≥ 92% of participants will know what angina is, its types, common causes, diagnostics, and management.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥ 92% of participants will know what angina is, its types, common causes, diagnostics, and management.
By the end of this course, the learner will be able to:
The term "angina" does not always specifically refer to the heart. Rather, it is a word used to characterize a particular type of sensation, irrespective of its underlying cause.
In the clinical setting, angina is most commonly used to describe chest pain caused by ischemia or decreased blood flow to the heart. Angina pectoris is another word used to describe angina, and it is the most common symptom of coronary heart disease (National Heart, Lung, and Blood Institute, 2023a).
Angina is a fairly common condition, affecting more than 10 million Americans. As serious as angina can be, having chest pain may not always be related to cardiovascular disease (CVD). Other common potential causes of chest pain may include indigestion, cardiac arrhythmias, and more. Though there could be multiple reasons for someone to experience chest pain, it should not be discredited or downplayed. All chest pain should be acknowledged and evaluated by a medical professional. In the event a person experiences angina that truly has an increased risk for an acute cardiac event, time is of the essence for evaluation and intervention (National Heart, Lung, and Blood Institute, 2023a).
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(AHA, 2024a) |
Acute coronary syndrome (ACS) is a cardiac emergency, necessitating quick interventions to re-establish adequate blood flow to the ischemic tissue. Studies show that delays in cardiac interventions in true myocardial infarctions result in higher mortality risk (Lukitasari et al., 2023).
Anginal equivalents often signify other symptoms that may indicate the same underlying myocardial oxygen deficiency. Common anginal equivalents reported by patients include nausea, profound fatigue, back pain, upper abdominal discomfort, and shortness of breath.
At present, the exact physiology behind angina pectoris is not fully understood. It is thought that ischemic myocardial tissues release chemical mediators such as bradykinin and adenosine, which stimulate sympathetic and vagal nerve fibers, resulting in the perception of pain. Advancing our understanding of these processes could significantly improve the speed and accuracy of differential diagnosis in cases of suspected angina (Alaeddini, 2018).
Angina typically occurs when there is a mismatch between oxygen supply and demand. In other words, the blood flow is not adequate to reach the tissues to ensure adequate oxygen exchange occurs. This is often due to plaque buildup or other blockage mechanisms, resulting in reduced blood flow (Klabunde, 2023).
Stable angina is the result of long-term vessel narrowing, often due to atherosclerosis (plaque buildup).
Unstable angina is characterized by a sudden and significant reduction in coronary artery blood flow. When evaluating this condition, it is essential to consider factors that may contribute to compromised coronary perfusion. Unstable angina can occur unpredictably and is not necessarily triggered by physical exertion. Due to its potential severity, it should always be regarded as a medical emergency.
This reduction in blood flow is often associated with the presence of atherosclerotic plaque. These vulnerable plaques are prone to rupture or dislodgement, which can lead to the release of embolic debris that partially blocks a coronary artery. Such partial, non-occlusive obstructions are often detected through coronary angiography or angioscopy and are believed to be the primary cause of unstable angina in most patients (Klabunde, 2023).
Individuals with microvascular angina will often have symptoms of stable angina (relieved by nitroglycerin and/or rest), yet all diagnoses return normal. A portion of these individuals may experience an abnormal stress test, but this is not the case for every person. Those with a diagnosis of microvascular angina are at a higher risk for coronary artery disease (CAD) (Sweis & Jivan, 2024).
Silent ischemia is somewhat self-explanatory. Individuals with silent ischemia will have reduced function and damage to the cardiac tissues but may not experience obvious symptoms (AHA, 2024b).
Angina-like chest pain can arise from both cardiac and noncardiac origins. Recognizing and differentiating these potential causes is essential, particularly when distinguishing between life-threatening cardiac events and other serious but less urgent conditions. It is equally important to acknowledge that several noncardiac factors can increase myocardial oxygen demand or mimic true angina pectoris in presentation.
Awareness of these alternative causes enhances clinical judgment, allowing for more accurate diagnoses and timely, appropriate interventions.
Chest Wall-Related Causes |
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Pulmonary-Related Causes |
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Psychogenic-Related Causes |
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(Teragawa et al., 2020) (AMBOSS, 2025) |
Chest pain originating from cardiac sources can arise from a variety of conditions beyond CAD. One example is aortic valve disease, in which obstruction of the aortic orifice impairs normal function. This impairment can lead to elevated systolic pressure and a subsequent decrease in myocardial oxygenation. Over time, aortic valve dysfunction often contributes to myocardial hypertrophy, resulting in a sustained increase in oxygen demand and the development of chest pain.
