Discharge Instructions for Angina

You have been diagnosed with a type of chest pain called angina. Angina occurs when your heart muscle doesn't get enough oxygen. It's 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. Women may experience discomfort in different areas. 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 coronary artery disease from getting worse, 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 the narrowing of your arteries.

Diet

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 salt (sodium), 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

Physical activity

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 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

• Hiking

• Dancing

• Martial arts

• Tennis

• Riding a bike

Don't start or increase your activity level without first seeing your healthcare provider. Follow your healthcare provider's directions for your amount and intensity of exercise.

Weight management

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.

Smoking

If you smoke or use other tobacco products including chewing tobacco or electronic cigarettes (vaping), get help to quit. 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.

Stress

Learn ways to manage stress to help you deal with stress in your home and work life. Your ability to place importance on 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.

Managing medicines

• 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.

Taking nitroglycerin

• 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 or tadalafil, at all. These can react with nitroglycerin and cause your blood pressure to drop dangerously low.

• If you use nitroglycerin to prevent angina attacks, follow your healthcare provider’s directions 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 to make sure you feel well enough to stand up.

  • If the angina goes away completely, rest awhile and follow your healthcare provider's directions 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)! Don't drive yourself to the hospital if you think you are having a heart attack as this poses a risk to yourself and other drivers on the road. Take an ambulance.

  • You may be told by your provider 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. 

Call 911

This is the fastest and safest way to get to the nearest emergency department. The paramedics can also start treatment on the way to the hospital, saving valuable time for your heart.

• If angina gets worse, it continues, or if it stops and returns, call 911 right away. Don't delay. You may be having a heart attack.

Don't wait until your symptoms are severe to call 911. Other reasons to call 911 besides chest pain include:

• Trouble breathing

• Feeling lightheaded, faint, or dizzy

• Rapid heartbeat

• Slower than usual heart rate compared to your normal

• Angina with weakness, dizziness, fainting, heavy sweating, nausea, or vomiting

• Extreme drowsiness, or confusion

• Weakness of an arm or leg or on one side of the face

• Trouble with speech or vision