Stable Angina

Stable angina is pain, pressure, or a sense of heaviness in the chest beneath the breastbone. It is brought on by physical exertion and is relieved by rest. The discomfort or pain may also be felt in the left arm or shoulder, the neck, or the lower jaw. These are all areas of the body supplied by the same nerve that goes to the heart.

What is going on in the body?

Atherosclerosis, or hardening of the arteries, is a condition in which fatty deposits, also called plaque, form inside blood vessel walls. Atherosclerosis that involves the arteries supplying the heart is known as coronary artery disease. Plaque can block the flow of blood through the arteries. The tissues that normally receive blood from these arteries then begin to suffer damage from a lack of oxygen. When the heart does not have enough oxygen, it responds by causing the pain or discomfort known as angina.

What are the causes and risks of the condition?

Factors that increase the risk of stable angina include:

What are the signs and symptoms of the condition?

Symptoms of stable angina include:

How is the condition diagnosed?

Stable angina is usually diagnosed by a history of chest discomfort that is caused by exertion but goes away with rest. A physical exam may reveal signs of hardening of the arteries. An electrocardiogram, or ECG, is a recording of the heart's electrical activity. An ECG is usually normal when a person has no pain, and it shows certain changes when pain develops. An ECG done during exercise will show similar changes even before angina develops.

A cardiac catheterization, or coronary angiogram, is a procedure that is used to look for narrowed coronary arteries. A contrast agent is injected into an artery and X-rays are then taken. This procedure can be used to find narrowed blood vessels supplying the heart. Experts disagree about who should undergo a cardiac catheterization. It may be useful for:

What can be done to prevent the condition?

A person may reduce the risk for developing stable angina by:

What are the long-term effects of the condition?

If untreated, atherosclerosis can lead to stable angina brought on by lower and lower levels of exertion. Unstable angina, a severe, progressive angina that medication cannot control, also can develop. Other long-term effects include congestive heart failure, heart attack, and arrhythmias, or irregular heartbeats.

What are the risks to others?

Stable angina is not contagious and poses no risk to others.

What are the treatments for the condition?

Several types of medications are often used in combination to reduce the symptoms of stable angina.

Calcium channel blockers, such as diltiazem, nifedipine, or verapamil, have been used for over 20 years to open the coronary arteries and lower high blood pressure. However, the findings of 2 recent studies have shown that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medications for coronary artery disease and high blood pressure. One study, for example, showed that the risk of heart attack was 27% greater and the risk of congestive heart failure was 26% higher for those taking a calcium channel blocker. The American Heart Association recommends discussing risks and benefits of the medication with the healthcare provider.

Several procedures can be used to reduce the symptoms of stable angina, including:

What are the side effects of the treatments?

Beta-blockers can cause:

Calcium channel blockers can cause:

Nitrates can cause headaches and low blood pressure. Aspirin and warfarin increase the risk of bleeding. Surgery can result in infection, bleeding, and allergic reaction to anesthesia.

What happens after treatment for the condition?

Most individuals with stable angina are encouraged to begin a regular exercise program. A person with stable angina should make every effort to reduce coronary risk factors. This may include smoking cessation, control of other diseases such as diabetes and high blood pressure, and following a healthy diet for heart disease prevention. Medications may need to be adjusted to achieve the best response.

How is the condition monitored?

The person will have periodic examinations and tests by the healthcare provider to discuss episodes of stable angina. Any new or worsening symptoms should be reported to the healthcare provider.

Author:William M. Boggs, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:11/29/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/05/01