Symptoms of Stable Angina

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe or that they cannot tell exactly where the pain is coming from. Other symptoms include:

• Fatigue
• Light-headedness or fainting
• Nausea, or feeling sick in the stomach
• Shortness of breath
• Sweating
• Weakness

Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.

Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Each type of angina has certain typical symptoms. For Stable Angina, symptoms include:

• Discomfort that feels like gas or indigestion
• Pain during physical exertion or mental stress
• Pain that spreads from your breastbone to your arms or back
• Pain that is relieved by medicines
• Pattern of symptoms that has not changed in the last 2 months
• Symptoms that go away within 5 minutes

Sourced from NIH

Causes of Stable Angina

Your heart muscle needs a constant supply of oxygen. The coronary arteries carry oxygen-rich blood to the heart. When the heart muscle has to work harder, it needs more oxygen. Symptoms of angina occur when blood supply to heart muscle is reduced. This happens when the coronary arteries are narrowed or blocked by atherosclerosis or by a blood clot.

The most common cause of angina is coronary artery disease. Angina pectoris is the medical term for this type of chest pain. Stable angina is less serious than unstable angina, but it can be very painful or uncomfortable.

There are many risk factors for coronary artery disease. Some include:

• Diabetes
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Sedentary lifestyle
• Smoking
• Advancing age
• Male sex

Anything that makes the heart muscle need more oxygen or reduces the amount of oxygen it receives can cause an angina attack in someone with heart disease, including:

• Cold weather
• Exercise
• Emotional stress
• Large meals

Other causes of angina include:

• Abnormal heart rhythms (your heart beats very quickly or your heart rhythm is not regular)
• Anemia
• Coronary artery spasm (also called Prinzmetal angina)
• Heart failure
• Heart valve disease
• Hyperthyroidism (overactive thyroid)

Sourced from NIH

Diagnosis of Stable Angina

Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.

Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.

Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:

• How long does the pain or discomfort last?
• How often does the pain occur?
• How severe is the pain or discomfort?
• What brings on the pain or discomfort, and what makes it better?
• Where do you feel the pain or discomfort?
• What does the pain or discomfort feel like?
• Your doctor will also need information about ischemic heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem. Your doctor can recommend steps you need to take to get medical care.

As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.

Your doctor may have you undergo some of the following tests and procedures.

• Blood tests to check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
• Chest X-ray to look for lung disorders and other causes of chest pain not related to ischemic heart disease. A chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help rule out other causes.
• Computed tomography angiography to examine blood flow through the coronary arteries. This test can rapidly diagnose ischemic heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
• Coronary angiography with cardiac catheterization to see if ischemic heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
• Echocardiogram to assess the strength of your heart beating, to help the doctor determine your risk of future heart problems.
• Electrocardiogram (EKG) to check for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious ischemic heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
• Hyperventilation testing to diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
• Magnetic resonance imaging or other noninvasive tests to check for problems with the heart’s movement or with blood flow in the heart’s small blood vessels.
• Provocation tests to diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
• Stress testing to assess your heart’s function during exercise. A stress test can show possible signs and symptoms of ischemic heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.

Sourced from NIH

Summary of Stable Angina

Angina is chest pain or discomfort that occurs if an area of your heart muscle does not get enough oxygen-rich blood. It is a common symptom of ischemic heart disease, which limits or cuts off blood flow to the heart.

There are several types of angina: stable, unstable, microvascular and variant. Angina chest pain, called an angina event, can happen when your heart is working hard. It can go away when you stop to rest again, or it can happen at rest. This pain can feel like pressure or squeezing in your chest. It also can spread to your shoulders, arms, neck, jaw, or back, just like a heart attack. Angina pain can even feel like an upset stomach. Symptoms can be different for women and men. If you have chest pain that does not go away, call 9-1-1 immediately.

Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:

• How long your angina events last
• How often your angina evens occur
• How well the angina responds to rest or medicines
• The causes or triggers of your angina

If you have stable angina, you can learn its pattern and predict when an event will occur, such as during physical exertion or mental stress. The pain usually goes away a few minutes after you rest or take your angina medicine. If the condition causing your angina gets worse, stable angina can become  unstable angina.

Symptoms: Pain and discomfort are the primary symptoms. Others include discomfort that feels like gas or indigestion, pain during physical exertion or mental stress, pain that spreads from your breastbone to your arms or back, pain that is relieved by medicines, pattern of symptoms that has not changed in the last 2 months, and symptoms that go away within 5 minutes.

Causes: Most often stable angina is caused by coronary artery disease. Anything that makes the heart muscle need more oxygen or reduces the amount of oxygen it receives can cause an angina attack in someone with heart disease including cold weather, exercise, emotional stress or large meals. There are other causes of stable angina, too. 

Diagnosis: Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.

Treatments: The world's leading angina researchers and medical doctors recommend medicine first for patients whose coronary artery disease does not put their lives at risk because it has proven to be effective and low-risk. If medicine fails to give relief or if the patient has special circumstances, doctors may recommend a procedure like stenting or heart bypass surgery which, while effective, carries risks of major complications. Doctors may also recommend non-invasive EECP which is effective and carries relatively little risk.