Stable angina
Angina - stable; Angina - chronic; Angina pectoris; Chest pain - angina; CAD - angina; Coronary artery disease - angina; Heart disease - anginaStable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blood vessels in the heart called the coronary arteries.
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Read Article Now Book Mark ArticleCauses
Your heart muscle needs a constant supply of oxygen. The coronary arteries carry oxygen-rich blood to the heart.
When the heart muscle has to work harder, it needs more oxygen. Symptoms of angina may occur when blood supply to the heart muscle is reduced. This happens when the coronary arteries are narrowed or blocked by atherosclerosis or by a blood clot.
Atherosclerosis
Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...
Read Article Now Book Mark ArticleThe most common cause of angina is coronary artery disease. Angina pectoris is the medical term for this type of chest pain.
Coronary artery disease
Coronary heart disease is a narrowing of the blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called co...
Read Article Now Book Mark ArticleStable angina is less serious than unstable angina, but it can be very painful or uncomfortable.
There are many risk factors for coronary artery disease. Some include:
Coronary artery disease
Coronary heart disease (CHD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disea...
Read Article Now Book Mark Article- Diabetes
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark Article - Family history of early coronary heart disease (a close relative such as a sibling or parent had heart disease before age 55 in a man or before age 65 in a woman)
- High blood pressure
High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
Read Article Now Book Mark Article - High LDL cholesterol
- Low HDL cholesterol
- Obesity
- Sedentary lifestyle
- Smoking
- Advancing age
- Male sex
Anything that makes the heart muscle need more oxygen or reduces the amount of oxygen it receives can cause an angina attack in someone with heart disease, including:
- Cold weather
- Exercise
- Emotional stress
- Large meals
Other causes of angina include:
- Abnormal heart rhythms (your heart beats very quickly or your heart rhythm is not regular)
Abnormal heart rhythms
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
Read Article Now Book Mark Article - Anemia
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark Article - Coronary artery spasm (also called Prinzmetal angina)
Coronary artery spasm
The coronary arteries supply blood and oxygen to the heart. Coronary artery spasm is a brief, sudden narrowing of one of these arteries.
Read Article Now Book Mark Article - Heart failure
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark Article - Heart valve disease
- Hyperthyroidism (overactive thyroid)
Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
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Symptoms
Symptoms of stable angina are most often predictable. This means that the same amount of exercise or activity may cause your angina to occur. Your angina should improve or go away when you stop or slow down the exercise.
The most common symptom is chest pain that occurs behind the breastbone or slightly to the left of it. The pain of stable angina most often begins slowly and gets worse over the next few minutes before going away.
Typically, the chest pain feels like tightness, heavy pressure, squeezing, or a crushing feeling. It may spread to the:
- Arm (most often the left)
- Back
- Jaw
- Neck
- Shoulder
Some people say the pain feels like gas or indigestion.
Indigestion
Indigestion (dyspepsia) is a mild discomfort in the upper belly or abdomen. It often occurs during or right after eating. It may feel like:Heat, bu...
Read Article Now Book Mark ArticleLess common symptoms of angina may include:
- Fatigue
- Shortness of breath
- Weakness
- Dizziness or lightheadedness
- Nausea, vomiting, and sweating
- Palpitations
Palpitations
Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck. You may:Have an unpl...
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Pain from stable angina:
- Most often comes on with activity or stress
- Lasts an average of 1 to 15 minutes
- Is relieved with rest or a medicine called nitroglycerin
Angina attacks can occur at any time during the day. Often, they occur between 6 a.m. and noon.
Exams and Tests
Your health care provider will examine you and check your blood pressure. Tests that may be done include:
- Coronary angiography
Coronary angiography
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart....
Read Article Now Book Mark Article - Blood cholesterol profile
- Electrocardiogram (ECG)
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark Article - Exercise tolerance test (stress test or treadmill test)
- Nuclear medicine (thallium) stress test
Stress test
Nuclear stress test is an imaging method that uses radioactive material to show how well blood flows into the heart muscle, both at rest and during a...
Read Article Now Book Mark Article - Stress echocardiogram
- Heart CT scan
Heart CT scan
A computed tomography (CT) scan of the heart is an imaging method that uses x-rays to create detailed pictures of the heart and its blood vessels. Th...
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Treatment
Treatment for angina may include:
- Lifestyle changes
- Medicines
- Procedures such as coronary angiography with stent placement
- Coronary artery bypass surgery
If you have angina, you and your provider will develop a treatment plan. This plan should include:
Develop a treatment plan
Coronary heart disease (CHD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. Angina is chest pain or discomfort that ...
