Stable angina is chest pain or discomfort that usually occurs with activity or stress. Angina is chest discomfort due to poor blood flow through the blood vessels in the heart.
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.
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.
The pain may feel like tightness, heavy pressure, squeezing, or crushing pain. It may spread to the:
Arm (usually the left)
Back
Jaw
Neck
Shoulder
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:
Back, arm, or neck pain
Fatigue
Shortness of breath
Weakness
The pain of stable angina usually:
Occurs after activity or stress
Lasts an average of 1 - 15 minutes
Is relieved with rest or a medicine called nitroglycerin
Angina attacks can occur at any time during the day, but a higher number occur between 6 a.m. and noon.
The options for treating angina include lifestyle changes, medications, and procedures such as coronary angioplasty with stent placement or coronary artery bypass surgery.
What medicines you should be taking to prevent angina
What activities are okay for you to do, and which ones are not
What medicines you should take when you have angina
What are the signs that your angina is getting worse
When you should call the doctor or 911
MEDICATIONS
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.
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 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.
Fraker TD Jr, Fihn SD, Gibbons RJ, 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.
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 AmericanHeart Association. J Am Coll Cardiol. 2011; 57:1404-1423.
Review Date:
6/22/2012
Reviewed By:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
