Stable Angina Pectoris

Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand. It is a common presenting symptom (typically, chest pain) among patients with coronary artery disease (CAD). Approximately 9.8 million Americans are estimated to experience angina annually, with 500,000 new cases of angina occurring every year. It is one of the three types of angina; stable, unstable and prinzmetal’s angina. It occurs when the heart muscle doesn’t get as much blood as it needs. This usually happens because one or more of the heart’s arteries is narrowed or blocked, also called ischemia. It’s not usually life threatening, but it’s a warning sign that you could be at risk of a heart attack or stroke.

Stable angina, also called angina pectoris, is the most common type of angina. Stable angina is a predictable pattern of chest pain. Tracking stable angina can help you manage your symptoms more easily.

Signs / Symptoms

What's common signs of stable angina pectoris?

  • Chest pain; that can feel like a vice squeezing your chest or like a heavy weight resting on you. It can also feel like fullness and uncomfortable pressure in the middle section of your chest.
  • The discomfort may spread to your neck, jaw, shoulder, back or arm
  • Mostly lasts less than 5 minutes
  • Is relieved by rest or medicine
  • Is triggered by physical exertion or stress

A stable angina episode can contain a few elements such as;

  • Shortness of breath
  • Nausea
  • Fatigue
  • Dizziness
  • Sweating

Common causes

What's common causes of stable angina pectoris?

The main component that creates angina pectoris is reduced blood flow to the heart muscles and by that lack of oxygen which causes ischemia in time. Certain factors, such as narrowing of the arteries which is called atherosclerosis, can prevent your heart from receiving more oxygen. Your arteries can become narrow and hard when plaque (a substance made of fat, cholesterol, calcium, and other substances) builds up inside the artery walls. Blood clots can also block your arteries and reduce the flow of oxygen-rich blood to the heart.

 

What are the risk factors for atherosclerosis that causes angina pectoris?
  • High cholesterol and/or high blood pressure levels
  • Diabetes
  • Smoking
  • History of heart diseases
  • Old age
  • Lack of exercise
  • Obesity
  • Stress
  • Unhealthy dietary habits

Departments & Emergency

Diagnosis and treatments for stable angina is conducted by cardiologist and on certain occasions emergency medicine doctors. So what are you supposed to do when you feel pain in your chest that suggests you may have something bigger than a heartburn or gas in your guts and you are worried about how to proceed.

If you have not been diagnosed with angina:
  • Stop what you’re doing and rest.
  • Make an urgent appointment to see a GP if the symptoms go away in a few minutes.
  • Call for an ambulance if the symptoms do not stop in a few minutes – this could be a heart attack.
  • If aspirin is easily available and you’re not allergic to it, chew 1 tablet while waiting for an ambulance – this can help if you’re having a heart attack.
If you’ve already been diagnosed with angina:
  • Stop what you’re doing and rest.
  • Take the medicine prescribed for you (glyceryl trinitrate, or GTN, spray or tablets).
  • Take another dose after 5 minutes if the first one does not help.
  • Call for an ambulance if you still have symptoms 5 minutes after taking the second dose.

Diagnosis

To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms and risk factors. They may also ask for severals tests to confirm your diagnosis such as;

  • Electrocardiogram (ECG)
  • Coronary Angiogram
  • Echocardiography
  • Blood tests for cardiac biomarkers and creatine kinase
  • Stress test

Treatment

  • Lifestyle changes
  • Medication;
    – Glyceryl trinitrate, (or GTN).
    – Beta Blockers
    – Calcium Channel Blockers(CCB)
    – Ivabradine, nicorandil or ranolazine
    – ACE Inhibitors
    – Statins
    – Low dose of aspirin
  • Surgical Procedures

 

Drugs

Glyceryl Trinitrate: Supposed to be taken during an angina attack. It comes as a mouth spray or tablets that dissolve under your tongue.

Beta Blockers & CCB: Used for preventing angina attacks. If you cannot take these drugs you will be given one the following ivabradine, nicorandil or ranolazine.

ACE Inhibitors & Statins & Aspirin: Used to prevent attacks and strokes.

 

Surgery

Surgery may be recommended if medicines are not helping control your angina. There are 2 types of surgery called coronary artery bypass graft (CABG) and coronary angioplasty and stent insertion. Both of these operations are similarly effective. The best one for you depends on your circumstances. If surgery is recommended, talk to your doctor or surgeon about your options.

FAQ

What is Angina Pectoris?

Angina pectoris or stable angina is the medical term for chest pain or discomfort due to coronary heart disease.

 
What is the duration of Angina pectoris?

Usually last for a short period of time for example 5 minutes or less.

 
What are the symptoms of Angina Pectoris?

Sudden pain around your chest that usually comes after physical exercise or a stressful event. This pain may also spread to your arm, chin, back and epigastric area( close to where your stomach is). You may also experience sweating, shortness of breath, dizziness etc. With rest and/or right medication the chest pain should go away and you would feel back to normal within 15 minutes.

References

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