What are the other Names for this Condition? (Also known as/Synonyms)

• Angina Pectoris
• Chronic Angina

What is Stable Angina? (Definition/Background Information)

• When an individual experiences chest pain during physical activity or when stressed, he/she is said to have Stable Angina. The condition is more common in middle-aged and older men
• If the coronary arteries narrow owing to a clot or plaque build-up, a portion of the heart does not get enough blood supply, thereby depriving the heart muscle of oxygen needed for its pumping activity. The heart muscles have to work harder to pump the blood and consume more oxygen in the process, which causes Stable Angina
• Typical symptoms of Stable Angina are chest pain or discomfort with physical activity. The pain usually recedes upon cessation of that particular physical activity
• The treatment options for this heart condition may include nitroglycerin pills, aspirin regimen and, medications to reduce blood pressure. With early diagnosis and prompt treatment, the prognosis of Stable Angina is reported to be good

Who gets Stable Angina? (Age and Sex Distribution)

• Stable Angina occurs worldwide in all races and ethnicities
• Angina (chest pain due to decreased blood flow to heart) is common in the age group of 55-79 years
• Men are more susceptible to Stable Angina than women

What are the Risk Factors for Stable Angina? (Predisposing Factors)

The risk factors for Stable Angina may include:

• Uncontrolled diabetes
• High LDL cholesterol and low HDL cholesterol
• Family history of coronary heart disease before age 50
• Male gender
• Lifestyle factors such as:
  • Not getting enough exercise
  • Obesity
  • Smoking
  • Physical exertion
  • Stress
  • Over-eating
• Cold weather
• Anemia 
• Heart condition that cause or include:
  • Erratic heart rhythms
  • Coronary artery spasm 
  • Heart failure
  • Heart valve disease
• Hyperthyroidism (increased activity of thyroid) in individuals with heart conditions

What are the Causes of Stable Angina? (Etiology)

Stable Angina may be caused by the following factors:

• Coronary heart disease, which is the most common cause of Stable Angina
  • When the coronary arteries narrow owing to atherosclerosis (plaque build-up in and on the arterial walls) or when a blood clot blocks them, a portion of the heart does not get enough blood supply
  • This deprives the heart muscle of oxygen needed for its pumping activity 
  • The heart muscles have to work harder to pump blood and consume more oxygen in the process, causing the symptoms commonly observed in Stable Angina
• Cardiac syndrome X: The syndrome leads to transient blockage of smaller blood vessels, possibly caused by a chemical imbalance in the heart
• High blood pressure that results in narrowing of the lumen of the blood vessels
• Severe anemia: Anemia leads to reduced number of red blood cells in blood, which may not be able to meet the oxygen demands of the heart during physical activity
• Hypertrophic obstructive cardiomyopathy: Blood supply to a part of the heart may be disrupted by thickening of ventricular walls, forcing the heart to pump harder during physical activity
• Aortic valve stenosis; the aortic valve is narrower than normal
• Aortic valve regurgitation: In this condition, there is backflow of blood into the heart due to improper functioning of the valve
• Uncontrolled diabetes

What are the Signs and Symptoms of Stable Angina?

Typical signs and symptoms of Stable Angina may include:

• Predictable chest pain; a particular kind/amount of exercise or activity may cause chest pain, which goes away
  • With rest
  • Or, when the individual stops or slows down the exercise
• Chest pain that occurs behind the breastbone or slightly to the left of to it. The pain of Stable Angina builds gradually and gets worse over the next few minutes before dissipating
• Chest pain manifested as chest tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, jaw, shoulder, neck and back
• Racing heart 
• Shortness of breath
• Lightheadedness
• Sweating
• Weakness and tiredness

How is Stable Angina Diagnosed?

Stable Angina is diagnosed by:

• A complete and thorough physical examination
• Medical history evaluation, with emphasis on coronary heart disease in the family before age 50
• Assessment of symptoms
• Electrocardiogram (EKG) to measure the electrical activity of heart. It can show signs of heart damage due to coronary heart disease and previous or current heart attack
• Stress testing to help monitor the activity of the heart when the organ needs more blood and oxygen. Narrowed and diseased coronary arteries are unable to supply enough oxygen rich blood to meet the heart’s demands. This test may identify the symptoms of coronary heart disease such as shortness of breath, atypical changes in heart rate, blood pressure, and heart rhythm
• Chest X-ray: A chest X-ray can help capture image of the organs and structures inside the chest such as the lungs, heart, and blood vessels
• Coronary angiography and cardiac catheterization to check heart function
• Coronary risk profile: Blood tests to measure cholesterol and triglyceride levels to assess risks of heart disease
• Thallium stress test to check the flow of blood in the heart while resting or during physical exertion
• Stress echocardiogram, to check heart function during rigorous physical activity
• Troponin assay, to differentiate between Unstable Angina and heart attack. Troponin is a protein fund in heart muscle that gets released in blood, if there is damage to the muscle. Therefore, the presence of troponin in blood a few hours after chest pain is indicative of damage to the heart

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Stable Angina?

Potential complications arising from Stable Angina include:

• Heart attack
• Sudden death due to abnormal heart rhythms or arrhythmias
• Progression to unstable angina, a condition where the heart does not get enough blood and oxygen even during the resting stage

How is Stable Angina Treated?

The treatment of Stable Angina may involve the following measures:

• Use of medications such as:
  • Nitroglycerin pills or sprays for chest pain
  • Blood thinners, such as aspirin, clopidogrel or prasugrel, to prevent blood clots from forming in the arteries and reduce the risk of having a heart attack
  • Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure and protect the heart
  • Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart 
  • Ranolazine for chronic pain in the chest
• Angioplasty: This surgical procedure may be used to either repair a blood vessel or place a stent within the blocked vessel to unblock it. In the latter, the blocked arteries of heart are vascularized by placing a stent in the narrowed segments of the arteries. 
• Heart-bypass: This may be necessary when it is not possible to treating blockages with angioplasty, or the chances of success is low

How can Stable Angina be Prevented?

Stable Angina may be prevented by considering the following measures:

• Taking nitroglycerin a few minutes ahead of exertion and excess physical activity
• Seeking medical attention for high blood pressure and cholesterol
• Maintaining proper blood sugar levels, if one is diabetic
• Having a balanced diet rich in fruits and vegetables and low in fat and cholesterol
• Getting regular exercise
• Taking steps to lose weight, if overweight or obese
• Smoking cessation

What is the Prognosis of Stable Angina? (Outcomes/Resolutions)

• The prognosis of Stable angina is reported to improve with early diagnosis and prompt treatment
• However, if the condition is not treated in a timely manner, it can result in a chronic deprivation of blood supply to parts of the heart
• Additionally, severe abnormalities in heart rhythms may lead to cardiac arrest and sudden death

Additional and Relevant Useful Information for Stable Angina:

The difference between Stable Angina and unstable angina may be explained as:

• Stable Angina is characterized by chest pain during physical active
• The chest pain in unstable angina occurs suddenly; the individual may be awake or even asleep when the pain starts