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Stable angina


Alternative Names:

Angina - stable; Angina - chronic; Angina pectoris; Chest pain - angina; CAD - angina; Coronary artery disease - angina; Heart diseas- angina

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 most often begins slowly and gets worse over the next few minutes before going away.

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

  • Arm (most often the left)
  • Back
  • Jaw
  • Neck
  • Shoulder

Some people say the pain feels like gas or indigestion.

Less common symptoms of angina may include:

  • Fatigue
  • Shortness of breath
  • Weakness
  • Dizziness or light-headedness
  • Nausea, vomiting, and sweating
  • Palpitations

Pain from stable angina:

  • Most often comes on after activity or stress
  • Lasts an average of 1 to 15 minutes
  • Is relieved with rest or a medicine called nitroglycerin

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

Exams and Tests:

Your health care provider will examine you and check your blood pressure. Tests that may be done include:

Treatment:

Treatment for angina can include:

  • Lifestyle changes
  • Medicines
  • Procedures such as coronary angiography with stent placement
  • Coronary artery bypass surgery

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

  • Medicines you regularly take to prevent angina
  • Activities that you can do and those you should avoid
  • Medicines you should take when you have angina pain
  • Signs that mean your angina is getting worse
  • When you should call the doctor or get emergency medical help

MEDICINES

You may need to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider'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), ticagrelor (Brilinta) or prasugrel (Effient) can help prevent blood clots from forming in your arteries, and reduce the risk of heart attack. Ask your provider if you should be taking these medicines.

You may need to take more medicines to help prevent you from having angina. These include:

  • ACE inhibitors to lower blood pressure and protect your heart
  • Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
  • Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart
  • Nitrates to help prevent angina
  • Ranolazine (Ranexa) to treat chronic angina

NEVER STOP TAKING ANY OF THESE DRUGS ON YOUR OWN. Always talk to your provider 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, ticagrelor and prasugrel).

Your provider 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 redirect blood flow around the narrowed or blocked blood vessels.

Outlook (Prognosis):

Stable angina most often improves when taking medicines.

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:

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 71.

Fihn SD, Blankenship JC, Alexander KP, Bittl JA, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014 Nov 4;64(18):1929-49. PMID: 25077860 www.ncbi.nlm.nih.gov/pubmed/25077860.

Morrow DA, Boden WE. Stable ischemic heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 54.


Review Date: 4/20/2015
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.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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