Heart Health
Diagnosing Angina: What Tests Will My Doctor Do?
A simple guide to the checks, heart scans, and treatment planning used when angina is suspected.
Patient information page | Last reviewed: June 2026
The quick answer
If you have chest pain that could be angina, your doctor will first listen carefully to your symptoms and check your risk factors. They may arrange an ECG, blood tests, blood pressure check, and other basic assessments.
If stable angina is suspected, you may be referred for heart imaging, often a CT coronary angiogram, echocardiogram, stress test, or coronary angiogram depending on your symptoms, local practice, and level of risk.
Chest pain that is severe, new, happening at rest, not settling, or associated with breathlessness, sweating, faintness, nausea, or pain spreading to the arm, jaw, neck, back, or upper abdomen needs emergency medical help.
What usually happens next?
The exact pathway varies between countries and health systems, but the overall aim is the same: to decide whether the chest pain is coming from the heart, how urgent it is, and what treatment will lower future risk.
Tell the story
Your doctor asks what the pain feels like, what brings it on, and what makes it settle.
Basic checks
ECG, blood pressure, blood tests, and examination help assess risk and rule out other causes.
Heart imaging
A scan may check the heart arteries, pumping function, or blood flow to the heart muscle.
Treatment plan
Treatment may include symptom relief, heart protection medicines, lifestyle changes, or a procedure.
1. The initial clinic visit
Your doctor will start by listening to your story. This is one of the most important parts of diagnosing angina.
They may ask:
- Where is the discomfort?
- What does it feel like: tight, heavy, burning, squeezing, or sharp?
- Does it spread to the arm, jaw, neck, back, or upper abdomen?
- Does it happen with walking, climbing stairs, cold weather, stress, or heavy meals?
- Does it settle with rest or prescribed GTN?
- How long does it last?
- Is it new, worsening, or happening at rest?
ECG
An electrocardiogram, often called an ECG or EKG, records the electrical activity of the heart using sticky patches on the skin.
It can show heart rhythm problems, signs of strain, or evidence of a previous heart attack. A normal ECG does not always rule out angina.
Blood tests
Blood tests may check cholesterol, blood sugar or HbA1c, kidney function, liver function, blood count, thyroid function, and other causes or risk factors.
If symptoms suggest a possible heart attack, urgent blood tests such as troponin may be needed.
Examination
Your doctor may check blood pressure, pulse, oxygen level, heart sounds, lungs, ankles, weight, and body mass index.
They may also look for signs of anaemia, valve disease, heart failure, or other conditions that can mimic or worsen angina.
Risk factors
Your doctor will consider age, smoking, diabetes, blood pressure, cholesterol, kidney disease, family history, and previous heart or circulation problems.
This helps decide how urgently you need further assessment.
2. Specialist referral
If stable angina is suspected, your doctor may refer you to a cardiology or chest pain clinic. The timing depends on your symptoms, local pathways, and whether there are emergency features.
The specialist team will review your story, ECG, blood tests, medicines, and risk factors. They will then decide which scan or test is most suitable.
Important
Do not wait for a routine appointment if symptoms become severe, happen at rest, last longer than usual, or do not settle as expected. Seek emergency medical help.
3. Heart scans and further tests
You will not usually need every test. The right test depends on your symptoms, age, kidney function, heart rhythm, exercise ability, previous results, and local availability.
CT coronary angiogram
A CT coronary angiogram uses a CT scanner and contrast dye injected into a vein, usually in the arm. It gives detailed pictures of the coronary arteries and can show narrowing or fatty plaque.
This test is often used to help diagnose coronary artery disease in people with suspected stable angina.
Echocardiogram
An echocardiogram is an ultrasound scan of the heart. It shows how well the heart muscle is pumping and whether the valves are working properly.
It does not directly show all the coronary arteries, but it can give important information about heart function and other causes of symptoms.
Stress test or stress imaging
Some people may need a test that checks how the heart behaves under stress. This may involve exercise, medicine that makes the heart work harder, or imaging such as stress echo, nuclear scan, CT, or MRI depending on the setting.
These tests can help show whether part of the heart muscle is not getting enough blood when demand increases.
Coronary angiogram
A coronary angiogram is an invasive test. A thin tube is passed through a blood vessel in the wrist or groin towards the heart. Contrast dye is injected directly into the coronary arteries while X-ray pictures are taken.
It may be recommended if symptoms are severe, scans suggest an important blockage, or a procedure such as a stent may be needed.
Quick test guide
| Test | What it checks | What to expect |
|---|---|---|
| ECG | Heart rhythm and electrical activity. | Sticky patches on the skin. Painless and quick. |
| Blood tests | Risk factors, anaemia, diabetes, cholesterol, kidney function, and sometimes heart muscle injury. | A blood sample from the arm. |
| CT coronary angiogram | Coronary artery narrowing and fatty plaque. | CT scan with contrast dye through a vein. |
| Echocardiogram | Heart pumping strength and valves. | Ultrasound probe on the chest. |
| Coronary angiogram | Detailed view of the coronary arteries. | A thin tube through the wrist or groin, with dye and X-ray pictures. |
4. The next steps: your treatment plan
If tests suggest stable angina, your doctor will build a plan to reduce symptoms and lower the risk of heart attack or stroke.
Symptom relief
You may be prescribed GTN spray or tablets to use when angina symptoms start. Some people also need daily medicines to reduce how often symptoms happen.
Heart protection
Your doctor may discuss medicines such as a statin, antiplatelet medicine, and blood pressure treatment if suitable for your situation.
Angina prevention medicines
Medicines such as beta blockers, calcium channel blockers, nitrates, or other anti-anginal medicines may help the heart work with less strain.
Lifestyle changes
Stopping smoking, a heart-healthy diet, physical activity, weight management, diabetes control, and blood pressure control all matter.
Some people need a procedure to improve blood flow, such as a stent or bypass surgery. Others are managed well with medicines and lifestyle changes. The right choice depends on your scan results, symptoms, overall risk, and personal circumstances.
When chest pain needs emergency help
Seek emergency medical help immediately if chest pain is severe, new or unexplained, happening at rest, not settling quickly, or worse than your usual angina.
Also seek urgent help if chest pain is associated with breathlessness, sweating, fainting, nausea, feeling very unwell, or pain spreading to the arm, jaw, neck, back, or upper abdomen.
Do not drive yourself to hospital with possible heart symptoms.
Key message
Diagnosing angina starts with your story, then basic checks such as ECG, blood tests, blood pressure, and examination.
If angina is suspected, heart imaging may be needed to look at the coronary arteries, heart function, or blood flow to the heart muscle.
The aim is not only to explain chest pain, but also to reduce future risk and help you live as safely and actively as possible.
References
- NHS. Angina.
- NHS. Coronary heart disease: diagnosis.
- British Heart Foundation. Tests for heart and circulatory conditions.
- British Heart Foundation. CT scans of the heart.
- American Heart Association. Angina and chest pain.
- Mayo Clinic. Angina diagnosis and treatment.