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Revision as of 00:37, 26 July 2011
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina (patient information) On the Web | ||
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to Hospitals Treating Chronic stable angina (patient information) | ||
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Risk calculators and risk factors for Chronic stable angina (patient information) | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S; Varun Kumar, M.B.B.S
Overview
Angina pectoris is a discomfort in the chest that is due to inadequate blood flow to the heart to meet its oxygen requirements.
What is angina?
Angina is a type of chest pain or discomfort that occurs as a consequence of inadequate blood supply to meet the oxygen requirements of the heart. The chest discomfort is brought on by exertion and is relieved by rest and/or oral medications. It is termed "stable" as the chest discomfort occurs with similar characteristics following similar activities or exercise. Stable angina is a warning sign of heart disease and should be evaluated by a doctor.
What are the symptoms of angina?
It's important to know the symptoms of a angina and seek medical help. The most common presentation include:
- Chest discomfort: that is caused by exertion. Other precipitating factors include emotional stress, large meal, cold weather. It 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. The pain may also spread to left arm, shoulder, back, neck and jaw.
- Shortness of breath: You may often feel tired and be short of breath
- Sweaty
- Lightheaded
- Unexplained tiredness after activity
- You may also have indigestion or be sick to your stomach
- Heart beating very fast or palpitations
What are the causes of 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 limits the blood supply to the heart(as shown in the video below). Specially when the muscles of the heart have to work harder during exercise or stress. <youtube v=GIWb4-a7A6A/>
Who is at risk for stable angina?
- 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)
- Risk factors that you can't change include:
- Age
- Family history of early coronary artery disease.
- 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 or pressure chest , 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.
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.
- Echocardiogram: This is a painless test to identify whether some areas of your heart are not contracting normally.
- Several 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.
- 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.
- Stress testing: The test is done when you are exercising. This makes it easier for doctors to diagnosis heart disease.
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.
What to expect (Outlook/Prognosis)
Stable angina usually improves with lifestyle modifications and medication.
Possible complications
- Heart attack
- Sudden death caused by abnormal heart rhythms (arrhythmias)
- Unstable angina