How to Help Someone Live With Angina

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What is angina?

Angina isn't actually a disease, but rather a symptom of a larger problem: coronary artery disease (CAD), which occurs when a substance called plaque builds up in the arteries leading to the heart. As CAD progresses, the blood flow to the heart decreases, leading to angina and potentially a heart attack.

Angina is considered stable (triggered by physical exertion or stress, relieved by resting or taking nitroglycerin) or unstable (often occurring at rest or with very little exertion). But in general, the only real difference between stable and unstable angina is the extent of narrowing of the coronary arteries. (There are also some rare forms of angina unrelated to CAD.) You can think of it as a "supply and demand" issue: if a patient has advanced CAD, there's a fixed supply of oxygenated blood moving to his heart. The supply may be sufficient when he's at rest, but if he exerts himself, the heart's increased demand for oxygenated blood simply can't be met.

Angina usually manifests as chest pain or discomfort, but sometimes people experience shortness of breath or pain in the jaw, arm, back, or shoulders.

Familiarize yourself with angina

Consult a cardiologist

It's impossible to overemphasize the seriousness of angina. The first time the person in your care experiences chest pain or discomfort, you must call 911 immediately because he could be having a heart attack. If it turns out not to be a heart attack, he still needs to be seen by a cardiologist for a full workup and treatment.

It's important to have the following information if he has already been evaluated by a cardiologist, has undergone angioplasty or bypass surgery (or been ruled out as a candidate for them), and has been told that his angina is an unavoidable symptom of his CAD. But don't despair: He may live a reasonably good life for years with angina -- provided that his CAD doesn't get worse. That's why it's crucial for both of you to learn about his angina, take steps to keep it from getting worse, and know when to take emergency measures.

Keep track of the symptoms

If he has stable angina, it's important to know the current status of his symptoms. That way you'll be able to immediately recognize when his CAD progresses.

Each time he has an episode of angina, write down the answers to the following questions:

*What triggered it? Exercise and stress are common triggers, but angina can also be brought on by eating a large meal or being exposed to very hot or cold temperatures.

*What did it feel like? Did he experience chest pain, discomfort, or tightness? Was the sensation accompanied by shortness of breath or nausea?

*How long did it last? Check the clock when symptoms first appear -- or better yet, set a stopwatch.

*What relieved it? Did symptoms disappear when he sat down or took emergency medication like nitroglycerin? How many tablets did he have to take?

After a few episodes, you'll see that there's a pattern to the symptoms. Keep alert for changes to the pattern, which may signal a progression to unstable angina.

Triggers and signs of angina

Avoid situations that bring on angina

After a few episodes of angina, you and the person in your care will become familiar with what usually triggers symptoms. If physical exertion is a trigger, figure out what level of activity brings on angina, then remind him to stop before symptoms begin. Or if he feels chest pain while walking, have him stop and rest or take nitroglycerin or whatever emergency medication he's been prescribed.

Emotional stress like anger or anxiety can also trigger an angina episode. Help him avoid situations that might get him worked up. If stressful situations are unavoidable, talk to his doctor about ways to help him cope.

Look out for signs of worsening CAD

You should be concerned if his angina episodes:

  • Occur more frequently
  • Last longer
  • Feel more severe
  • Happen without the usual trigger (for example, without physical exertion)
  • Aren't relieved by rest or emergency medication like nitroglycerin

These changes may indicate that he's at a very high risk for heart attack. If you notice any of these changes, call 911.

In case of an emergency

Have a plan in place

Because angina can be a precursor to a heart attack, you need to be ready for an emergency. A little advance planning will ease a lot of worry.

Here's how to come up with an emergency action plan:

*Talk to the doctor about what to do in case of an emergency. If the person you're caring for has been prescribed nitroglycerin or other emergency medication, make sure you have detailed instructions on how it should be used.

*Write down the signs and symptoms of a heart attack, instructions for using nitroglycerin or other emergency medication, emergency phone numbers, and the location of the nearest hospital that offers 24-hour emergency cardiac care.

*Go to your neighborhood copy center and make several copies of this information. You may want to have the copies laminated.

*Place copies of the emergency information by each phone in your home. And make sure both of you carries a copy with you at all times.

*Discuss the emergency information with all family members and caregivers. Give them copies to carry with them.

Know when to call 911

If you and the patient are familiar with the pattern of his stable angina, you'll be able to tell if his symptoms change. Even so, it's not always easy to tell the difference between unstable angina and a heart attack. Call 911 if he experiences any of the following:

  • Chest pain or discomfort that isn't relieved by three nitroglycerin tablets in succession, each taken five minutes apart
  • Chest pain or discomfort that lasts for more than 20 minutes
  • Chest pain or discomfort that's more severe than a typical angina episode
  • Light-headedness, nausea, sweating, or pale skin

In general, it's best to call 911 if you have any reason to think he's having a heart attack. He may try to talk you out of it, but waiting even an hour or two may limit his chances of surviving. Don't wait longer than 20 minutes to see if his symptoms go away.

How to Help Someone Live With Angina




If he has difficulty following the schedule, consider investing in an automated medication dispenser. These locked devices automatically dispense pills at preprogrammed times. When it's time for him to take a dose, the dispenser will remind him with an audible alarm and flashing light. For a list of some of the top-rated dispensers, visit the Senior Health website. Some medical supply stores may also carry this type of dispenser.

Treat conditions that can worsen heart disease, and encourage heart-healthy habits

If someone has angina, it's important to treat any other medical problems that might make his heart disease worse. High cholesterol, high blood pressure, and diabetes are all conditions that need to be properly managed. Talk to his doctor about any concerns you might have.

The key to living well with stable angina is slowing or stopping the progression of CAD. If he doesn't already have a healthy lifestyle, he needs to make some changes. These include:

  • Being as active as possible (within the limits of his angina)
  • Eating a low-fat, high-fiber diet
  • Managing blood pressure and cholesterol levels
  • Losing excess weight
  • Quitting smoking and avoiding secondhand smoke

For more information, see our checklist for helping your parent prevent a heart attack.

Stephanie Trelogan

Stephanie Trelogan writes about heart disease, stroke, and depression issues that concern people caring for their aging parents. See full bio