Stable angina: Everything you need to know
A person with stable angina usually has something blocking their arteries or making it difficult for fresh blood to flow through them and into the heart. The lack of blood flow to the heart, called ischemia, is what causes the pain.
A person with stable angina may have episodes of pain that are brought on by physical exertion or stress. Episodes are generally short and then disappear.
There are a few different causes of stable angina, and symptoms may vary. Stable angina is sometimes called angina pectoris.
The pain from angina may be an indicator or warning sign of a heart attack.
Angina pectoris symptoms
Chest pain is the most common symptom of stable angina.
The primary symptom of stable angina is chest pain. People often describe the pain as a feeling of squeezing or pressure in the chest. Some people say it feels as if their chest is full, while others may say the chest feels compressed or that they feel as though they have indigestion.
The symptoms can vary from person to person, but the pain will usually last only a few minutes at a time.
During an episode, the pain may stay in the chest, or it may radiate to the arms, shoulders, neck, or jaw.
An episode of stable angina may also cause:
Episodes usually occur during exercise or physical activities, such as climbing flights of stairs. The symptoms may also be more likely in the morning, but they can happen at any time.
Once a person with stable angina experiences an episode, subsequent episodes may not be as alarming or surprising, as symptoms tend to follow a similar pattern.
Causes and risk factors
Eating a heavy meal may trigger episodes of pain.
The heart not getting enough oxygen is the direct cause of stable angina.
People with stable angina have symptoms most often when they are emotionally stressed or doing physical activity.
Other than stress and physical activity, episode triggers may include such things as eating a heavy meal, exposure to extreme temperatures, or smoking.
Stable angina is typically an aspect of coronary heart disease (CHD,) and the two conditions share some similar risk factors.
Some underlying factors, such as atherosclerosis, may make the symptoms worse. Atherosclerosis causes the opening in the arteries to narrow as plaque builds up inside the walls.
Plaque is a mixture of fat, cholesterol, and other substances that sticks to the walls of the arteries, making them narrower.
People who have blood clots in their arteries may also be at risk of both stable and unstable angina. Blood clots can partially or entirely block off an artery, restricting the amount of blood that can reach the heart.
Risk factors for CHD and stable angina include:
- high blood pressure
- high LDL cholesterol or low HDL cholesterol
- family history of heart disease
- sedentary lifestyle
To diagnose stable angina, doctors will first do a physical exam and ask about any medical history the person has or underlying conditions.
They may take a person's blood pressure and will often order an electrocardiogram (ECG) to look at the heart's functioning.
Other tests that can help a doctor make a diagnosis include:
- computed tomography (CT) scans to give an image of the heart
- exercise tolerance tests performed on a treadmill
- blood cholesterol profile to asses for risk factors, including atherosclerosis
- a coronary angiography to see how well blood flows through the arteries
In some cases, doctors can run C-reactive protein (CRP) tests. Higher levels of CRP may indicate a higher risk of being diagnosed with heart disease.
A person can treat an episode of stable angina by resting or taking medication if necessary. However, long-term treatment will focus on making changes to reduce the chances of further incidents.
Treatment may include:
Prescription medications are a common treatment for stable angina.
Nitroglycerin is a standard medicine for relieving the pain from stable angina. It relaxes coronary arteries, which reduces the workload of the heart.
A person may need to carry nitroglycerin with them at all times. Doctors will recommend a specific dosage, depending on a person's symptoms and overall health.
A doctor may also prescribe medications to treat underlying conditions, such as high blood pressure or high cholesterol, to reduce the risk of an episode.
If doctors believe blood clots are an underlying risk, they may recommend blood thinners to help prevent blockages in the arteries.
Doctors will usually recommend that a person makes healthful lifestyle choices, such as eating a varied diet rich in whole grains, fruits, and vegetables.
They may also tell the person to look into stress-reducing techniques, such as yoga, meditation, or breathing exercises.
Light exercises or physical therapy can also help reduce symptoms and slowly increase the physical activity a person can handle over time.
Health-creating lifestyle choices may also reduce the risk of high cholesterol and high blood pressure.
An angioplasty is a common surgical procedure used to treat stable angina. It involves locating the problem area in the artery, then adding a permanent stent to widen it and hold it open.
Angioplasty is a minimally invasive procedure, which should help prevent symptoms.
More invasive surgeries may be necessary in some cases. These can include procedures such as a coronary artery bypass to replace damaged or blocked pieces of the artery.
Stable angina vs. unstable angina
Pain from stable angina comes in episodes and typically lasts only a few minutes at a time, whereas pain from unstable angina is often severe and can be long-lasting.
Pain from unstable angina can also come on while a person is resting or sleeping. The pain may get worse over time, and rest and medicine may not help symptoms.
Blood clots that partially or entirely block off the arteries leading to the heart may cause unstable angina. Unstable angina is usually a medical emergency.
Anyone experiencing new or worsening symptoms of chest pain or tightness should contact their doctor. This may be a sign of serious heart issues, such as a heart attack.
The outlook for people with stable angina can vary but is usually good. Medication is often enough to manage symptoms, and when a person makes healthful lifestyle changes, it can help improve their quality of life, reduce their risk factors, and prevent symptoms from getting worse.
Symptoms may get worse, and a person's risk of developing other conditions may also increase if they do not make positive lifestyle choices.
Similarly, episodes of stable angina may continue, and people may develop a greater risk for severe complications, such as a heart attack or unstable angina.
Making positive lifestyle changes is a start, but it is still vital to see a doctor at the first sign of stable angina symptoms. Working directly with a doctor to manage symptoms, as soon as they show up, may give a person the best outlook possible.