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Patient Instructions

You may feel pressure, squeezing, burning, or tightness in your chest. You may also have pressure, squeezing, burning, or tightness in your arms, shoulders, neck, jaw, throat, or back.

Women may feel discomfort in their back, shoulders, and stomach area also.

You may also have indigestion or be sick to your stomach. You may feel tired and be short of breath, sweaty, lightheaded, or weak.

Most times, people have angina during cold weather or physical activity, such as climbing stairs, walking uphill, lifting something, or engaging in sexual activity.

Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity. If you are lying down, sit up in bed. Try deep breathing to help with the stress.

Your doctor may have prescribed nitroglycerin pills or spray for severe attacks. This medicine works quickly to make your symptoms go away. Sit down when you use your nitroglycerin.

If you have nitroglycerin pills:

• Place the pill between your cheek and gum, or under your tongue. Allow it to dissolve. Do not swallow it.
• Wait 5 minutes. If your symptoms do not go away, you may try a second dose.
• Wait another 5 minutes. You may use a third pill if you need it.
• Do not use more than 3 tablets.

If you have nitroglycerin spray:

• Do not shake the container.
• Hold the container close to your open mouth.
• Spray the medicine onto or under your tongue. Do not inhale or swallow the medicine. Close your mouth.
• Wait 3 to 5 minutes. If your symptoms do not go away, you may try a second dose.
• Wait another 3 to 5 minutes. You may try a third dose if you need it.

Call 911 if your angina pain:

• Does not go away after 15 minutes
• Does not go away after 3 doses of nitroglycerin
• Is getting worse
• Returns after the nitroglycerin helped at first

Do not smoke, eat, or drink for 5 to 10 minutes after taking nitroglycerin. If you do smoke, you should try to quit. Your doctor can help you.

After your symptoms have gone away, write down a few details about the event. Keep a record of:

• The time of day
• What you were doing
• How long the pain lasted
• What it felt like
• What you did to relieve it

Ask yourself some questions:

• Did you take all of your heart medicines the correct way?
• Were you more active than normal?
• Did you just have a large meal?

Share this information with your doctor at your regular visits.

Try not to do activities that put a strain on your heart. Your doctor may prescribe a nitroglycerin medicine for you to take before an activity, to prevent symptoms.

Call 911 if your angina pain:

• Does not go away after 15 minutes
• Does not go away after 3 doses of nitroglycerin
• Is getting worse
• Returns after the nitroglycerin helped at first

Call your doctor if:

• You are having angina symptoms more often.
• You are having angina when you are sitting. This is called rest angina.
• You are feeling tired more often.
• You are feeling faint or lightheaded.
• Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady.
• You are having trouble taking your heart medicines.
• You have any other unusual symptoms.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.