Stable angina

Definition

Stable angina is chest pain or discomfort that most often occurs with activity or stress. Angina is due to poor blood flow through the blood vessels in the heart.

Alternative Names

Angina - stable; Angina - chronic; Angina pectoris

Causes

Your heart muscle needs a constant supply of oxygen. The coronary arteries carry blood containing oxygen to the heart.

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 atherosclerosis or by a blood clot.

The most common cause of angina is coronary artery disease. Angina pectoris is the medical term for this type of chest pain.

Stable angina is less serious than unstable angina, but it can be very painful or uncomfortable.

There are many risk factors for coronary artery disease. Some include:

Anything that makes the heart muscle need more oxygen or reduces the amount of oxygen it receives can cause an angina attack in someone with heart disease, including:

Other causes of angina include:

Symptoms

Symptoms of stable angina are most often predictable. This means that the same amount of exercise or activity may cause your angina to occur. Your angina should improve or go away when you stop or slow down the exercise.

The most common symptom is chest pain that occurs behind the breastbone or slightly to the left of it. The pain of stable angina usually begins slowly and gets worse over the next few minutes before going away.

Typically, the chest pain feel like tightness, heavy pressure, squeezing, or a crushing feeling. It may spread to the:

Some people say the pain feels like gas or indigestion.

Less common symptoms of angina may include:

Pain from stable angina:

Angina attacks can occur at any time during the day. Most occur between 6 a.m. and noon.

Exams and Tests

Your doctor or nurse will examine you and check your blood pressure. Tests that may be done include:

Treatment

Treatment for angina can include:

If you have angina, you and your doctor will develop a daily treatment plan. This plan should include:

MEDICINES

You may need to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your doctor's directions closely to help prevent your angina from getting worse.

Nitroglycerin pills or spray may be used to stop chest pain.

Anti-clotting drugs such as aspirin and clopidogrel (Plavix) or prasugrel (Effient) can help prevent blood clots from forming in your arteries, and reduce the risk of heart attack. Ask your doctor if you should be taking these medicines.

Your doctor may give you one or more medicines to help prevent you from having angina. These include

NEVER STOP TAKING ANY OF THESE DRUGS ON YOUR OWN. Always talk to your doctor first. Stopping these drugs suddenly can make your angina worse or cause a heart attack. This is especially true of anti-clotting drugs (aspirin, clopidogrel, and prasugrel).

Your doctor may recommend a cardiac rehabilitation program to help improve your heart's fitness.

SURGICAL TREATMENT

Some people will be able to control angina with medicines and not need surgery. Others will need a procedure called angioplasty and stent placement (also called percutaneous coronary intervention) to open blocked or narrowed arteries that supply blood to the heart.

Blockages that cannot be treated with angioplasty may need heart bypass surgery to replace the damaged blood vessels.

Outlook (Prognosis)

Stable angina most often improves when taking medicines.

When to Contact a Medical Professional

Get medical help right away if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.

Call 911 if your angina pain:

Call your doctor if:

Get medical help right away if a person with angina loses consciousness.

Prevention

A risk factor is something about you that increases your chance of getting a disease or having a certain health condition.

Some risk factors for heart disease you cannot change, but some you can. Changing the risk factors that you can control will help you live a longer, healthier life.

References

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e-44-e164.

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 71.

Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 57.



Review Date: 5/13/2014
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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