What is Stable Angina?
Stable angina, also known simply as angina, is a symptom that signals a lack of blood supply to the heart (known as myocardial ischemia). It usually causes chest discomfort or similar feelings which get worse with physical activity and improve when at rest or after taking medication like nitroglycerin. Often, this is an early warning sign of underlying heart disease. In the United States, angina affects 10 million people, making it especially important to know how to recognize its signs, understand the risks, and manage the situation accordingly.
What Causes Stable Angina?
Stable angina is fundamentally caused when the heart’s need for oxygen is more than what it’s getting. This match between demand and supply often results in discomfort. There are multiple factors behind stable angina, but narrowed coronary arteries are the most common cause. This is explained in more detail below.
Risk Factors and Frequency for Stable Angina
Coronary heart disease impacts more than 17 million adults in the United States, with men making up 55% of these cases. It’s responsible for over half a million deaths each year in the country. Both men and women at the age of 40 face a significant lifetime risk of developing this disease, estimated at 49% for men and 32% for women. The likelihood of heart-related incidents increases with age and affects both genders, even though men are generally more susceptible. It’s worth noting that coronary heart disease isn’t just an issue in the US; it’s actually the leading cause of death in adults across all socio-economic backgrounds globally.
Coronary heart disease can also seriously affect your quality of life. For example, it can cause angina, a condition that’s already affecting over 10 million people in the US, with an additional 500,000 new cases popping up each year.
Signs and Symptoms of Stable Angina
Stable angina is a condition where people tend to experience chest pain or discomfort. Regular check-ups are important to catch early symptoms. Doctors often screen patients for several factors including blood pressure, weight, sleep patterns, stress levels, endurance during physical activities, and consumption habits of alcohol, tobacco, and illicit drugs.
People with this condition often describe their pain as discomfort in the chest, or similar feelings caused by intense physical activity, but it usually goes away when they rest or use nitroglycerin. These symptoms can also present as breathlessness, nausea, or extreme tiredness for the level of activity they’re doing.
To differentiate between chest discomfort caused by heart-related issues and other causes, the doctor might go into detail about your symptoms. They might ask about the type of pain you’re feeling, where it’s located, what may influence it, and how long it lasts.
Angina pain is usually described as feeling like pressure, heavy, tight, or squeezing. It typically covers a wider area of the chest instead of a single spot. Depending on the affected area, the pain might also spread to other areas. Symptoms usually get worse with increased physical demand like walking, lifting heavy items, or emotional stress, and last between 2 to 5 minutes. Stopping the activity causing the pain or taking nitroglycerin generally helps relieve the pain. Atypical physical examination findings are not to be taken as indicative of this condition due to lack of specific symptoms.
Testing for Stable Angina
If your doctor suspects you have stable angina, which is a type of chest pain often linked to heart disease, there are several tests they might perform:
- They might do an electrocardiogram (a test that measures the electrical activity of your heartbeat) to check for signs of active heart strain or past heart damage.
- Your doctor could also take a chest x-ray to help rule out other issues that could be causing your chest pain, particularly things not related to the heart like infections, physical injuries, or a collapsed lung (known as a pneumothorax).
- Blood tests are another important part of the evaluation. These could include a complete blood count (which looks at the cells in your blood), a comprehensive metabolic panel (which checks your body’s chemical balance and metabolism), a lipid panel (to check your cholesterol), and a troponin test (which can detect heart damage). These tests can help rule out other non-heart-related issues, like anemia (a low red blood cell count), infections, or kidney diseases. They can also help figure out how severe your angina might be.
- Based on the results of these tests, your doctor will consider how severe your risk may be. For individuals who may be at moderate to high risk, they may consider stress testing (tests that check how your heart works during physical activity) or proceed with a more detailed examination of your heart’s blood vessels.
Remember, these tests are all designed to give your doctor the most complete picture of your health and to ensure that you are getting the best possible treatment. Angina may seem scary, but with the right diagnosis and treatment, it can be managed effectively.
Treatment Options for Stable Angina
Treatment for stable angina, a type of chest pain, aims to reduce risk factors that can lead to heart disease. A combined approach involving different health professionals can be helpful, particularly for people dealing with multiple health conditions. This could include specialists in nutrition, diabetes, addiction counselling, and physical and occupational therapy.
The first step in treating stable angina often involves changes to lifestyle. These might include:
Quitting tobacco: Stopping smoking is the most effective way to reduce the risk of heart disease. In fact, smokers are roughly two times more likely to die from heart disease than non-smokers. However, studies show that once a person stops smoking, their risk of dying from heart disease becomes about the same as someone who has never smoked.
