. Anemia can be caused by a number of different things, including problems with your diet, blood loss and some diseases.

anemia and an overactive

thyroid gland
Your thyroid gland is a small organ that sits in your neck, just in front of your windpipe. It sends out a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

thyroid gland. Both can cause angina. For more, see Other causes of angina.
Check for causes of chest pain that don't have anything to do with your heart. For more, see Other causes of chest pain.

If you do have angina, your doctor will also try to find out what type you have. We have looked at treatments for the type called stable angina. But there are two other types. For more, see Other types of angina.

Tests

Your doctor may suggest you have some of these tests. After you have the results, your doctor may also suggest that you see a doctor who specializes in heart problems (a cardiologist).

An electrocardiogram (ECG)

The first test your doctor will suggest is an electrocardiogram, or ECG for short.

Source:
Gibbons RJ, Abrams J, Chatterjee K, et al.
ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.
November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

¹ The ECG shows the electrical activity in your heart as a line on a graph. This test helps your doctor tell if your heart is beating properly and if you have certain heart problems. For more, see Tests for angina.

Blood tests

Your doctor will also suggest some blood tests. These can help tell if you have

anemia
Anemia is when you have too few red blood cells. Anemia can make you get tired and breathless easily. It can also make you look pale. Anemia can be caused by a number of different things, including problems with your diet, blood loss and some diseases.

anemia,

diabetes
Diabetes is a condition that causes too much sugar to circulate in your blood. It happens when your body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes).

diabetes or

high cholesterol
If you've been told that you have high cholesterol it usually means that your total cholesterol level is 240mg/dL or higher. But doctors also look at the amount of good (HDL) and bad (LDL) cholesterol you have in your blood. Having high levels of bad cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.

high cholesterol. If your doctor thinks you might have an overactive

thyroid gland
Your thyroid gland is a small organ that sits in your neck, just in front of your windpipe. It sends out a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

thyroid gland, you'll need a blood test for that, too.

An X-ray

You will need an

X-ray
X-rays are pictures taken of the inside of your body. They are done by passing very small amounts of radiation through your body and onto film. X-rays can also be used as a treatment, such as in radiation therapy for cancer.

X-ray of your chest if your doctor thinks you might have lung disease or

heart failure
When the heart loses its ability to push enough blood through the circulation, it is called heart failure.

heart failure.

A trial of treatment

Your doctor might give you a treatment for angina to see if it takes away your discomfort or pain. The treatment is called nitroglycerin (NTG for short).

A stress test

Your primary care doctor might set up a stress test. This test shows how much stress your heart can take before it is under too much strain. For more, see Tests for angina.

Seeing a cardiologist

Your cardiologist can set up any more tests you need. Here's a list of some that he or she might suggest.

Source:
National Heart, Lung and Blood Institute.
What is angina?
November 2007. Available at http://www.nhlbi.nih.gov/health/dci (accessed on 8 October 2008).

A stress test. Your cardiologist might suggest this test if your primary care doctor hasn't already.
An echocardiogram. This test uses sound waves to make a picture of your heart. The picture shows how blood flows through your heart and if your heart is pumping properly, among other things.
Coronary angiography. This test uses a dye to make your coronary arteries show up on an X-ray. It can show blockages. Your doctor might suggest this test right away if he or she thinks you have bad coronary artery disease.

Source:
Gibbons RJ, Abrams J, Chatterjee K, et al.
ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.
November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

¹

For more, see Tests for angina.

Sources for the information on this page:

Gibbons RJ, Abrams J, Chatterjee K, et al.ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

National Heart, Lung and Blood Institute.What is angina?November 2007. Available at http://www.nhlbi.nih.gov/health/dci (accessed on 8 October 2008).

This information was last updated on Apr 14, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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