Read Article Now Book Mark Article- Medicines you regularly take to prevent angina
- Activities that you can do and those you should avoid
- Medicines you should take when you have angina pain
- Signs that mean your angina is getting worse
Your angina is getting worse
Angina is a type of chest discomfort due to poor blood flow through the blood vessels of the heart muscle. This article discusses how to care for yo...
Read Article Now Book Mark Article - When you should call your provider or get emergency medical help
MEDICINES
You may need to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent your angina from getting worse.
Nitroglycerin pills or spray may be used to stop chest pain.
Anti-clotting medicines such as aspirin and clopidogrel (Plavix), ticagrelor (Brilinta) or prasugrel (Effient) can help prevent blood clots from forming in your arteries and reduce the risk of heart attack. Ask your provider if you should be taking these medicines.
You may need to take more medicines to help prevent you from having angina. These include:
- ACE inhibitors to lower blood pressure and protect your heart
ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are medicines. They treat heart, blood vessel, and kidney problems.
Read Article Now Book Mark Article - Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
- Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart
- Nitrates to help prevent angina
- Ranolazine (Ranexa) to treat chronic angina
NEVER STOP TAKING ANY OF THESE MEDICINES ON YOUR OWN. Always talk to your provider first. Stopping these medicines suddenly can make your angina worse or cause a heart attack. This is especially true for anti-clotting medicines (aspirin, clopidogrel, ticagrelor and prasugrel).
Your provider may recommend a cardiac rehabilitation program to help improve your heart's fitness.
SURGICAL TREATMENT
Some people will be able to control angina with medicines and not need surgery. Others will need a procedure called angioplasty and stent placement (also called percutaneous coronary intervention) to open blocked or narrowed arteries that supply blood to the heart.
Angioplasty and stent placement
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...
Read Article Now Book Mark ArticleBlockages that cannot be treated with angioplasty may need heart bypass surgery to redirect blood flow around the narrowed or blocked blood vessels.
Heart bypass surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.
Read Article Now Book Mark ArticleOutlook (Prognosis)
Stable angina most often improves when taking medicines.
When to Contact a Medical Professional
Get medical help right away if you have new, unexplained chest pain or pressure. If you have had angina before, contact your provider.
Call 911 or the local emergency number if your angina pain:
- Is not better 5 minutes after you take nitroglycerin
- Does not go away after 3 doses of nitroglycerin
- Is getting worse
- Returns after the nitroglycerin helped at first
Contact your provider if:
- You are having angina symptoms more often
- You are having angina when you are sitting (rest angina)
- You are feeling tired more often
- You are feeling faint or lightheaded
- Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady (regular)
- You are having trouble taking your heart medicines
- You have any other unusual symptoms
Get medical help right away if a person with angina loses consciousness (passes out).
Prevention
Some studies have shown that making a few lifestyle changes can prevent blockages from getting worse and may actually improve them. Lifestyle changes can also help prevent some angina attacks. Your provider may tell you to:
- Lose weight if you are overweight
- Stop smoking
- Exercise regularly
- Drink alcohol in moderation only
- Eat a healthy diet that is high in vegetables, fruits, whole grains, fish, and lean meats
Your provider will also recommend that you keep other health conditions such as high blood pressure, diabetes, and high cholesterol levels under control.
If you have one or more risk factors for heart disease, talk to your provider about taking aspirin or other medicines to help prevent a heart attack. Aspirin therapy (75 to 325 mg a day) or medicines such as clopidogrel, ticagrelor or prasugrel may help prevent heart attacks in some people. Aspirin and other blood-thinning therapies are recommended if the benefit is likely to outweigh the risk of side effects.
References
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.
Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 56.
Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.
Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation. 2023;148(9):e9–e119. PMID: 37471501 pubmed.ncbi.nlm.nih.gov/37471501/.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19)2199-2269. PMID: 29146533 pubmed.ncbi.nlm.nih.gov/29146533/.
Writing Committee Members, Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;78(22):e187-e285. PMID: 34756653 pubmed.ncbi.nlm.nih.gov/34756653/.
Chest pain
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Angina causes and symptoms
Animation
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Stable angina - illustration
Angina is a specific type of pain in the chest caused by inadequate blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).
Stable angina
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Stable angina - illustration
Angina is a specific type of pain in the chest caused by inadequate blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).
Stable angina
illustration
Review Date: 1/1/2023
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 02/19/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.