Another cardiac-related source of chest pain is mitral valve prolapse, characterized by excess mitral valve leaflet tissue compromising normal valve function. Individuals with mitral valve prolapse are more prone to experiencing chest pain due to an associated oxygen supply imbalance.
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(Rao et al., 2025) |
Anginal symptoms may vary from person to person. Typical symptoms will often include chest pain or pressure; this may or may not radiate to other locations within the body.
Women experiencing anginal symptoms could vary even more from the typical symptoms, which is often a reason why some women may have delayed onset to seek care. Women could experience any variety of the typical symptoms, but they may also experience no symptoms or less common ones, such as stomach aches and nausea (Mayo Clinic Staff, 2024).
As nurses perform their assessment, there are many key pieces of data that can be obtained simply by talking to patients and their loved ones. It is important that nurses perform a focused history and symptom evaluation to evaluate for any key data collected or to watch for known risk factors for angina/chest pain.
Cardiac causes of ischemic angina can often be ruled out by obtaining a thorough patient history, conducting a physical examination, and assessing for basic laboratory tests. A complete blood count, along with electrolyte panels that include blood urea nitrogen (BUN), creatinine, and glucose levels, can help identify infectious or metabolic causes of chest discomfort. In individuals with true angina pectoris, these laboratory findings, along with chest X-rays, can be within normal limits. A chest x-ray may be beneficial in revealing cardiomegaly or other abnormalities in patients with a history of myocardial infarction, ischemic cardiomyopathy, pericardial effusion, or acute pulmonary edema.
To further assess myocardial perfusion, a cardiac stress test may help determine whether the heart receives sufficient blood flow during physical exertion or pharmacologic stress. For patients unable to exercise due to arthritis or other conditions, medications can be administered to simulate the effects of physical stress on the heart—this is known as a pharmacologic stress test.
Despite its frequent use, a resting ECG has limitations in diagnosing acute angina.
Cardiac catheterization is an invasive procedure that can be utilized as a diagnostic and therapeutic intervention for certain ischemic heart conditions. It plays a critical role in evaluating angina by directly assessing coronary circulation and cardiac function. Typically performed in a specialized catheterization lab under sterile conditions and local anesthesia, the procedure involves the insertion of a flexible catheter into a vein or artery, most commonly in the groin (femoral artery) or wrist (radial artery), and advancing it toward the heart (National Heart, Lung, and Blood Institute, 2022a).
Cardiac catheterization is indicated for a range of clinical purposes, including:
A computed tomography (CT) scan is a noninvasive diagnostic study that allows providers to view advanced images within the body. A cardiac CT scan is specifically utilized to allow for advanced imaging of the heart and coronary vasculature. A CT scan consists of X-ray imaging in combination with computerized methods to create 3D images and models of the cardiac structures. This diagnostic study can often be used to help providers identify diseases or defects within the blood vessels that supply the heart and surrounding structures (National Heart, Lung, and Blood Institute, 2022b).
A coronary calcium scan is a cardiac CT that measures the amount of calcium buildup in the cardiac wall and structures. If there is a significant buildup of calcium, the diagnosis may point toward CAD (National Heart, Lung, and Blood Institute, 2022b).
Cardiac magnetic resonance imaging (MRI) is another noninvasive diagnostic study that is often used if the results of previous diagnostics are unclear. This study uses magnets, radio waves, and computers to develop detailed imaging of the heart and its surrounding structures. Cardiac MRIs are especially beneficial in detecting inflammation or scarring of the heart.
Cardiac biomarkers are chemicals released into the bloodstream when the heart muscles are under stress or damaged. These biomarkers are often utilized to help determine risk for and manage ACS, which is known to be life-threatening. One of the most commonly known cardiac biomarkers is troponin, which is used to diagnose cardiac ischemia.
The Canadian Cardiovascular Society grading scale is commonly used for the classification of angina severity:
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(Canadian Cardiovascular Society, 2020) |
Nursing interventions for angina/chest pain symptoms have been pretty standard for many years, with little deviation.
Providers may order routine labs, such as serial troponins and cardiac enzymes, to assess for any changes in clinical status. Medication and supplemental oxygen may also be ordered for symptom management.
In addition to assessment and diagnostics, healthcare providers should continuously monitor for clinical changes and notify providers as necessary.
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(Rao et al., 2025) |
Antianginal and anti-ischemic drugs
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(Rao et al., 2025) |
Adopting a healthier diet, staying active, and managing stress are all solid interventions to reduce the incidence and threat of anginal symptoms. When a poor diet is at play, risk factors increase for conditions such as CAD, hyperlipidemia, hypertension, diabetes, heart disease, and more.
All medications serve a specific purpose, so it is important to provide education on what medications are intended for, risks, and side effects, as well as instruct patients not to abruptly stop any medication without speaking to their prescribing provider.
