Angina - chronic
    
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Angina - chronic

Definition

Stable angina is chest pain or discomfort that typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes before going away. It quickly goes away with medication or rest, but may happen again with additional activity or stress.

Stable angina is also called chronic angina.

See also: Unstable angina

Alternative Names

Angina - stable; Angina - chronic; Angina pectoris

Causes

Angina is caused by too little blood flow to the heart. The most common cause of angina is coronary heart disease (CHD). Angina pectoris is the medical term for this type of chest pain.

Situations that increase blood flow to the heart may cause angina in people with CHD. These include exercise, heavy meals, and stress.

The risk factors for angina include:

  • Being male
  • Diabetes
  • Family history of coronary heart disease before age 50
  • High blood pressure
  • High LDL cholesterol and low HDL cholesterol
  • Not getting enough exercise
  • Obesity
  • Smoking

Less common causes of angina include:

Symptoms

The most common symptom is chest pain that occurs behind the breastbone or slightly to the left. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to shoulder, arm, jaw, neck, back, or other areas.

Some people say the pain feels like gas or indigestion.

The pain:

  • Occurs after activity, stress, or exertion
  • Lasts 1 to 15 minutes
  • Is usually relieved with rest or a medicine called nitroglycerin

Exams and Tests

Your health care provider will perform a physical exam and measure your blood pressure. The following tests may be done to diagnose or rule out angina:

  • Coronary angiography
  • ECG
  • Exercise tolerance test (stress test or treadmill test)
  • Stress echocardiogram

Treatment

Treatment involves rest and medicine.

Medicines used to treat angina include:

  • Nitroglycerin
  • Blood thinners, including aspirin and clopidogrel (Plavix)
  • Cholesterol-lowering drugs
  • Blood pressure medicines, including calcium channel blockers, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors

Ranolazine (Ranexa) is a relatively new medicine approved for the treatment of chronic angina. The drug is for patients who do not respond to traditional angina treatment. It should be used in combination with other medication. Your doctor will tell you which ones.

Your doctor may recommend a cardiac rehabilitation program to help improve your heart's fitness.

Some patients may need surgery such as:

  • Angioplasty
  • Coronary artery bypass grafting (CABG)

Recent studies show that angioplasty with stenting does not help you live longer than medicine alone, but it can reduce angina or other symptoms of coronary artery disease.

Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.

Outlook (Prognosis)

Stable angina usually improves with medication.

Possible Complications

  • Unstable angina
  • Heart attack
  • Sudden death caused by lethal arrhythmias

When to Contact a Medical Professional

You should seek medical attention if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.

Immediately go to the hospital if chest pain or heaviness lasts longer than 15 minutes or is not relieved with medication prescribed by your doctor. The pain may represent unstable angina or a heart attack.

Call your health care provider if:

  • You have chest pain and have never seen a doctor for it
  • Your need to take more and more nitroglycerin to make your angina go away
  • Angina episodes happen more often, last longer than usual, or feel different than before
  • You have shortness of breath

Seek immediate medical help if a person with angina loses alertness (consciousness).

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.

The best prevention for angina is to lower your risk for coronary heart disease. 

  • Stop smoking
  • Lose weight if you are overweight
  • Control blood pressure, diabetes, and cholesterol

Reducing risk factors may prevent the blockages from getting worse and can reduce their severity, which reduces angina pain.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].

Gibbons RJ, Abrams J, Chatterjee K, et al.: ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003; 41(1): 159-68.

U.S. Food and Drug Administration. FDA Approves New Treatment for Chest Pain. Rockville, MD: National Press Office; January 31, 2006. Press Release P06-15.

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo; WB Saunders; 2005: 1281-1308.

Mehta SB. Management of coronary heart disease: stable angina, acute coronary syndrome, myocardial infarction. Prim Care. 2005; 32(4): 1057-81.

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