Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blood vessels in the heart called the coronary arteries.

When the heart muscle has to work harder, it needs more oxygen. Symptoms of angina may 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.


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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 most often begins slowly and gets worse over the next few minutes before going away.

NEVER STOP TAKING ANY OF THESE DRUGS ON YOUR OWN. Always talk to your provider first. Stopping these drugs suddenly can make your angina worse or cause a heart attack. This is especially true for anti-clotting drugs (aspirin, clopidogrel, ticagrelor and prasugrel).

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.

Angina usually feels like pressure, tightness or squeezing in your chest. This can feel painful or like a dull ache. You might also feel it in your shoulders, arms, neck, jaw, back or stomach. 


Other symptoms of angina can include:

The most common cause is coronary heart disease. This is when the arteries that supply your heart muscle with blood and oxygen are narrowed by a fatty substance called plaque. It means less blood flows to your heart muscle and can cause angina symptoms. 


There are common triggers for angina pain, like:

Your doctor will prescribe you medication that will improve symptoms and help your heart to function better. But a change in lifestyle will help prevent more fatty substance called plaque forming in your arteries and improve your symptoms of angina. 


Try our lifestyle tips to see some improvements:

Many people with angina have a good quality of life and continue as usual. Living an active lifestyle is also really important to help stop your underlying coronary heart disease from getting worse. 


Your doctor or nurse can tell you if you need to make any changes to your routine and make specific lifestyle changes.

This booklet is for people with angina, and for their friends and family. It explains what angina is, what causes it, how angina is diagnosed, and what can be done to treat the condition. It also explains what to do if you experience angina, or if you think you may be having a heart attack.


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Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the discomfort of indigestion. If you have unexplained chest pain, seek medical help right away.

Stable angina. Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you're walking uphill or in the cold weather may be angina.

Symptoms of angina in women can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also have symptoms such as:

If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Only drive yourself to the hospital if there is no other transportation option.

If chest discomfort is a new symptom for you, it's important to see your health care provider to determine the cause and to get proper treatment. If you've been diagnosed with stable angina and it gets worse or changes, seek medical help immediately.

Doctors have long known that mental or psychological stress can lead to angina (chest pain or discomfort caused by inadequate blood to the heart). Now, new research reveals a direct correlation between angina and stress-related activity in the brain's frontal lobe. The study included 148 people with coronary artery disease with an average age of 62. All underwent brain and heart imaging tests done in conjunction with mental stress testing, which involved mental arithmetic and public speaking. Imaging tests were also done under "control" conditions, which featured simple counting and recalling a neutral event. Researchers monitored the participants for angina during the tests; they also assessed angina rates again after two years.

Activity in the inferior frontal lobe area of the brain during mental stress was linked to the severity of self-reported angina, both during the brain imaging and at the two-year follow-up. A better understanding of how the brain reacts to stress may be an important consideration for doctors who treat angina, according to the study's lead author. The study was published online Aug. 10, 2020, by the journal Circulation: Cardiovascular Imaging.

Introduction:  The prognostic value of angina during exercise stress testing is controversial, possibly due to previous studies not differentiating typical from non-typical angina. We aimed to assess the prognostic value of typical angina alone, or in combination with ST depression, during exercise stress testing for predicting cardiovascular events.

Methods:  We conducted a prospective observational cohort study including all patients who performed a clinical exercise stress test at the department of Clinical Physiology, Kalmar County Hospital between 2005 and 2012. The association between typical angina/ST depression and incident acute coronary syndrome (ACS) and cardiovascular mortality were analysed using Cox regression for long-term and 1-year follow-up.

Results:  Out of 11605 patients (median follow-up 6.7 years), 623 (5.4%) developed ACS and 319 (2.7%) died from cardiovascular causes. Compared to patients with no angina and no ST depression, typical angina and ST depression were associated with increased risk of future ACS; hazard ratio (HR) 3.5 ([95%CI] 2.6-4.7). This association was even stronger for ACS within one year (typical angina with and without concomitant ST depression; HR 20.8 (13.9-31.3) and 9.7 (6.1-15.4), respectively). Concordance statistics for ST depression in predicting ACS during long-term follow-up was 0.58 (0.56-0.60) and 0.69 (0.65-0.73) for ACS within one year, and 0.64 (0.62-0.66) and 0.77 (0.73-0.81), respectively, when typical angina was added to the model.

Exercise stress testing is an important diagnostic tool for the evaluation of suspected or known cardiac disease. In 2002, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised their guidelines for exercise testing. Ten categories from the ACC/ AHA 1997 guidelines were modified: ST heart rate adjustment, unstable angina, older patients, acute coronary syndromes, chest pain centers, acute myocardial infarction, asymptomatic patients, valvular heart disease, rhythm disturbances, and hypertension. Adjustment of the ST heart rate can identify myocardial ischemia in asymptomatic patients with elevated cardiac risk. Intermediate- and low-risk patients with unstable angina, acute coronary syndromes, or chest pain should undergo exercise stress testing when clinically stable. Provided they are stable, patients who have had acute myocardial infarction can undergo a submaximal exercise test before discharge or a symptom-limited exercise stress test any time after two to three weeks have elapsed. In asymptomatic patients with cardiac risk factors, the exercise stress test may provide valuable prognostic information. Aortic regurgitation is the only valvular heart disorder in which there is significant evidence that exercise stress testing is useful in management decisions. The stress test also can be used in older patients to identify the presence of coronary artery disease. However, because of other comorbidities, a pharmacologic stress test may be necessary. Exercise stress testing can help physicians successfully evaluate arrhythmia in patients with syncope. The exercise stress test also can help identify patients at risk of developing hypertension if they show an abnormal hypertensive response to exercise.

Exercise stress testing is an important diagnostic tool for the evaluation of suspected or known cardiac disease. In 2002, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised their guidelines for exercise testing. Ten categories from the ACC/AHA 1997 guidelines were modified: ST heart rate adjustment, unstable angina, older patients, acute coronary syndromes, chest pain centers, acute myocardial infarction, asymptomatic patients, valvular heart disease, rhythm disturbances, and hypertension. Adjustment of the ST heart rate can identify myocardial ischemia in asymptomatic patients with elevated cardiac risk. Intermediate-and low-risk patients with unstable angina, acute coronary syndromes, or chest pain should undergo exercise stress testing when clinically stable. Provided they are stable, patients who have had acute myocardial infarction can undergo a submaximal exercise test before discharge or a symptom-limited exercise stress test any time after two to three weeks have elapsed. In asymptomatic patients with cardiac risk factors, the exercise stress test may provide valuable prognostic information. Aortic regurgitation is the only valvular heart disorder in which there is significant evidence that exercise stress testing is useful in management decisions. The stress test also can be used in older patients to identify the presence of coronary artery disease. However, because of other comorbidities, a pharmacologic stress test may be necessary. Exercise stress testing can help physicians successfully evaluate arrhythmia in patients with syncope. The exercise stress test also can help identify patients at risk of developing hypertension if they show an abnormal hypertensive response to exercise. 006ab0faaa

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