Stable angina is pain, pressure, or a sense of heaviness in the chest beneath the breastbone. It is brought on by physical exertion and is relieved by rest. The discomfort or pain may also be felt in the left arm or shoulder, the neck, or the lower jaw. These are all areas of the body supplied by the same nerve that goes to the heart.
What is going on in the body?
Atherosclerosis, or hardening of the arteries, is a condition in which fatty deposits, also called plaque, form inside blood vessel walls. Atherosclerosis that involves the arteries supplying the heart is known as coronary artery disease. Plaque can block the flow of blood through the arteries. The tissues that normally receive blood from these arteries then begin to suffer damage from a lack of oxygen. When the heart does not have enough oxygen, it responds by causing the pain or discomfort known as angina.
What are the causes and risks of the condition?
Factors that increase the risk of stable angina include:
high blood pressure
high blood cholesterol
lack of exercise
Symptoms & Signs
What are the signs and symptoms of the condition?
Symptoms of stable angina include:
chest pain or discomfort that is brought on by exertion but goes away with rest
palpitations, or an unusual awareness of the heart beating in the chest
shortness of breath
Diagnosis & Tests
How is the condition diagnosed?
Stable angina is usually diagnosed by a history of chest discomfort that is caused by exertion but goes away with rest. A physical exam may reveal signs of hardening of the arteries. An electrocardiogram, or ECG, is a recording of the heart’s electrical activity. An ECG is usually normal when a person has no pain, and it shows certain changes when pain develops. An ECG done during exercise will show similar changes even before angina develops.
A cardiac catheterization, or coronary angiogram, is a procedure that is used to look for narrowed coronary arteries. A contrast agent is injected into an artery and X-rays are then taken. This procedure can be used to find narrowed blood vessels supplying the heart. Experts disagree about who should undergo a cardiac catheterization. It may be useful for:
a person who has severe angina that affects his or her ability to lead a normal life
a young, vigorous person who has a large amount of healthy heart at risk if he or she has a heart attack
someone whose diagnosis is not clear
Prevention & Expectations
What can be done to prevent the condition?
A person may reduce the risk for developing stable angina by:
lowering high blood pressure
controlling blood cholesterol
eating a diet designed to minimize heart disease
What are the long-term effects of the condition?
If untreated, atherosclerosis can lead to stable angina brought on by lower and lower levels of exertion. Unstable angina, a severe, progressive angina that medication cannot control, also can develop. Other long-term effects include congestive heart failure, heart attack, and arrhythmias, or irregular heartbeats.
What are the risks to others?
Stable angina is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
Several types of medications are often used in combination to reduce the symptoms of stable angina.
Beta-blockers, such as atenolol or metoprolol are used to decrease the work level of the heart, so that the same effort requires less oxygen.
Nitrates, such as nitroglycerin or isosorbide mononitrate, help to expand the small arteries and veins. This improves the blood flow to the heart.
Aspirin may prevent heart attacks. Warfarin may prevent blood clots. However, its use in treating stable angina remains controversial.
Calcium channel blockers, such as diltiazem, nifedipine, or verapamil, have been used for over 20 years to open the coronary arteries and lower high blood pressure. However, the findings of 2 recent studies have shown that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medications for coronary artery disease and high blood pressure. One study, for example, showed that the risk of heart attack was 27% greater and the risk of congestive heart failure was 26% higher for those taking a calcium channel blocker. The American Heart Association recommends discussing risks and benefits of the medication with the healthcare provider.
Several procedures can be used to reduce the symptoms of stable angina, including:
angioplasty, a procedure in which a tube with a balloon is inserted into the blocked artery and inflated. This reopens the artery and allows blood to flow.
placing a stent, a rigid tube similar to a tiny drinking straw, into the artery at the reopened area to keep it from narrowing again
laser surgery, which uses light waves to dissolve plaque
atherectomy, which involves removing plaque that causes narrowing of a blood vessel
What are the side effects of the treatments?
Beta-blockers can cause:
a slow heartbeat
low blood pressure
Calcium channel blockers can cause:
swelling of the ankles
low blood pressure
a higher risk of heart attack and congestive heart failure
Nitrates can cause headaches and low blood pressure. Aspirin and warfarin increase the risk of bleeding. Surgery can result in infection, bleeding, and allergic reaction to anesthesia.
What happens after treatment for the condition?
Most individuals with stable angina are encouraged to begin a regular exercise program. A person with stable angina should make every effort to reduce coronary risk factors. This may include smoking cessation, control of other diseases such as diabetes and high blood pressure, and following a healthy diet for heart disease prevention. Medications may need to be adjusted to achieve the best response.
How is the condition monitored?
The person will have periodic examinations and tests by the healthcare provider to discuss episodes of stable angina. Any new or worsening symptoms should be reported to the healthcare provider.