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Stable angina Causes and Risks:
Coronary artery disease is by far the most common cause of angina . Blockages in the coronary arteries, called plaques, prevent enough blood from reaching the heart muscle . Activities or situations that require increased blood flow to the heart may cause angina. These include exercise , heavy meals, and stress .
Less common causes of angina include coronary artery spasm (also called Prinzmetal's angina), diseases of the heart valves, heart failure , and abnormal heart rhythms .
The risk factors for angina include male sex, cigarette smoking , high cholesterol levels (in particular, high LDL cholesterol and low HDL cholesterol), high blood pressure , diabetes , a family history of coronary heart disease before age 55, a sedentary lifestyle, and being more than 30% over ideal body weight .
Angina affects approximately 3.1% of the population of the U.S.
Prevention:
The best prevention is to modify the risk factors that can be changed. Stop smoking , lose weight if you are overweight , and control blood pressure , diabetes , and cholesterol . Some studies have shown that modifying risk factors can prevent the progression of arterial blockages and can even lead to a decrease in the severity of blockages.
Aspirin, antianginal medications such as nitrates (nitroglycerin), beta-blockers, calcium channel blockers, or others may be prescribed to prevent the occurrence of angina and lessen its severity.
Symptoms:
- chest pain or pressure
- mid sternal (under the breastbone) or slightly to the left
- may radiate to shoulder, arm, jaw, neck, back or other areas
- tightness, squeezing, crushing, burning, choking , or aching
- may feel similar to "gas" or indigestion .
- usually not sharply localized
- precipitated by activity, stress , exertion
- usually short duration, 1 to 15 minutes
- usually relieved by rest and/or nitroglycerin
Signs and Tests:
Pain that is not relieved by 3 nitroglycerin tablets, 5 minutes apart, and that lasts longer than 15 minutes may represent a heart attack rather than angina .
An examination may show change in blood pressure . A transient heart murmur or arrhythmias (irregular heart beats) may occur.
ECG changes during exercise tolerance (treadmill) testing confirms the diagnosis of angina.
Heart scans or an angiography of the heart may be indicated in some circumstances.
Cardiac enzymes ( CPK isoenzymes ) may be run to make sure that no damage to the heart has occurred following a prolonged episode of chest pain .
Treatment:
The goals of treatment are the reduction of symptoms and prevention of complications.
Rest if angina occurs.
Sublingual nitroglycerin relieves the pain of nitroglycerin during an attack. Prophylactic (preventative) treatment with nitroglycerin, beta-blockers, calcium channel blockers, and aspirin (see salicylates - oral) may prevent angina . Medications may be given to control cholesterol , blood pressure , and abnormal heart rhythms .
Cardiac rehabilitation programs may be recommended to improve cardiovascular fitness.
Surgery may be recommended in certain situations. This includes CABG (coronary artery bypass grafting) or PTCA ( balloon angioplasty ).
Prognosis:
Angina symptoms are usually improved with treatment. The death rate varies and depends on many factors. Sudden death, acute MI ( heart attack ), or unstable angina may occur.
Complications:
Call Your Healthcare Provider:
Call your health care provider if chest pain which has not been evaluated develops; known angina changes in character, frequency, severity, or duration; or a known angina requires increasing doses of nitroglycerin or is not relieved within 15 minutes.
Picture:
P0036.pctArterial occlusive disease - toes
P0239.pctHeart, front view
This is an illustration of the exterior of the heart. The arteries are colored blue and represent blood that is flowing into the heart. The veins are red and indicate blood flow out from the heart. The chambers are also labeled.
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