--- title: "Coronary artery disease, angina and how it is assessed" description: "What coronary artery disease is, how angina is assessed, which tests are used and how medication, stents and surgery compare as treatments." url: "https://www.drmartins.org/conditions/coronary-artery-disease/" author: "Dr Joao Martins" medical_reviewer: "Dr Joao Martins" review_status: "approved" date_published: "2026-09-01" date_modified: "2026-09-01" --- # Coronary artery disease, angina and how it is assessed Coronary artery disease is the gradual build-up of fatty deposits in the arteries that supply the heart muscle. When a narrowing limits blood flow, exertion can produce chest discomfort, breathlessness or fatigue, a pattern known as angina. Diagnosis combines the description of symptoms, cardiovascular risk factors and imaging of the arteries. Treatment always includes medication and risk factor management; a stent or bypass surgery is added for selected patients when symptoms persist or when the pattern of disease warrants it. ## When to seek urgent help Call 999 if chest discomfort is severe, lasts more than 15 minutes, occurs at rest, or comes with sweating, nausea or breathlessness. Angina that is becoming more frequent, occurring with less exertion, or appearing at rest needs urgent medical assessment rather than a routine appointment. ## Key facts - Angina is a symptom of restricted blood flow, not a separate disease from coronary artery disease. - Medication and risk factor treatment reduce the risk of heart attack; stents mainly improve symptoms. - Blood pressure, cholesterol, diabetes control, smoking and physical activity all measurably change outcomes. - Symptoms that are worsening, occurring at rest or waking you at night need urgent assessment, not a routine one. ## What happens in the arteries The coronary arteries run across the surface of the heart and supply the heart muscle itself with blood. Over years, fatty material and inflammatory cells accumulate within the artery wall, forming plaque. This process, atherosclerosis, is gradual and usually silent for a long time. Symptoms appear in two quite different ways. A stable narrowing limits how much extra blood can reach the muscle during exertion, producing predictable discomfort that eases with rest. A plaque that ruptures can trigger a clot that blocks the artery suddenly, which is a heart attack. The distinction matters because the first is assessed in clinic and the second is an emergency. ## Recognising angina Angina is typically a heaviness, tightness or pressure across the centre of the chest, sometimes spreading to the arm, neck or jaw. It comes on with exertion or emotional stress, and settles within a few minutes of rest. Some people, particularly women and people with diabetes, experience breathlessness or unusual fatigue on exertion rather than chest pain. The important clinical distinction is between stable and unstable symptoms. Stable angina follows a predictable pattern over weeks or months. Symptoms that are newly appearing, becoming more frequent, occurring with progressively less exertion, or happening at rest represent unstable disease and need urgent assessment. ## How the diagnosis is made Assessment starts with the history, examination, blood pressure, blood tests including cholesterol and glucose, and a resting ECG. The likelihood of coronary disease is then judged from the symptom pattern together with age and risk factors. For stable chest pain, CT coronary angiography is now the usual first-line imaging test in the UK. It uses a CT scanner with an injection of contrast to show the coronary arteries directly, and is good at establishing whether significant disease is present. Functional tests, such as stress echocardiography, assess whether a narrowing is actually limiting blood flow. Invasive coronary angiography is used where the diagnosis remains unclear or where treatment is being planned. ## Treatment: what each part is for It helps to separate the two goals of treatment, because they are achieved differently. Reducing the risk of a future heart attack is achieved with medication and risk factor management: statins and other lipid-lowering treatment, antiplatelet medication where indicated, blood pressure control, diabetes management, stopping smoking, physical activity and diet. This is the part of treatment that changes long-term outcome, and it applies to everyone with the diagnosis. Relieving symptoms is achieved with anti-anginal medication and, where symptoms persist despite it, by opening the narrowed artery with a stent or, for some patterns of disease, with bypass surgery. For stable disease, a stent is primarily a treatment for symptoms; the decision to proceed depends on how limiting the symptoms are, what the imaging shows and what you consider acceptable. ## Living with the diagnosis Most people with coronary artery disease continue to work, exercise and travel. Cardiac rehabilitation, regular review of medication and periodic reassessment of risk factors are the routine parts of follow-up. Any change in the pattern of symptoms should prompt a review rather than waiting for the next scheduled appointment. ## Sources - [Coronary heart disease](https://www.nhs.uk/conditions/coronary-heart-disease/) — NHS - [Recent-onset chest pain of suspected cardiac origin (CG95)](https://www.nice.org.uk/guidance/cg95) — NICE --- General information only. It does not replace individual medical advice, diagnosis or emergency care. In an emergency call 999.