Stable angina pectoris (also known as angina pectoris) causes chest pain after physical activity or emotional stress. It is often an early sign of heart disease and occurs due to narrowed or blocked arteries in the heart.
Certain risk factors, such as a family history of heart disease or a personal history of smoking, can increase your chances of developing this condition. If you have stable angina, lifestyle changes and medication are necessary. Without treatment, this condition can progress and increase the risk of heart attack.
The symptoms of stable angina are consistent and predictable. Symptoms are usually triggered by physical exertion or increased stress. You can expect episodes of stable angina to last up to 15 minutes. While symptoms mostly affect the chest, they can spread to other parts of the body.
Pain
Stable angina pain usually begins gradually and increases in intensity before disappearing. Behind the sternum or immediately to the left of it, the crushing and tightening in the chest begins. This pain can spread, reaching the arm (usually the left), back, jaw or shoulder. The pain usually goes away with rest or medication.
Different people can experience pain differently. Some people may have discomfort only in the shoulder or neck.
Additional symptoms
Less often, stable angina can have a wider effect on the body. Additional signs of this condition may include:
- Feeling tired or sleepy
- Shortness of breath
- Muscle weakness
- Vertigo
- Nausea or vomiting
- sweating
- Heart palpitations
Stable angina occurs when your heart muscles are not getting enough oxygen from the blood, usually because of a narrowed or blocked coronary artery (blood vessels in the heart). An insufficient amount of oxygen activates receptors in the heart muscles and coronary blood vessels. When you are stressed or tired from physical activity, your heart has to work harder to pump blood, which leads to symptoms.
This condition is usually an early sign of coronary artery disease. Coronary artery disease occurs when too much plaque builds up in your blood vessels, reducing the flow of blood and oxygen to your heart muscles.
Other conditions, including heart failure, heart valve problems, anemia, and a fast heart rate, can also cause chest pain and increase the risk of developing stable angina.
Risk factors
While coronary artery disease is the most common cause of stable angina, other factors can increase your risk. This includes:
- Family history of heart disease
- diabetes
- Hypertension (high blood pressure)
- High levels of low-density lipoprotein (LDL or “bad”) cholesterol
- Low levels of high-density lipoprotein (HDL or “good”) cholesterol
- obesity
- Smoking
- Sedentary lifestyle
- Older years
- Male sex
Chest pain is a serious symptom—if you have new or worsening chest pain, it’s important to see a doctor as soon as possible. Your doctor will ask about your medical history, perform a physical exam, learn about your symptoms, and rule out conditions such as a heart attack to rule out the need for emergency medical care.
Your doctor may order additional tests to find out the underlying cause of your chest pain. These exams may include:
- Electrocardiogram (ECG): It records the electrical activity of the heart
- Chest X-ray: Takes pictures of the chest to rule out lung-related causes
- Blood test: It checks for elevated protein levels in the heart, cholesterol levels and other signs of inflammation
- Echocardiogram: It uses sound waves to create images of the heart to see how well it is working
- Magnetic resonance imaging of the heart (MRI): Takes pictures of the heart to check the heart and its blood vessels for damage or disease
- Stress testing: Track your heart rate as you complete the exercises
- Computed tomography (CT) angiography: It relies on multiple x-rays to assess how well blood is flowing through the coronary arteries to detect signs of heart disease
- Coronary angiography: It monitors blood flow in the heart using contrast dye and a catheter to detect blockages and other potential causes of angina
If you are diagnosed with stable angina, the goals of treatment are to reduce pain, prevent future symptoms, and prevent complications such as heart attack and death. Rest alone is sometimes enough to relieve symptoms, but medications and medical procedures can help.
Medicines for symptoms
Health professionals prescribe several medications to relieve pain and lower blood pressure. This includes:
- Nitrostat (nitroglycerin)
- Beta-blockers, such as Lopressor (metoprolol) and Cardicor (bisoprolol)
- Calcium channel blockers such as Verelan (verapamil) or diltiazem (sold under brand names such as Cardizem and Diltzac)
Preventive medicines
Several medications prevent stable angina and reduce the risk of complications such as stroke or heart attack. Your doctor may prescribe one or more of the following options, depending on your symptoms:
- Aspirin
- Statins, such as Lipitor (atorvastatin) and Crestor (rosuvastatin)
- Angiotensin-converting enzyme (ACE) inhibitors, such as Lotensin (benazepril) and Zestril (lisinopril)
- Angiotensin receptor blockers (ARBs) such as Cozaar (losartan)
- Ranexa (ranolazine)
Procedures
In some cases, such as when the risk of complications is high or when medications are not controlling symptoms, healthcare providers may recommend a revascularization procedure (ie, restoring blood flow to blocked arteries).
Procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) can help with revascularization. CABG is surgery that uses healthy blood vessels from another part of the body to redirect blood flow. PCI involves the use of stents or cages to open up the affected blood vessels.
Lifestyle changes for heart health can help you prevent heart disease and reduce your risk of cardiovascular events such as heart attack. Consider these strategies:
- Avoid or quit smoking
- Eat a diet rich in fruits, vegetables and lean protein
- Manage obesity with proper diet and exercise
- Aim to get 150 minutes of moderate physical activity each week
- Sleep at least seven hours a night
- Limit alcohol use
- Manage stress with techniques such as yoga, meditation and spending time with loved ones
Episodes of stable angina usually resolve with rest or after taking Nitrostat (nitroglycerin). Without treatment or prolonged stress, the condition of your heart can worsen, increasing the risk of complications. Potential complications include:
- Unstable angina: A more serious form of chest pain that can occur even at rest and does not go away with medication or rest
- heart attack: A medical emergency that occurs when you have a blocked coronary artery
- Arrhythmia (irregular heartbeat): A restriction of blood flow to the heart, causing your heart to beat too fast, too slowly or irregularly
- Cardiac arrest: Sudden stopping of your heart, which can often be fatal
The prognosis (overall outlook) of stable angina depends on several factors, such as heart disease risk and general health.
Stable angina is a sign of heart disease and can increase the risk of a heart attack. Treatment and following a healthy lifestyle can help reduce symptoms, reduce the risk of cardiovascular events and help you live well.
It’s also important to stay in touch with your health care providers and let your loved ones know about your condition so they can help you hold yourself accountable for lifestyle changes. Having a heart condition can be scary, but knowing you have support can go a long way.