Chronic stable angina (patient information): Difference between revisions

	Chronic stable angina
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Chronic stable angina?
What to expect (Outlook/Prognosis)?
Possible complications
Prevention
Chronic stable angina On the Web
Ongoing Trials at Clinical Trials.gov
Images
NICE Guidance
FDA on Chronic stable angina
CDC on Chronic stable angina
Chronic stable angina in the news
Blogs on Chronic stable angina
Directions to Hospitals Treating Chronic stable angina
Risk calculators and risk factors for Chronic stable angina

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Latest revision as of 21:24, 11 February 2015

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Meagan Doherty, Justine Cadet, 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 fails 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 in predictable patterns and with similar characteristics each time. It usually occurs following the same types of 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. Symptoms of angina can include one or more of the following:

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 by a medicine called nitroglycerin.
Spreading pain that extends to left arm, shoulder, back, neck or jaw.

Shortness of breath: You may 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

What should you ask your doctor?

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) because 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.
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 one or more of the following:

Lifestyle modifications
Proper medication
Invasive procedures including (coronary angioplasty, stent placement, or coronary artery bypass surgery).

Medications to treat blood pressure, diabetes, or high cholesterol to prevent angina include but are not limited to:

ACE inhibitors: lower blood pressure
Beta-blockers: lower heart rate, blood pressure, and the amount of oxygen consumed
Calcium channel blockers: relax arteries and lower blood pressure
Nitrates: prevent angina
Ranolazine: treats chronic angina
Aspirin and clopidogrel or prasugrel help prevent blood clots from forming in your arteries, and reduces your risk of having a heart attack.

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.

Medications to avoid

Patients diagnosed with chronic stable angina should avoid using the following medications:

Almotriptan
If you have been diagnosed with chronic stable angina, consult your physician before starting or stopping any of these medications.

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: This type of chest pain/discomfort is a greater predictor of an impending heart attack and 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

