Chronic stable angina (patient information)
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Chronic stable angina |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S; Varun Kumar, M.B.B.S
Overview
Angina is a type of chest pain or discomfort that occurs as a consequence of inadequate blood supply that causes a failure to meet the oxygen needs of the heart. The chest discomfort is commonly brought on by exertion and is typically relieved by rest and/or oral medications. It is termed stable as the chest discomfort occurs with similar characteristics each time and usually occurs following similar activities or exercise. Stable angina is a warning sign of heart disease and should be evaluated by a doctor. {{#ev:youtube|0ckGyCT2u3M}}
What are the symptoms of angina?
It's important to know the symptoms of angina and to seek medical help if you think you are experiencing angina. The most common presentation include:
- Chest discomfort:
- A common precipitating factor is exertion. Other precipitating factors include emotional stress, large meals, and cold weather. The discomfort is often described as a sense of heaviness, squeezing, pressure, or band like tightness.
- Most anginal discomfort is located in the center of the chest behind the breast bone and lasts between 1-15 minutes.
- Pain is relieved with rest or or a medicine called nitroglycerin.
- Spreading pain that extends to left arm, shoulder, back, neck or jaw.
- Shortness of breath: You may often feel tired and be short of breath
- Sweaty
- Feeling Lightheaded
- Unexplained tiredness after activity
- You may also have indigestion or be sick to your stomach
- A sensation in which you can feel your heart beating irregularly or too fast: palpitations
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What causes angina?
Angina is a symptom of underlying coronary artery disease that is characterized by a fatty material called plaque that builds up over many years on the inner walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). This build up limits the blood supply to the heart (as shown in the video below). Blood supply is specifically limited when the muscles of the heart have to work harder during exercise or when a person is under stress. {{#ev:youtube|GIWb4-a7A6A}}
Who is at highest risk?
- Certain risk factors make it more likely that you will develop coronary artery disease (CAD) and subsequently present with anginal pain.
- Major risk factors for stable angina that you can control include:
- Smoking
- High blood pressure
- High blood cholesterol
- Overweight and obesity
- Physical inactivity
- Diabetes (high blood sugar)
- Poor diet
- Risk factors that you can't change include:
- Age
- Family history of early coronary artery disease.
- Previous heart attack
- Having other diseases that affect the heart
- Certain CAD risk factors tend to occur together. When they do, it’s called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.
When to seek urgent medical care?
- You should seek medical care if you are experiencing:
- New, unexplained chest pain, upper body discomfort in one or both arms, the back, neck, jaw, or stomach
- Shortness of breath
- Nausea, vomiting
- Lightheadedness or fainting
- Breaking out in a cold sweat
- If the symptoms mentioned above persists for more than 15 minutes even after resting or three doses of nitroglycerin or is worsening, call 911 immediately as these symptoms could be the signs of a heart attack (also called myocardial infarction or MI) and immediate treatment is essential.
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Diagnosis
- Some health problems may cause the similar symptoms with angina. So people with any of those symptoms should go to see the doctor to be diagnosed and treated as early as possible.
- Your doctor will perform a physical exam and measure your blood pressure and may suggest following tests to diagnose or rule out angina:
- Electrocardiogram(ECG): This is the most important and painless procedure in which a healthcare professional will measure the electrical activity of your heart to find whether there are any heart abnormalities or irregular heart beats.
- Blood tests: Blood tests such as lipid levels, glucose levels to test for risk factors and CK-MB Test, troponins test can be done by your doctor to determine whether or not your heart is damaged.
- Echocardiogram: This is a painless test to identify whether some areas of your heart are not contracting normally.
- Stress testing: The test is done when you are exercising. This makes it easier for doctors to diagnosis heart disease.
- Coronary angiography: This is an imaging test that involves the injection of a special dye into your coronary arteries so that visible images can be seen on x rays to show the inside of your coronary arteries and to determine whether or not there is any obstruction of blood flow.
Treatment options
- Angina can be treated by combining lifestyle modifications, medications and invasive procedures (coronary angioplasty, stent placement or coronary artery bypass surgery).
- You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol to prevent 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 to treat chronic angina
- Aspirin and clopidogrel or prasugrel helps prevent blood clots from forming in your arteries, and reduces your risk of having a heart attack.
- Nitroglycerin pills or spray may be used to stop chest pain.
- Follow your doctor's directions closely to help prevent your angina from getting worse. 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 also recommend a cardiac rehabilitation program to help improve your heart's fitness
- Some patients may need surgery to improve blood flow through the coronary arteries.
- Angioplasty with stent placement is a procedure where a catheter is passed into the coronary artery of the heart through the arteries in leg or arm. This procedure is done to keep open a coronary artery that has become too narrow.
- Not every blockage can be treated with angioplasty. Some people need coronary bypass (heart surgery). Whether this procedure can be done depends on which of the coronary arteries are narrowed and how severely they are narrowed.
Where to find medical care for Chronic stable angina?
Directions to Hospitals Treating Chronic stable angina
What to expect (Outlook/Prognosis)?
Stable angina usually improves with lifestyle modifications and proper medication. {{#ev:youtube|O3jJ-s23G5M}}
Possible complications
- Myocardial infarction (Heart attack)
- Sudden death caused by abnormal heart rhythms (arrhythmias)
- Unstable angina: A greater predictor of an impending heart attack that needs immediate medical attention
Prevention
- Taking the proper medication nitroglycerin prior to an exercise or activity that requires if prescribed by your physician.
- decreasing your risk for coronary heart disease through life style modifications that may include:
- Exercise regularly
- Eat a proper diet that includes lots of fruits vegetables and whole foods
- Eat a diet low in fat and cholesterol
- Avoid stressful situations or activities
- If obese or overweight, lose weight and maintain a healthy BMI
- Stop smoking
- Control any risk factors you may have including blood pressure, diabetes, and cholesterol through medication and life style modification
- Stop smoking
- Consume moderate amounts of alcohol (one glass a day for women, two for men) may reduce your risk of heart problems. However, avoid harmful binge drinking