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Angina Pectoris, Stable
 
This is an abbreviated version of the complete article.*
Basic Facts
Angina pectoris results from a condition called coronary heart disease, an accumulation of plaque in the coronary blood vessels that reduces blood flow to the heart.
The pain or tightness that is angina results from ischemia, or the lack of oxygenated blood available to meet the needs of the heart.
Angina that occurs during or after physical exercise or emotional stress is called stable angina because the pattern of events that puts extra work on the heart results in heart pain that is predictable.
In a healthy heart, an increased demand for oxygen because of exercise, for example, results in increased blood flow to the heart. But when coronary arteries are narrowed or blocked by plaque (a condition called atherosclerosis or hardening of the arteries), the heart does not receive enough blood to meet these periods of increased oxygen demands. Stable angina is pain associated with this unmet demand for blood and oxygen in the heart brought on by physical activity or emotional stress.

Angina that occurs during or after physical exercise or emotional stress is referred to as stable because of the predictable pattern of heart pain caused by exertion or stress. Stable angina can occur intermittently for weeks, months, or even years. When angina occurs unpredictably or during rest, however, it is called unstable angina.

WHAT ARE THE SYMPTOMS?

Stable angina pain usually lasts between 2 and 15 minutes. The pain associated with angina can vary, and people make different comparisons to express the pain they feel. Many people describe angina as pain or pressure, a feeling of tightness, a heavy, crushing feeling, or discomfort just below the breastbone. Other people report that angina pain feels mild when it begins and then rises in intensity. Angina may also feel similar to heartburn or indigestion, create a sensation of heaviness in the chest that may also be felt in the neck, throat, jaw, shoulder and arm, or cause shortness of breath. Angina may sometimes cause such other symptoms as:
  • Anxiety;
  • Nausea;
  • Lightheadedness; and
  • Profuse sweating.
CAUSES AND RISK FACTORS

The conditions that may predispose a person to stable angina can be inherited. However, other risks for stable angina are lifestyle-oriented factors that affect the development of coronary heart disease, or CHD, and include:
  • Smoking;
  • Having high cholesterol levels;
  • Not exercising regularly;
  • Being diagnosed with hypertension, or high blood pressure;
  • Eating a diet high in fat and cholesterol;
  • Having diabetes;
  • Being more than 30 percent over one's ideal weight; and
  • Using cocaine or similar recreational drugs.
DIAGNOSIS

To diagnose stable angina pectoris, a physician will take a careful medical history, conduct a physical exam, measure blood pressure and cholesterol levels, listen to the patient describe symptoms, and perform a resting electrocardiogram, or ECG. If these tests do not produce a definite diagnosis, the physician may order one or more of the following tests:
  • ECG stress test, a form of electrocardiography, in which the heart is monitored at rest and during exercise;
  • Echocardiographic stress testing, in which the effects of exercise are measured and viewed using ultrasound waves; and
  • Cardiac catheterization and angiography, in which a catheter is inserted into an artery to measure blood pressure, determine the amount of oxygen in the blood, and measure the pumping power of the heart.
TREATMENT APPROACH

The goal of therapy for stable angina is to relieve ischemia, or the unmet need for blood and oxygen, and control the underlying coronary heart disease that causes angina. The best way to control the progression of CHD is to control the risk factors that cause it, such as smoking, high blood pressure, and high cholesterol. People who experience angina may have to take medications to control cholesterol, blood pressure, and abnormal heart rhythms.

Some medications that may be used for stable angina pectoris include:
  • Nitrates (nitroglycerin);
  • Beta-blockers;
  • Long-acting calcium channel blockers; and
  • Aspirin (in low doses).
When medication does not adequately increase blood supply to the heart, surgery may be necessary to treat the CHD that causes angina symptoms. Current surgical options for treating angina because of CHD include coronary angioplasty, also called balloon angioplasty, and coronary artery bypass graft surgery.

*If you would like to read this article in its entirety, please call our office and ask to meet with one of our specialists to receive a Prescription Pad form.

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