Discharge Instructions for Angina
You have been diagnosed with a type of chest pain called angina. Angina occurs when not enough oxygen reaches the heart muscle. It is most often felt under your breastbone, in your left shoulder, or down your left arm. The pain may even spread to your jaw or back. Exercise, increased activity, emotional upset, or stress can trigger this pain. With proper treatment and lifestyle changes to reduce risk factors, most people with angina are able to maintain a full and active life.
Managing risk factors
Your healthcare provider will work with you to make lifestyle changes as needed. This can help prevent worsening of coronary artery disease, which is likely the cause of your angina.
Coronary artery disease is a narrowing of the blood vessels that supply oxygen and nutrients to the heart muscle. The blood vessels can also spasm and reduce the oxygen reaching the heart muscle from the narrowing inside of the artery. Managing your risk factors may prevent both of these causes of narrowing of your arteries.
Your healthcare provider will give you information on dietary changes that you may need to make, based on your situation. Your provider may recommend that you see a registered dietitian for help with diet changes. Try these changes to start:
Eat less fat and cholesterol
Eat less sodium (salt), especially if you have high blood pressure
Eat more fresh vegetables and fruits
Eat lean proteins, such as fish, poultry, and legumes (beans and peas), and eat less red meat and processed meats
Use low-fat dairy products
Use vegetable and nut oils in limited amounts
Limit sweets and processed foods such as chips, cookies, and baked goods
Limit sodas and high calorie drinks
Limit greasy and fried foods, or those high in saturated fat
Limit alcohol intake
Your healthcare provider may recommend that you increase your physical activity if you have not been as active as possible. This may include moderate to vigorous intensity physical activity for at least 30 to 60 minutes each day for at least 5 to 7 days per week. A few examples of moderate to vigorous intensity physical activity include:
Walking at a brisk pace, about 3 to 4 miles per hour
Jogging or running
Swimming or water aerobics
Riding a bike
Don't start or increase your activity level without first seeing your healthcare provider.
If you are overweight, your healthcare provider will work with you to lose weight and lower your BMI (body mass index) to a normal or near-normal level. Making diet changes and increasing physical activity can help. A healthy and reasonable goal for weight loss is to lose 10% of your current weight per year.
If you smoke, break the smoking habit. Enroll in a stop-smoking program to improve your chances of success. You can also join a support group. Talk to your healthcare provider about nicotine replacement products or medicines to help you quit.
Learn ways to manage stress to help you deal with stress in your home and work life. Your ability to prioritize your health depends on your mental health and focus. Feeling supported in the rest of your life is key to achieving success with your health.
Keep a record of your episodes of chest pain. Take these with you when you see your healthcare provider.
Take your medicines exactly as directed. Don’t skip doses. If you miss a dose, call your healthcare provider right away.
If you have unwanted side effects from your medicine, tell your healthcare provider right away.
Keep your nitroglycerin with you at all times.
If you’re on nitroglycerin, don’t take medicines used to treat erectile dysfunction (such as sildenafil) at all. These can react with nitroglycerin and cause your blood pressure to drop to a dangerous or even life-threatening level.
If you use nitroglycerin to prevent angina attacks, follow your healthcare provider’s instructions for your kind of nitroglycerin (pill, spray, or skin patch).
If you use nitroglycerin to stop an angina attack, follow these steps:
Sit down, because you may become dizzy.
Put 1 tablet under your tongue, or between your lip and gum, or between your cheek and gum. Let the tablet dissolve completely. Don't chew or swallow the tablet.
If you use a spray, then spray once on or under your tongue. Don't inhale. Close your mouth. Wait a few seconds before you swallow and don't rinse your mouth for 5 to 10 minutes.
After taking 1 tablet or spraying once, continue sitting for 5 minutes.
If the angina goes away completely, rest awhile and follow your provider's orders about returning to your normal routine.
If the chest pain or pressure continues, call 911 right away. Don't delay. You may be having a heart attack (acute myocardial infarction, or AMI)!
You may be told by your doctor to call 911 after taking 2 or 3 tablets or sprays of nitroglycerin (spaced 5 minutes apart) and the chest pain or pressure is still present 5 minutes after the last dose. Don't take more than 3 tablets, or spray more than 3 times, within 15 minutes.
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Severe dizziness, or fainting
Nausea or vomiting
Fast heartbeat (higher than 100 beats per minute)
Angina attacks that last longer, occur more often, or are more severe than in the past
Angina that occurs at rest, wakes you up out of sleep, or does not resolve
July 14, 2018
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Eckel, R. Circulation. 2013, is. 128, ed. 20., Exercise and fitness in the prevention of cardiovascular disease, Up To Date, McEvoy, G. AHFS Drug Information Essentials. 2014.
Gandelman, Glenn, MD, MPH,Snyder, Mandy, APRN