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Stable angina


Alternative Names:

Angina - stable; Angina - chronic; Angina pectoris

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:

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

  • Coronary angiography
  • Coronary risk profile (special blood tests)
  • ECG
  • Exercise tolerance test (stress test or treadmill test)
  • Nuclear medicine (thallium) stress test
  • Stress echocardiogram
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 doctor 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 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

  • 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 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.

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.

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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