Lowering cholesterol levels: Following the Mediterranean diet, which is high in fruits and vegetables, can help to reduce your cholesterol levels and, in turn, decrease the risk of heart disease.
Controlling blood pressure: The American Heart Association/American College of Cardiology guidelines state that a blood pressure reading of above 130/80 mmHg is considered high. The goal is to keep blood pressure below these levels, as rising blood pressure can significantly increase the risk of heart disease and strokes.
Managing diabetes: Weight loss, increased physical activity, and the proper management of related health conditions can aid in controlling diabetes.
Losing weight: Being overweight is one of the leading preventable causes of early death. A weight loss plan should be designed according to each individual’s needs, involving lifestyle changes and potentially surgical options.
Regular physical activity: Engaging in moderate-intensity exercise for an average of 150 minutes per week, or 75 minutes of high-intensity exercise per week, can help lower overall risk factors for heart disease.
Medications can also play a role in managing stable angina. Commonly used drugs include:
Aspirin: Aspirin may be beneficial in individuals at low-risk for heart disease, as it can reduce the risk of nonfatal heart attacks. However, this should be decided on a case-by-case basis, given the risk of major bleeding associated with aspirin use.
Statin therapy: Statins have been found to reduce the occurrence of heart attack, stroke, and death due to the cardiovascular disease in individuals, regardless of their risk level for coronary disease.
ACE inhibitors and angiotensin receptor blockers (ARBs): These medications can be useful in controlling blood pressure, and are especially recommended for high-risk individuals or people with known cardiovascular disease.
There are also certain medications for managing angina symptoms:
Beta-blockers: These drugs can lower heart rate, blood pressure and how hard the heart has to work, which can help in reducing angina symptoms.
Nitrates: Nitrates can help to reduce angina symptoms by relaxing blood vessels, which decreases the pressure and workload on the heart.
Ranolazine: This medication, which is FDA-approved for stable angina, helps control symptoms, although its exact method of action is not fully understood.
What else can Stable Angina be?
When dealing with heart conditions like stable angina, it’s necessary to consider a variety of potential causes. These causes fall under different categories such as cardiovascular, gastrointestinal, pulmonary and musculoskeletal. Here are some of the conditions that could potentially explain the symptoms, and a brief description of each:
Cardiovascular:
- Acute coronary syndrome:
- Unstable angina: symptoms don’t always follow a set pattern and chest pain may even occur at rest
- NSTEMI: heart-related proteins are high in the blood and there could be changes on an EKG heart tracing
- STEMI: similar to NSTEMI but with certain changes in the heart tracing EKG
- Myocarditis: high levels of heart-related proteins in the blood and changes in EKG.
- Pericarditis: the EKG shows certain heart tracing changes and chest pain which typically eases when leaning forwards.
Gastrointestinal:
- Esophageal spasm: symptoms likely to occur around meal times and there may be difficulty swallowing
- Gastroesophageal reflux disease (GERD): symptoms also likely to appear around meal times
Pulmonary:
- Asthma: unusual lung noises during a physical investigation. Symptoms expected to improve with lung care and inhaled medications.
- Chronic obstructive pulmonary disease (COPD): similar to asthma.
- Pulmonary embolus: chest pain felt more acutely when inhaling and possibly fast heart rate or low oxygen levels.
Musculoskeletal:
- Costochondritis: chest pain which can be caused by recent heavy lifting or exercise.
- Trauma: history of injury, x-rays may reveal fractures.
What to expect with Stable Angina
The outlook for stable angina can differ based on its cause. No matter the cause, it’s important to vigorously manage risk factors. For those with stable angina, regular check-ups should be carried out to watch for increasing symptoms or any signs that the condition is moving towards becoming unstable angina.
Possible Complications When Diagnosed with Stable Angina
The main concern with stable angina is that it could lead to a severe heart condition called acute coronary syndrome. To lessen this risk, doctors should use methods to control and reduce the patient’s risk factors. Regular check-ups are necessary, and health care providers must pay close attention to the patient’s status.
Main Concerns:
- Progression to acute coronary syndrome
- Risk factor control and medical optimization
- Need for regular monitoring
- Close attention from health care providers
Preventing Stable Angina
Heart disease is a top reason for fatalities in the United States. It’s crucial for everyone to learn about the warning signs of a heart attack, along with unstable and stable chest pain, formally known as unstable angina and stable angina. It’s also important to be aware of preventative steps to reduce the risk of heart disease, such as altering risk factors and making healthy lifestyle changes.
