Everything To Know about Stable Angina

Stable angina (also known as angina pectoris) causes chest pain after physical activity or emotional distress. It's often an early sign of heart disease and occurs due to narrowed or blocked arteries in the heart.

Certain risk factors, like a family history of heart disease or a personal history of smoking, can increase your odds of developing this condition. If you have stable angina, lifestyle changes and medications are essential. Without treatment, this condition can progress and raise your risk of a heart attack.

Stable Angina Symptoms 

Stable angina symptoms are consistent and predictable. Symptoms are usually triggered by physical exertion or heightened stress. You can expect stable angina episodes to last up to 15 minutes. While symptoms mainly affect your chest, they can also spread to other parts of your body.

Pain

Stable angina pain typically starts gradually and rises in intensity before going away. A crushing, squeezing chest pain and tightness begins behind the breastbone or just to the left of it. This pain can spread, reaching the arm (typically the left), back, jaw, or shoulder. The pain usually subsides with rest or medication. 

Different people can experience the pain differently. Some people may have discomfort in only the shoulder or neck.

Additional Symptoms 

Less commonly, stable angina can have a broader effect on the body. Additional signs of this condition may include:

• Feeling tired or sleepy
• Shortness of breath
• Muscle weakness
• Dizziness
• Nausea or vomiting
• Sweating
• Heart palpitations

Causes

Stable angina occurs when your heart muscles don't receive enough oxygen from the blood, usually due to a narrowed or blocked coronary artery (blood vessels in the heart). Insufficient oxygen triggers 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, leading 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 blood and oxygen flow to the heart muscles.

Other conditions, including heart failure, heart valve problems, anemia, and fast heart rate, can also cause chest pain and increase your 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. These include:

• Family history of heart disease
• Diabetes
• Hypertension (high blood pressure)
• High low-density lipoprotein (LDL or "bad") cholesterol levels
• Low high-density lipoprotein (HDL or "good") cholesterol levels
• Obesity
• Smoking
• Sedentary lifestyle
• Older age
• Male sex

Diagnosis

Chest pain is a serious symptom—if you're experiencing new or worsening chest pain, it's important to see a healthcare provider as soon as possible. Your provider will ask about your medical history, perform a physical exam, learn more about your symptoms, and screen for conditions like a heart attack to rule out the need for emergency medical attention.

Your provider can order additional tests to learn the underlying cause of your chest pain. These exams may include:

• Electrocardiogram (EKG): Records the heart's electrical activity
• Chest X-ray: Creates images of the chest to rule out lung-related causes
• Blood test: Checks for elevated protein levels in the heart, cholesterol levels, and other signs of inflammation
  
• Echocardiogram: Uses soundwaves to create images of the heart to see how well it is working
• Cardiac magnetic resonance imaging (MRI): Produces images of the heart to check the heart and its blood vessels for damage or disease
• Stress testing: Track your heart activity while you complete exercises
• Computed tomography (CT) angiography: Relies on multiple X-rays to assess how well blood flows through coronary arteries to detect signs of heart disease
• Coronary angiography: Monitors blood flow in the heart with the help of contrast dye and a catheter to detect blockages and other potential causes of angina

Stable Angina Treatment

If you receive a diagnosis of stable angina, the goals of treatment are to reduce pain, prevent symptoms in the future, and prevent complications like heart attack and death. Rest alone is sometimes enough to relieve symptoms, but medications and medical procedures can help.

Medications for Symptoms

Healthcare providers prescribe several medications to ease the pain and lower blood pressure. These include:

• Nitrostat (nitroglycerin)
• Beta-blockers, such as Lopressor (metoprolol) and Cardicor (bisoprolol)
• Calcium-channel blockers like Verelan (verapamil) or diltiazem (sold under brand names like Cardizem and Diltzac)

Preventive Medications

Several medications prevent stable angina and lower your risk of complications such as stroke or heart attack. Your provider 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) like Cozaar (losartan)
• Ranexa (ranolazine)

Procedures

In some cases, such as when the risk of complications is high or when medication does not control symptoms, healthcare providers may recommend a procedure for revascularization (i.e., restoring blood flow to blocked arteries).

Procedures like coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) can help with revascularization. CABG is a surgery that uses healthy blood vessels from another part of the body to reroute blood flow. PCI involves using stents or cages to open up the affected blood vessels.

Prevention

Heart-healthy lifestyle changes can help you prevent heart conditions and lower your risk of cardiovascular events like a heart attack. Consider these strategies:

• Avoid or quit smoking
• Eat a diet rich in fruits, vegetables, and lean proteins
• Manage obesity with proper eating and exercise
• Aim to get 150 minutes of moderate physical activity each week
• Sleep at least seven hours per night
• Limit alcohol use
• Manage stress through techniques such as yoga, meditation, and spending time with loved ones

Complications

Stable angina episodes typically resolve with rest or after taking Nitrostat (nitroglycerin). Without treatment or prolonged stress, your heart condition can worsen, increasing the risk of complications. Potential complications include:

• Unstable angina: A more severe form of chest pain that can occur even at rest and doesn't go away with medication or rest
• Heart attack: A medical emergency that occurs when you have a blocked coronary artery
• Arrhythmia (irregular heartbeat): Restriction of blood to the heart, causing your heart to beat too fast, too slow, or irregularly
• Cardiac arrest: The sudden stopping of your heart, which can often be fatal 

Living With Stable Angina

The prognosis (overall outlook) of stable angina depends on several factors, like your risk of heart disease and overall health status.

Stable angina is a sign of heart disease and can increase your heart attack risk. Getting treatment and following a heart-healthy lifestyle can help reduce your symptoms, lower your risk of cardiovascular events, and help you live well.

It's also important to stay in contact with your healthcare provider and tell your loved ones about your condition so they can help hold you accountable for lifestyle changes. Having a heart condition can be scary, but knowing that you have support can go a long way.