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Stable angina
Definition
Stable angina is chest pain or discomfort that typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes before going away. It quickly goes away with medication or rest, but may happen again with additional activity or stress.
See also: Unstable angina
Alternative Names
Angina - stable; Angina - chronic; Angina pectorisCauses
Your heart muscle is working all the time, so it needs a continuous supply of oxygen. This oxygen is provided by the coronary arteries, which carry blood.
When the heart muscle has to work harder, it needs more oxygen. Symptoms of angina occur when the coronary arteries are narrowed or blocked by hardening of the arteries (atherosclerosis), or by a blood clot.
The most common cause of angina is coronary heart disease (CHD). Angina pectoris is the medical term for this type of chest pain.
Stable angina is predictable chest pain. Although less serious than unstable angina, it can be very painful or uncomfortable.
Anything that requires the heart muscle to need more oxygen can cause an angina attack, including:
- Cold weather
- Exercise
- Emotional tension
- Large meals
The risk factors for coronary heart disease include:
- Being male
- Diabetes
- Family history of coronary heart disease before age 50
- High blood pressure
- High LDL cholesterol and low HDL cholesterol
- Not getting enough exercise
- Obesity
- Smoking
Less common causes of angina include:
- Abnormal heart rhythms
- Anemia
- Coronary artery spasm (also called Prinzmetal's angina)
- Heart failure
- Heart valve disease
- Hyperthyroidism
Symptoms
The most common symptom is chest pain that occurs behind the breastbone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the:
- Arm
- Back
- Jaw
- Neck
- Shoulder
Some people say the pain feels like gas or indigestion.
The pain typically:
- Occurs after activity, stress, or exertion
- Lasts an average of 1 - 15 minutes
- Is usually relieved with rest or a medicine called nitroglycerin
Angina attacks can occur at any time during the day, but most occur between 6 a.m. and noon.
Other symptoms of angina include:
- A feeling of indigestion or heartburn
- Dizziness or light-headedness
- Nausea, vomiting, and cold sweats
- Palpitations
- Shortness of breath
- Unexplained tiredness after activity (more common in women)
Exams and Tests
Your health care provider will perform a physical exam and measure your blood pressure. The following tests may be done to diagnose or rule out angina:
- Coronary angiography
- Coronary risk profile
- ECG
- Exercise tolerance test (stress test or treadmill test)
- Stress echocardiogram
Treatment
The options for treating angina include medications and surgery.
Medicines used to treat angina include:
- Nitroglycerin
- Blood thinners, including aspirin and clopidogrel (Plavix)
- Cholesterol-lowering drugs
- Blood pressure medicines, including calcium channel blockers, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors
Ranolazine (Ranexa) is a relatively new medicine approved for the treatment of chronic angina. The drug is for patients who do not respond to traditional angina treatment. It should be used in combination with other medication.
Your doctor may recommend a cardiac rehabilitation program to help improve your heart's fitness.
Some patients may need surgery to help improve the flow of blood through the coronary arteries, such as:
Recent studies show that angioplasty with stenting does not help you live longer than medicine alone. However, it can reduce angina or other symptoms of coronary artery disease.
Angioplasty with stenting can be a life-saving procedure if you are having a heart attack.
Outlook (Prognosis)
Stable angina usually improves with medication.
Possible Complications
- Heart attack
- Sudden death caused by abnormal heart rhythms (arrhythmias)
- Unstable angina
When to Contact a Medical Professional
Seek medical attention if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.
Call 911 or your local emergency number if you experience chest pain or heaviness. The pain may be a sign of unstable angina or a heart attack.
Call your health care provider if:
- Angina episodes happen more often, last longer than usual, or feel different than before
- You have shortness of breath
- You need to take more and more nitroglycerin to make your angina go away
Seek immediate medical help if a person with angina loses consciousness.
Prevention
Your doctor may tell you to take nitroglycerin a few minutes in advance if you plan to perform an activity that may trigger angina pain.
The best way to prevent angina is to lower your risk for coronary heart disease:
- Control blood pressure, diabetes, and cholesterol
- Lose weight if you are overweight
- Stop smoking
Reducing risk factors may prevent the blockages from getting worse, and can make them less severe, which reduces angina pain.
If you have one or more risk factors for heart disease, talk to your doctor about possibly taking aspirin or other medicines to help prevent a heart attack. Aspirin therapy (75 mg - 325 mg a day) or a drug called clopidogrel may help prevent heart attacks in some people.
References
Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].
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;116:2762-2772.
Reviewed By: Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