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000198.htm

Template:WH

Template:WS

@@ Line 1: / Line 1: @@
+__NOTOC__
 '''For the WikiDoc page for this topic, click [[Chronic stable angina|here]]'''
 {{Chronic stable angina (patient information)}}
-{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[Lakshmi Gopalakrishnan]], M.B.B.S; [[Varun Kumar]], M.B.B.S
+{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[Meagan Doherty]], [[Justine Cadet]], [[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 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.
+Angina is a type of [[chest pain]] or discomfort that occurs as a consequence of inadequate blood supply that fails 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 in predictable patterns and with similar characteristics each time. It usually occurs following the same types of 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 angina is occuring. The most common presentation include:
+It's important to know the symptoms of angina and to seek medical help if you think you are experiencing angina.
+Symptoms of angina can include one or more of the following:
 *Chest discomfort:
 :*A common precipitating factor is exertion. Other precipitating factors include [[stress (patient information)|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]].
+:*Pain is relieved with rest or by 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 [[Dyspnea|short of breath]]
+*Shortness of breath: You may feel tired and be [[Dyspnea|short of breath]]
 *[[Perspiration|Sweaty]]
-*[[Lightheaded]]
+*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 [[Palpitation (patient information)|palpitations]]
+*A sensation in which you can feel your heart beating irregularly or too fast:  [[Palpitation (patient information)|palpitations]]
+==What should you ask your doctor?==
 {{#ev:youtube|p47QFhkKKfI}}
 ==What causes angina?==
-Angina is a  symptom of underlying [[Coronary heart disease (patient information)|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.
+Angina is a  symptom of underlying [[Coronary heart disease (patient information)|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}}
@@ Line 37: / Line 41: @@
 :*Physical inactivity
 :*[[Diabetes]] (high blood sugar)
+:*Poor diet
 *Risk factors that you can't change include:
 :*Age
 :*[[Family history]] of early [[Coronary heart disease (patient information)|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.
@@ Line 46: / Line 53: @@
 ==When to seek urgent medical care?==
 *You should seek medical care if you are experiencing:
-:*New, [[chest pain|unexplained chest pain]] or pressure chest , upper body discomfort in one or both arms, the back, neck, jaw, or stomach
+:*New, [[chest pain|unexplained chest pain]], upper body discomfort in one or both arms, the back, neck, jaw, or stomach
 :*[[Shortness of breath]]
 :*[[Nausea]], [[vomiting]]
@@ Line 52: / Line 59: @@
 :*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 (patient information)|heart attack]] (also called [[myocardial infarction]] or [[MI]]) and immediate treatment is essential.
+*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 (patient information)|heart attack]] (also called [[myocardial infarction]] or [[MI]]) because immediate treatment is essential.
 {{#ev:youtube|U2DkFeBKkM8}}
@@ Line 66: / Line 73: @@
 ==Treatment options==
-*Angina can be treated by combining lifestyle modifications, medications and invasive procedures (coronary [[angioplasty]], [[stent]] placement or [[coronary artery bypass surgery]]).
+*Angina can be treated by combining one or more of the following:
+:*Lifestyle modifications
+:*Proper medication
+:*Invasive procedures including (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.
+*Medications to treat blood pressure, diabetes, or high cholesterol to prevent angina include but are not limited to:
-:*[[ACE inhibitors]] to lower blood pressure and protect your heart
+:*[[ACE inhibitors]]: lower blood pressure
-:*[[Beta-blocker]]s to lower heart rate, blood pressure, and oxygen use by the heart
+:*[[Beta-blocker]]s: lower heart rate, blood pressure, and the amount of oxygen consumed
-:*[[Calcium channel blocker]]s to relax arteries, lower blood pressure, and reduce strain on the heart
+:*[[Calcium channel blocker]]s: relax arteries and lower blood pressure
-:*[[Nitrate]]s to help prevent angina
+:*[[Nitrate]]s: prevent angina
-:*[[Ranolazine]] to treat chronic angina
+:*[[Ranolazine]]: treats 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 (patient information)|heart attack]].
+:*[[Aspirin]] and [[clopidogrel]] or [[prasugrel]] help prevent blood clots from forming in your arteries, and reduces your risk of having a [[Heart attack (patient information)|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
-*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 [[CABG|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.
-*Some patients may need surgery to improve blood flow through the coronary arteries.
+====Medications to avoid====
-:*'''[[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 '''[[CABG|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?==
+{{MedCondContrPI
-[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|angina}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating Chronic stable angina]
+|MedCond =  chronic stable angina|Almotriptan}}
 ==What to expect (Outlook/Prognosis)?==
-Stable angina usually improves with lifestyle modifications and medication.
+Stable angina usually improves with lifestyle modifications and proper medication.
 {{#ev:youtube|O3jJ-s23G5M}}
 ==Possible complications==
-*[[Heart attack (patient information)|Heart attack]]
+*Myocardial infarction ([[Heart attack (patient information)|Heart attack]])
 *Sudden death caused by abnormal heart rhythms ([[arrhythmias]])
-*[[Unstable angina]]
+*[[Unstable angina]]: This type of chest pain/discomfort is a greater predictor of an impending heart attack and needs immediate medical attention
 ==Prevention==
-*Your doctor may tell you to take [[nitroglycerin]] a few minutes in advance if you plan to perform an activity that may trigger angina pain.
+*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 (patient information)|coronary heart disease]] through life style modifications that may include:
-*The best way to prevent angina is to lower your risk for [[coronary heart disease (patient information)|coronary heart disease]]:
+:*Exercise regularly
-:*Avoid or reduce [[Stress (patient information)|stress]] as much as you can.
+:*Eat a proper diet that includes lots of fruits vegetables and whole foods
-:*Control your [[hypertension (patient information)|blood pressure]], [[diabetes]], and [[Hypercholesterolemia (patient information)|cholesterol]].
+:*Eat a diet low in fat and cholesterol
-:*Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables.
+:*Avoid stressful situations or activities
-:*Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. However, talk to your doctor before beginning or increasing your activity or exercise level.
+:*If obese or overweight, lose weight and maintain a healthy BMI
-:*Lose weight if you are [[Obesity|overweight]].
+:*[[Smoking|Stop smoking]]
+:*Control any risk factors you may have including [[hypertension (patient information)|blood pressure]], [[diabetes]], and [[Hypercholesterolemia (patient information)|cholesterol]] through medication and life style modification
 :*[[Smoking|Stop smoking]]
+*Consume moderate amounts of [[alcoholism (patient information)|alcohol]] (one glass a day for women, two for men) may reduce your risk of heart problems. However, avoid harmful binge drinking
-*Moderate amounts of [[alcoholism (patient information)|alcohol]] (one glass a day for women, two for men) may reduce your risk of heart problems. However, drinking larger amounts does more harm than good.
+==Sources==
-*Reducing your heart disease risk factors may prevent the blockages from getting worse and can make them less severe, which reduces angina pain.
-*New guidelines no longer recommend [[hormone replacement therapy]], vitamins E or C, antioxidants, or [[folic acid]] to prevent heart disease. The use of [[Hormone replacement therapy for menopause (patient information)|hormone replacement therapy]] in women who are close to [[Menopause (patient information)|menopause]] or who have finished menopause is controversial at this time.
-==Source==
 http://www.nlm.nih.gov/medlineplus/ency/article/000198.htm
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