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Alternative Names Return to topAngina - stable; Angina - chronic; Angina pectoris
Definition Return to top
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
Causes Return to top
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.
The risk factors for coronary heart disease include:
Anything that requires the heart muscle to need more oxygen can cause an angina attack, including:
Other causes of angina include:
Symptoms Return to top
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:
Some people say the pain feels like gas or indigestion.
The pain typically:
Angina attacks can occur at any time during the day, but most occur between 6 a.m. and noon.
Other symptoms of angina include:
Exams and Tests Return to top
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:
Treatment Return to top
The options for treating angina include lifestyle changes, medications, and invasive procedures such as coronary angioplasty or stent placement and coronary artery bypass surgery.
You and your doctor should agree on a plan for treating your angina on a daily basis. This should include:
You may be asked 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.
Taking aspirin and clopidogrel (Plavix) helps prevent blood clots from forming in your arteries, and reduces your risk of having a heart attack. Ask your doctor whether you should be taking these medications.
Your doctor may give you one or more medicines to help prevent you from having angina.
NEVER ABRUPTLY STOP TAKING ANY OF THESE DRUGS. Always talk to your doctor first. Stopping these drugs suddenly can make your angina worse or cause a heart attack.
Your doctor may recommend a cardiac rehabilitation program to help improve your heart's fitness.
INVASIVE AND SURGICAL TREATMENT
Some patients may need surgery to help improve the flow of blood through the coronary arteries.
Angioplasty and stent placement (also called percutaneous coronary intervention) is a procedure in which a physician inserts a catheter through an artery in either the arm or leg and advances the catheter into the heart. It is done to both open up and keep open a coronary artery that has become too narrow.
Angioplasty with stenting probably does not help you live longer than treatment with 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 or unstable angina.
Heart bypass surgery may be done for some people, depending on which of the coronary arteries are narrowed and the severity of the narrowing.
Outlook (Prognosis) Return to top
Stable angina usually improves with medication.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
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:
Seek immediate medical help if a person with angina loses consciousness.
Prevention Return to top
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:
Moderate amounts of alcohol (one glass a day for women, two for men) may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.
Reducing risk factors may prevent the blockages from getting worse, and can make them less severe, which reduces angina pain.
References Return to top
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.
Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, et al. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Circulation. 2008;118:586-606.
U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396-404.
Weintraub WS, Spertus JA, Kolm P, Maron Dj, Zhang Z, Jurkovitz C, et al. Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008;359:677-687.Update Date: 4/23/2009 Updated 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.