Chronic stable angina (patient information)

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 * Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S; Varun Kumar, M.B.B.S

Overview
Angina is a type of chest pain or discomfort that occurs as a consequence of inadequate blood supply to meet the oxygen requirements of the heart. The chest discomfort is brought on by exertion and is relieved by rest and/or oral medications. It is termed stable as the chest discomfort occurs with similar characteristics following similar activities or exercise. Stable angina is a warning sign of heart disease and should be evaluated by a doctor.

What are the symptoms of angina?
It's important to know the symptoms of a angina and seek medical help. The most common presentation include:
 * Chest discomfort:
 * Precipitating factors commonly is caused by exertion. Other precipitating factors include emotional stress, large meal, cold weather. It is often described as a sense of heaviness, squeezing, pressure, or band like tightness.
 * Most anginal discomfort is located in the center of the chest behind the breast bone and lasts between 1-15 minutes.
 * Pain is relieved with rest or or a medicine called nitroglycerin.
 * The pain may also spread to left arm, shoulder, back, neck and jaw.


 * Shortness of breath: You may often feel tired and be short of breath
 * Sweaty
 * Lightheaded
 * Unexplained tiredness after activity
 * You may also have indigestion or be sick to your stomach
 * Heart beating very fast or palpitations

What causes angina?
Angina is a symptom of underlying coronary artery disease that is characterized by a fatty material called plaque that builds up over many years on the inner walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). This limits the blood supply to the heart(as shown in the video below). Specially when the muscles of the heart have to work harder during exercise or stress.

Who is at highest risk?

 * Certain risk factors make it more likely that you will develop coronary artery disease (CAD) and subsequently present with anginal pain.


 * Major risk factors for stable angina that you can control include:
 * Smoking
 * High blood pressure
 * High blood cholesterol
 * Overweight and obesity
 * Physical inactivity
 * Diabetes (high blood sugar)


 * Risk factors that you can't change include:
 * Age
 * Family history of early coronary artery disease.


 * Certain CAD risk factors tend to occur together. When they do, it’s called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

When to seek urgent medical care?

 * You should seek medical care if you are experiencing:
 * New, unexplained chest pain or pressure chest, upper body discomfort in one or both arms, the back, neck, jaw, or stomach
 * Shortness of breath
 * Nausea, vomiting
 * Lightheadedness or fainting
 * Breaking out in a cold sweat


 * If the symptoms mentioned above persists for more than 15 minutes even after resting or three doses of nitroglycerin or is worsening, call 911 immediately as these symptoms could be the signs of a heart attack (also called myocardial infarction or MI) and immediate treatment is essential.

Diagnosis

 * Some health problems may cause the similar symptoms with angina. So people with any of those symptoms should go to see the doctor to be diagnosed and treated as early as possible.


 * Your doctor will perform a physical exam and measure your blood pressure and may suggest following tests to diagnose or rule out angina:
 * Electrocardiogram(ECG): This is the most important and painless procedure in which a healthcare professional will measure the electrical activity of your heart to find whether there are any heart abnormalities or irregular heart beats.
 * Blood tests: Blood tests such as lipid levels, glucose levels to test for risk factors and CK-MB Test, troponins test can be done by your doctor to determine whether or not your heart is damaged.
 * Echocardiogram: This is a painless test to identify whether some areas of your heart are not contracting normally.
 * Stress testing: The test is done when you are exercising. This makes it easier for doctors to diagnosis heart disease.
 * Coronary angiography: This is an imaging test that involves the injection of a special dye into your coronary arteries so that visible images can be seen on x rays to show the inside of your coronary arteries and to determine whether or not there is any obstruction of blood flow.

Treatment options

 * Angina can be treated by combining lifestyle modifications, medications and invasive procedures (coronary angioplasty, stent placement or coronary artery bypass surgery).


 * You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol to prevent angina.
 * ACE inhibitors to lower blood pressure and protect your heart
 * 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 to treat chronic angina
 * Aspirin and clopidogrel or prasugrel helps prevent blood clots from forming in your arteries, and reduces your risk of having a heart attack.


 * Nitroglycerin pills or spray may be used to stop chest pain.


 * Follow your doctor's directions closely to help prevent your angina from getting worse. NEVER ABRUPTLY STOP TAKING ANY OF THESE DRUGS. Always talk to your doctor first. Stopping these drugs suddenly can make your angina worse or cause a heart attack. Your doctor may also recommend a cardiac rehabilitation program to help improve your heart's fitness


 * Some patients may need surgery to improve blood flow through the coronary arteries.
 * Angioplasty with stent placement is a procedure where a catheter is passed into the coronary artery of the heart through the arteries in leg or arm. This procedure is done to keep open a coronary artery that has become too narrow.
 * Not every blockage can be treated with angioplasty. Some people need coronary bypass (heart surgery). Whether this procedure can be done depends on which of the coronary arteries are narrowed and how severely they are narrowed.

Where to find medical care for Chronic stable angina?
Directions to Hospitals Treating Chronic stable angina

What to expect (Outlook/Prognosis)?
Stable angina usually improves with lifestyle modifications and medication.

Possible complications

 * Heart attack
 * Sudden death caused by abnormal heart rhythms (arrhythmias)
 * Unstable angina

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 way to prevent angina is to lower your risk for coronary heart disease:
 * Avoid or reduce stress as much as you can.
 * Control your blood pressure, diabetes, and cholesterol.
 * Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables.
 * Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. However, talk to your doctor before beginning or increasing your activity or exercise level.
 * Lose weight if you are overweight.
 * Stop smoking


 * Moderate amounts of alcohol (one glass a day for women, two for men) may reduce your risk of heart problems. However, drinking larger amounts does more harm than good.


 * Reducing your heart disease risk factors may prevent the blockages from getting worse and can make them less severe, which reduces angina pain.


 * New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease. The use of hormone replacement therapy in women who are close to menopause or who have finished menopause is controversial at this time.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/000198.htm