Angina pectoris - stable

Alternative names
Angina - stable

Definition
Angina is a pain or discomfort in the chest or adjacent areas caused by insufficient blood flow to the heart muscle. This chest pain is relieved by rest or medication within a short period of time (usually 15 minutes). Chest pain of a longer duration or pain appearing with a lower level of effort than before, even at rest, should be considered unstable angina.

Causes, incidence, and risk factors

Angina affects approximately 3% to 5% of the population in the U.S. The most common cause is Coronary artery disease (CAD).

In CAD, blockages in the coronary arteries, called plaques, prevent an adequate amount of blood from reaching the heart muscle. Situations that require increased blood flow to the heart may cause angina in people with CAD. These include exercise, heavy meals, and Stress.

The risk factors for CAD (which in turn causes angina) include the following:

• Male gender
  
• Cigarette Smoking
  
• High Cholesterol levels (in particular, high LDL and low HDL cholesterol)
  
• High blood pressure (Hypertension)
  
• Diabetes
  
• Family history of Coronary heart disease before age 55
  
• Sedentary lifestyle
  
• Obesity

Less common causes of angina include the following:

• Coronary artery spasm (also called Prinzmetal’s angina)
  
• Diseases of the heart valves
  
• Heart failure
  
• Abnormal heart rhythms
  
• Anemia

These conditions may also coexist with CAD.

Symptoms
A feeling of tightness, heavy pressure, or squeezing or crushing chest pain that:

• is under the breastbone or slightly to the left
  
• is not clearly focused in one spot
  
• may radiate to shoulder, arm, jaw, neck, back, or other areas
  
• may feel similar to gas or Indigestion.
  
• is precipitated by activity, stress, or exertion
  
• lasts 1 to 15 minutes
  
• is usually relieved by rest or nitroglycerin

Chest pain or heaviness that is not relieved by three sublingual nitroglycerin tablets under the tongue, each taken 5 minutes apart, or that lasts longer than 15 minutes may represent unstable angina or a Heart attack. Call your heart doctor and report to the local emergency room.

Signs and tests

Your health care provider may note changes in your blood pressure. A heart murmur or arrhythmias (irregular heartbeats) may occur.

An exercise tolerance test (stress test or treadmill test) may show ECG changes associated with the chest pain, which confirm the diagnosis of Coronary artery disease in patients with angina.

A stress Echocardiogram may show that the heart’s ability to squeeze (contract) is altered.

In some circumstances, your health care provider may request a heart scan or an Coronary angiography to help assess the condition.

Treatment

The goals are to reduce symptoms and prevent complications. If you experience angina, rest. If your health care provider recommended that you you take nitroglycerin to relieve the discomfort, do so.

The long-term treatment for stable angina includes nitroglycerin or oral nitrates administered through the skin, aspirin, beta-blockers, and calcium channel blockers. Other medications may also be given to control High Cholesterol, High blood pressure, or Abnormal heart rhythms.

Your health care provider may recommend a cardiac rehabilitation program to help improve your heart’s fitness.

Some patients may need surgery to treat the underlying Coronary artery disease. This may include PTCA (balloon Angioplasty to a coronary artery). PTCA usually includes placement of a stent, a wire mesh device to help keep the artery open. Another type of surgery is coronary artery bypass grafting (CABG).

Expectations (prognosis)
Stable angina is usually improved with medical treatment. However, this condition is often a sign of Coronary artery disease, which is usually a progressive disease.

Complications

• Unstable angina
  
• Heart attack
  
• Sudden death caused by lethal arrhythmias

Calling your health care provider

Call your health care provider if any of the following occur:

• Chest pain develops that has not been evaluated
  
• Your angina changes in frequency, severity, duration, or character (for example, it happens at rest)
  
• Your angina requires increasing doses of nitroglycerin or is not relieved within 15 minutes

Prevention

If you will be engaging in an activity that may trigger angina, you may take nitroglycerin a few minutes in advance to prevent the pain.

In the long term, the best prevention for angina is to modify as many risk factors for Coronary heart disease as possible:

• Stop Smoking
  
• Lose weight if you are overweight
  
• Control blood pressure, Diabetes, and cholesterol

Reducing risk factors, according to some studies, can prevent the progression of arterial blockages and can even lead to a decrease in the severity of blockages, thus markedly reducing angina.

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