Stable
Angina (Angina pectoris) is the medical term for chest pain or
discomfort due to coronary heart disease.
It occurs when the heart muscle doesn't get as much blood as it needs.
This usually happens because one or more of the heart's arteries is narrowed or
blocked, also called ischemia.
“Stable angina is
chest pain or discomfort that most often occurs with activity or stress. Angina
is due to poor blood flow through the blood vessels in the heart,”-MedlinePlus.
Etiology
Major Risk factors
ü
Age (≥ 45 years for men, ≥ 55 for women)
ü
Cigarette smoking
ü
Diabetes mellitus (DM)
ü
Dyslipidemia
ü
Family history of premature cardiovascular
disease (men <55 years, female <65 years old)
ü
Hypertension (HTN)
ü
Kidney disease (microalbuminuria or GFR<60
mL/min)
ü
Obesity (BMI ≥ 30 kg/m2)
ü
Physical inactivity
Conditions that exacerbate or provoke
angina
ü
Medications
ü
Vasodilatorsü
Excessive thyroid replacement
ü
Vasoconstrictors
ü
Polycythemia which thickens the blood causing it
to slow its flow through the heart muscle
ü
Hypothermia
ü
Hypovolaemia
ü
Hypervolaemia
Other medical problems
ü
Profound anemia
ü
Uncontrolled HTN
ü
Hyperthyroidism
ü
Hypoxemia
ü
Tachyarrhythmia
ü
Bradyarrhythmia
ü
Valvular heart disease
ü
Hypertrophic cardiomyopathy
Clinical Features
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 usually 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:
ü
Arm (most often the left)
ü
Back
ü
Jaw
ü
Neck
ü
Shoulder
Less common symptoms of angina may include:
ü
Fatigue
ü
Shortness of breath
ü
Weakness
ü
Dizziness or light-headedness
ü
Nausea, vomiting, and sweating
ü
Palpitations
Investigation
ü Coronary
angiography
ü Coronary
risk profile (special blood tests)
ü ECG
ü Exercise
tolerance test (stress test or treadmill test)
ü Nuclear
medicine(thallium)stress test
ü Stress
echocardiogram
Treatment
Medical treatment
ü ACE
inhibitors to lower blood pressure and protect your heart (Captopril, Enalapril,
Lansopril etc)
ü Beta-blockers
to lower heart rate, blood pressure, and oxygen use by the heart(
ü Calcium
channel blockers to relax arteries, lower blood pressure, and reduce strain on
the heart(Amlodipine , nefedipine and other drugs can be use)
ü Nitrates to
help prevent angina
ü Ranolazine
(Ranexa) to treat chronic angina
Surgical Intervention
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.
Blockages
that cannot be treated with angioplasty may need heart bypass surgery to
replace the damaged blood vessels.
Prevention
A risk
factor is something about you that increases your chance of getting a disease
or having a certain health condition. Some risk factors for heart disease you
cannot change, but some you can. Changing the risk factors that you can control
will help you live a longer, healthier life.
References
1. Medlineplus
2. Wikipedia
4. Davidson’s principal
& practice of medicine 21th edition
