|Read our E-Magazine|
|Receive our E-Newsletters|
|Become our Fan|
Stable angina is chest pain or discomfort that often occurs with activity or stress. Angina is a type of chest discomfort caused by poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).
See also: Unstable angina
Angina - stable; Angina - chronic; Angina pectoris
Your heart muscle is working all the time, so it needs a constant 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 less serious than unstable angina, but it can be very painful or uncomfortable.
The risk factors for coronary heart disease include:
Anything that makes the heart muscle need more oxygen can cause an angina attack in someone with heart disease, including:
Other causes of angina include:
Symptoms of stable angina are 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.
The pain may feel like tightness, heavy pressure, squeezing, or crushing pain. It may spread to the:
Some people say the pain feels like gas or indigestion.
Some patients (women, older adults, and people with diabetes) may have different symptoms, such as:
The pain of stable angina usually:
Angina attacks can occur at any time during the day, but a higher number occur between 6 a.m. and noon.
Other symptoms of angina include:
Your health care provider will do a physical exam and measure your blood pressure. Tests that may be done to diagnose or rule out angina include:
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) or prasugrel (Effient) 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 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.
Some people will be treated with medicines and will not need surgery to treat a blockage or narrowing. Others will need a procedure to open narrowed or blocked blood vessels that supply blood to the heart.
Stable angina usually improves with medication.
Seek medical attention 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:
Seek medical help right away if a person with angina loses consciousness.
Your doctor may tell you to take nitroglycerin a few minutes in advance if you plan to perform an activity that may trigger the pain of angina.
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 heart problems. However, drinking larger amounts does more harm than good.
Reducing your heart disease risk factors may prevent the blockages from getting worse and can make them less severe, which reduces angina pain.
New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease. The use of hormone replacement therapy in women who are close to menopause or who have finished menopause is controversial at this time.
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.
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.
Becker RC, Meade TW, Berger PB, Ezekowitz M, O'Connor CM, Vorchheimer DA, et al. The primary and secondary prevention of coronary artery disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):776S-814S.
Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961-972. Epub 2009 Feb 18.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women -- 2011 update: A guideline from the American Heart Association. J Am Coll Cardiol. 2011; 57:1404-1423.