Angina and chest pain can look and feel different to everyone, but this does not make it any less serious. Any time there is a new or worsening aspect of angina symptoms, patients should be instructed to contact their provider and/or present to the closest emergency department.
Patient Profile:
Kami is a 51-year-old nurse and military veteran who completed two tours in the Middle East. During her deployments, she began smoking as a coping mechanism to manage chronic stress and the constant threat of explosive devices. Though she considers herself physically fit and does not have diabetes, she has continued smoking since returning from duty.
Presenting Complaint:
For the past two weeks, Kami has experienced nighttime episodes of chest discomfort described as a crushing sensation radiating to her left arm. The most recent episode lasted approximately 30 minutes and extended to her shoulder and jaw. In response, she smoked a cigarette to alleviate her anxiety. She reports that the chest pain never occurred during menstruation, though she has not yet undergone menopause. Kami has no known allergies, is not pregnant, and her medical history is otherwise unremarkable.
Family History:
Initial Evaluation:
Upon presentation to the emergency department, Kami's vital signs were within normal limits:
A comprehensive workup was initiated, including:
Initial Clinical Impression and Management:
Despite unremarkable initial findings, Kami's symptoms and clinical history prompted her physician to suspect Prinzmetal angina (variant angina), a condition involving transient coronary artery vasospasms often occurring at rest and frequently during the night or early morning.
Initial Treatment Plan:
Sublingual Nitroglycerin: For immediate relief during acute vasospastic episodes.
Long-acting nitrate and calcium channel blocker: To improve coronary blood flow and prevent recurrence. Medication adjustments may be necessary based on therapeutic response.
Lifestyle Modification: Kami was strongly advised to quit smoking. A smoking cessation class was recommended, though pharmacologic support for cessation was deferred at this time.
Contingency Plan: If Kami fails to respond to first-line therapy, her physician may introduce alpha-adrenergic blockers to lower blood pressure and counteract the vasoconstrictive effects of stress hormones. Should pharmacologic measures prove inadequate or if coronary obstruction develops, coronary angioplasty or other interventional procedures may be considered.
Prognosis and Follow-Up:
Kami was counseled that Prinzmetal angina is a chronic yet manageable condition. Symptoms often follow a cyclical pattern, and many patients see improvement with medical therapy over time. If well-controlled, medication tapering may be considered after 6–12 months. Regular follow-up and adherence to lifestyle modifications, especially smoking cessation, will be critical in preventing progression and maintaining cardiac health.
Patient Profile:
John is a 54-year-old car salesman who works 50+ hours per week and has little time for exercise or partaking in a healthy diet. John works hard to provide for his family but spends very little time taking care of himself, as evidenced by eating fast food multiple times weekly, poor exercise habits, and long, stressful work hours.
Presenting Complaint:
John presents to his local emergency department complaining of a heavy, crushing chest pain that began while he was mowing his lawn. He described the pain as a tight, squeezing sensation in the center of his chest, radiating to his left shoulder, arm, and jaw. He rates the pain as 9/10. The pain improved slightly when he stopped activity and rested, but it did not completely go away.
Past Medical History:
Medication History:
Initial Evaluation:
Upon presentation to the emergency department, John's vital signs were as follows:
Physical Exam:
Diagnostics:
Plan:
Patient Profile:
Maria is a 58-year-old female who works as a medical assistant in a busy primary care clinic. Maria has had intermittent chest discomfort for a few days, thought to be indigestion, along with back pain and nausea.
Presenting Complaint:
Maria presents to an urgent care clinic with complaints of profound fatigue, nausea, and mild upper back discomfort for the past 24 hours. She denies significant chest pain but describes a "pressure" across her upper back between her shoulder blades. She reports feeling "off" and short of breath when climbing stairs. Symptoms worsened this morning after walking her dog.
Past Medical History:
Medication History:
Initial Evaluation:
Upon presentation to the emergency department, Maria's vital signs were as follows:
Physical Exam:
Diagnostics:
Plan:
Angina is most commonly associated with cardiovascular causes, though that is not always the case. As healthcare providers, it is important to have a generalized knowledge base of what angina is, potential causes, and how to identify and treat it properly. Some cases of angina can often present as a sign of something much worse, with a need to intervene rapidly. Anytime angina is suspected, it must be thoroughly evaluated to uncover its root cause. Health professionals need to stay alert not only to the classic signs of angina but also to less obvious, related symptoms to quickly recognize heart-related ischemia and act fast to restore proper oxygen supply to affected tissues. Through better understanding and thorough observation, healthcare providers can more effectively manage this challenging condition (symptom) that continues to impact so many lives.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.