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Stable angina
 
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Watch & Learn:Chest pain

Stable angina

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Angina - stable; Angina - chronic; Angina pectoris

Stable angina is chest pain or discomfort that most often occurs with activity or stress. Angina is due to poor blood flow through the blood vessels in the heart.

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  • Causes

    Your heart muscle needs a constant supply of oxygen. The coronary arteries carry blood containing oxygen to the heart.

    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 atherosclerosis or by a blood clot.

    The most common cause of angina is coronary artery disease. 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.

    There are many risk factors for coronary artery disease. Some include:

    • Diabetes 
    • High blood pressure
    • High LDL cholesterol and low HDL cholesterol
    • Smoking

    Anything that makes the heart muscle need more oxygen or reduces the amount of oxygen it receives can cause an angina attack in someone with heart disease, including:

    • Cold weather
    • Exercise
    • Emotional stress
    • Large meals

    Other causes of angina include:

    • Abnormal heart rhythms (your heart beats very quickly or your heart rhythm is not regular)
    • Anemia
    • Coronary artery spasm (also called Prinzmetal's angina)
    • Heart failure
    • Heart valve disease
    • Hyperthyroidism (overactive thyroid)
  • 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.

  • When to Contact a Medical Professional

    Get medical help right away if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.

    Call 911 if your angina pain:

    • Is not better 5 minutes after you take nitroglycerin
    • Does not go away after three doses of nitroglycerin
    • Is getting worse
    • Returns after the nitroglycerin helped at first

    Call your doctor if:

    • You are having angina symptoms more often
    • You are having angina when you are sitting (rest angina)
    • You are feeling tired more often
    • You are feeling faint or light-headed
    • Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady
    • You are having trouble taking your heart medicines
    • You have any other unusual symptoms

    Get medical help right away if a person with angina loses consciousness.

  • 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.

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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.

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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.

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