If your stable angina limits you physically because of chest pain, your doctor likely will advise you to have a coronary artery angiography (cardiac catheterization) to look for significant blockages. A heart specialist (cardiologist) also may do this test to diagnose coronary artery disease when other tests are not conclusive, in an emergency when a person is having a heart attack, and in some people with newly diagnosed congestive heart failure.

When one or more significant blockages are found, the heart specialist will determine if the blockage(s) can be opened with a procedure called balloon angioplasty, also called percutaneous transluminal coronary angioplasty or PTCA. In balloon angioplasty, a catheter is inserted into an artery in the groin or forearm, and then threaded through the circulatory system into the blocked coronary artery. Once inside the coronary artery, a small balloon at the catheter tip is inflated briefly to open the narrowed blood vessel. Usually, balloon inflation is followed by the placement of a stent, a wire mesh that expands with the balloon. The wire mesh remains inside the artery to keep it open. The balloon is deflated and the catheter is removed.

If the blockages cannot be opened with balloon angioplasty, the cardiologist will likely suggest coronary artery bypass surgery (CABG). CABG involves grafting one or more blood vessels onto the coronary arteries to bypass the narrowed or blocked areas. The blood vessels to be grafted can be taken from an artery inside the chest, an artery in the arm, and from a long vein in the leg.

The goal of treating heart attacks or sudden worsening of angina is to restore blood flow rapidly to the section of heart muscle no longer getting blood flow. Patients immediately receive medication to relieve pain. They also receive a beta-blocker to slow the heart rate and decrease the work of the heart and aspirin combined with other medications to dissolve or inhibit blood clotting. When possible, patients are transferred to a cardiac catheterization laboratory for immediate angiography and balloon angioplasty of the most significant blockage. In some people with coronary artery disease, other symptoms or complications will require treatment with additional therapies. For example, medication may be needed to treat cardiac arrhythmias (abnormal heart rhythms), low blood pressure or heart failure.