### Date : 2024-11-03 16:47 ### Topic : Stable Angina #cardiology ---- **Stable angina** is a type of chest pain or discomfort that occurs when the heart muscle doesn't get enough oxygen-rich blood. It typically happens during **physical exertion or emotional stress** when the heart needs more oxygen, but coronary arteries are narrowed or blocked due to **atherosclerosis** (buildup of plaque). Stable angina is predictable, has a similar pattern each time, and is relieved by rest or medication (e.g., nitroglycerin). ### Pathophysiology In stable angina, **atherosclerotic plaque** narrows the coronary arteries, restricting blood flow to the myocardium. Under resting conditions, this blood flow may be adequate, but during increased demand (e.g., exercise or stress), the restricted arteries cannot deliver sufficient oxygen, leading to **myocardial ischemia** and resulting in angina symptoms. ### Characteristics of Stable Angina 1. **Predictable Pattern**: - Stable angina occurs in a regular, predictable pattern, usually triggered by activities or situations that increase heart rate and oxygen demand. 2. **Duration**: - The pain typically lasts a few minutes (usually 5–15 minutes) and subsides with rest or the use of nitroglycerin. 3. **Relief by Rest or Medication**: - Rest reduces the heart's oxygen demand, allowing symptoms to resolve. - **Nitroglycerin** helps by dilating blood vessels, improving blood flow to the heart muscle, and reducing workload on the heart. ### Causes and Risk Factors The main cause of stable angina is **atherosclerosis** in the coronary arteries. Risk factors for developing atherosclerosis include: - **Hypertension** (high blood pressure) - **Hyperlipidemia** (high cholesterol and triglycerides) - **Diabetes mellitus** - **Smoking** - **Family history** of heart disease - **Sedentary lifestyle** - **Obesity** - **Advanced age** ### Symptoms of Stable Angina The typical symptoms of stable angina are: 1. **Chest Pain or Discomfort**: - Usually described as a pressure, tightness, or squeezing sensation in the chest. - Pain may radiate to the left arm, shoulder, jaw, back, or neck. 2. **Shortness of Breath**: - Some patients may experience shortness of breath with exertion rather than chest pain, especially older adults or those with diabetes. 3. **Other Symptoms**: - Nausea, sweating, dizziness, or fatigue can accompany angina, especially during intense physical exertion. ### Diagnosis of Stable Angina Diagnosis typically involves clinical evaluation, risk assessment, and tests to evaluate the heart's blood supply: 1. **History and Physical Examination**: - Detailed history of the chest pain (location, duration, triggers, and relieving factors) and risk factor assessment. 2. **Electrocardiogram (ECG)**: - May show normal results at rest but can reveal **ST-segment depression** or **T-wave inversion** during an episode or stress testing. 3. **Exercise Stress Test**: - Involves monitoring the heart with ECG while the patient exercises, to assess for ischemic changes during physical activity. - **Pharmacologic stress testing** (using medications like dobutamine or adenosine) may be used if the patient cannot exercise. 4. **Imaging Tests**: - **Stress Echocardiography**: Ultrasound to assess heart function and blood flow, particularly during stress. - **Nuclear Stress Test**: Radioactive dye and imaging assess blood flow to different parts of the heart. - **Coronary Angiography**: Invasive procedure to visualize coronary arteries, often used if stress tests suggest significant coronary artery disease (CAD). 5. **Blood Tests**: - **Lipid profile** and **blood glucose** to assess risk factors, as well as **troponin** if unstable angina or myocardial infarction (MI) is suspected. ### Treatment of Stable Angina Treatment focuses on relieving symptoms, improving quality of life, and reducing the risk of a heart attack by managing underlying conditions. 1. **Lifestyle Modifications**: - **Smoking cessation**, **regular exercise**, a **heart-healthy diet**, weight management, and **stress reduction**. - Control of blood pressure, blood sugar (in diabetics), and cholesterol levels. 2. **Medications**: - **Nitrates** (e.g., nitroglycerin): Provides immediate relief of angina by dilating coronary arteries and reducing the heart's workload. - **Beta-blockers** (e.g., metoprolol, atenolol): Decrease heart rate and myocardial oxygen demand, reducing angina episodes. - **Calcium channel blockers** (e.g., diltiazem, amlodipine): Reduce myocardial oxygen demand by relaxing blood vessels and decreasing heart workload. - **Aspirin**: Low-dose aspirin can reduce the risk of blood clots and lower the risk of heart attack in patients with stable angina. - **Statins** (e.g., atorvastatin, rosuvastatin): Lower cholesterol levels to reduce plaque buildup and slow CAD progression. - **ACE inhibitors or ARBs** (e.g., lisinopril, losartan): May be prescribed to lower blood pressure, especially in patients with high blood pressure, diabetes, or heart failure. 3. **Revascularization Procedures**: - Considered if symptoms are not controlled with medications or if diagnostic tests reveal significant blockages: - **Percutaneous Coronary Intervention (PCI)**: Also known as angioplasty, often with stent placement, to open narrowed arteries. - **Coronary Artery Bypass Grafting (CABG)**: Surgical procedure where blocked coronary arteries are bypassed using grafts from other vessels, typically in more severe or multi-vessel disease. ### Prognosis and Complications - **Prognosis**: With effective treatment, many people with stable angina lead relatively normal lives. However, stable angina can progress, and the risk of developing an unstable angina or a heart attack remains. - **Complications**: Without treatment, stable angina can progress to **unstable angina**, **myocardial infarction**, or **heart failure**. Regular monitoring and adherence to medications and lifestyle changes are essential to manage risks. ### Summary - **Stable Angina**: Predictable chest pain due to myocardial ischemia from coronary artery disease, typically triggered by exertion or stress. - **Symptoms**: Include chest pain, shortness of breath, and fatigue, which are relieved by rest or nitroglycerin. - **Diagnosis**: Clinical history, stress testing, and imaging tests such as echocardiography or coronary angiography. - **Treatment**: Lifestyle changes, medications (nitrates, beta-blockers, statins, aspirin), and possibly revascularization procedures (PCI or CABG) if symptoms persist. Stable angina requires ongoing management and risk factor control to improve quality of life and prevent progression to more severe cardiac events. ### Reference: - ### Connected Documents: -