Best Ways to Manage Stable Angina

Medically Reviewed

It may start as a feeling of squeezing or suffocating in the midchest, with pain that shoots to the left arm. But it’s not a heart attack, it’s angina—chest pain that’s a symptom of heart disease.

Episodes such as those can be managed by drugs like nitrates and, in more severe cases, procedures like stenting to improve blood flow. However, research shows that you can also ease angina by making heart-healthy changes to your lifestyle.

Why does angina happen?

Chronic stable angina occurs when your heart is deprived of blood that can’t flow freely because an artery is narrowed or blocked. Sufferers often describe angina as pressure or squeezing in the chest, not unlike indigestion, with pain that sometimes occurs in the shoulders, arms, neck, jaw, or back.

Unlike unstable angina, which comes on unexpectedly, chronic stable angina has a typical pattern: It occurs when you’re physically active, under stress, exposed to extreme temperatures, or eating a heavy meal, for example. Rest or nitrates usually relieve it. An attack typically lasts less than five minutes.

What you can do

Employing strategies to self-manage stable angina can significantly lessen angina frequency, improve the way in which everyday activities are hampered by angina, and reduce symptoms of depression, suggests a 2014 analysis published in BMC Cardiovascular Disorders.

Researchers reviewed the findings of nine clinical trials conducted between 1994 and 2012 that focused on angina self-management. All stable angina patients in the trials were taught techniques to help them self-manage their condition. The patients’ training included supportive coaching, anxiety and stress management or counseling, an exercise program, nutrition planning, a medication review, relaxation training, and techniques to conserve energy.

Patients across all the studies reported significant reductions in the frequency of both angina episodes and nitrate use to relieve symptoms. They also reported a significant improvement in symptoms of depression. Once the patients had begun practicing self-management, the effects lasted up to 24 weeks, when the longest follow-up period ended.

You may be able to obtain similar results by practicing some of these strategies:

Maintain a healthy weight. Aim for a body mass index between 18.5 and 24.9 and a waist circumference of less than 35 inches for women or less than 40 inches for men. If you’re overweight, set a goal to lose 10 percent of your body weight.

• Eat a healthful diet. Keep meals small, as large, heavy meals can trigger angina. Focus on fresh fruits, vegetables, and low-fat dairy, foods high in omega-3 fatty acids (like salmon), plant stanols (almonds, Brussels sprouts) and soluble fiber (beans, apples). Limit saturated fats, trans fats, cholesterol, and salt.

• Get moving. While it may seem counterintuitive to exercise if exertion brings on angina, increasing your fitness improves your overall heart health, thereby lessening angina.

Slowly build up to 30 to 60 minutes of aerobic activity (like walking) five or more days a week. Take rests when you need them.

• Avoid tobacco. Smoking promotes the buildup of artery-clogging plaque, limits blood flow, and raises blood pressure. If you smoke, ask your doctor about smoking-cessation aids.

• Limit alcohol. If you drink, limit your intake to no more than one drink a day for women or two drinks a day for men.

• Consider cardiac rehab. If you’ve had a heart attack, heart surgery, or a procedure like angioplasty or stenting, you may benefit from cardiac rehabilitation, a professionally supervised program that includes education and counseling to help increase fitness and heart health and reduce risk of future heart problems. Ask your doctor to recommend a program.

• Ask about aspirin. Taking a low-dose daily aspirin can help prevent blood clots in the arteries in some people. Ask your doctor if aspirin therapy is right for you.

• Get plenty of rest. And space out activities during the day. Consider adaptive devices, like a walker or a handheld showerhead, to save energy. But, while saving energy is important, so is activity—so pace yourself.

• Manage stress. Use relaxation techniques, like deep breathing or meditation, to start or end your day. Yoga and tai chi (a series of slow movements) can also help relieve stress.

When to call a doctor

If you have angina, note the pattern of your episodes. If angina pain starts to occur more often, last longer, worsen in severity, or occur at rest, seek medical help. Your angina may be worsening or becoming unstable, which suggests a high heart attack risk.

Also be aware of less traditional symptoms, including shortness of breath, nausea, tingling, sweating, dizziness and tooth pain, which women are more likely than men to experience.