(Unstable Angina; Stable Angina; Angina Pectoris; Cardiac Angina; Variant Angina)
- Stable angina —Has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be.
—Is more unpredictable and/or severe. Chest pain may occur while resting or even sleeping (nocturnal angina). The discomfort may last longer and be more intense than that of stable angina.
- Unstable angina may be a sign that you are about to have a heart attack . It should be treated as an emergency.
- Variant or Prinzmetal's angina —Caused by temporary spasm (contraction) of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.
|Typical Angina Pain Areas|
|Women are more likely to experience atypical pain, outside of these areas.|
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|Coronary Artery Disease|
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Stable or Unstable Angina
- Exercise or exertion
- Cold weather
- A large meal
- Emotional stress
- Occur more often
- Last longer
- Are triggered more easily
Variant or Prinzmetal's Angina
- Gender: male
- Increased age
- Strong family history of heart disease
- Obesity and overweight
- High blood pressure
- Sedentary lifestyle
- High blood cholesterol (specifically, high low-density lipoprotein [LDL] cholesterol and low high-density lipoprotein [HDL] cholesterol)
- Excessive alcohol intake
Pressure or squeezing chest pain
- Chest pain or discomfort is the key symptom of angina
- Some people do not experience the pain as severely
- Elderly people, women, and people with diabetes are more likely to have atypical or subtle symptoms
- Some people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest pain
- Chest pain of any kind requires a medical evaluation to determine the cause
- Pain in the shoulder(s) or arm(s), or into the jaw(s)
- Shortness of breath
- Blood tests
- Electrocardiogram (EKG)
Exercise stress test
- A medication is used to simulate the effects of physical exertion for those who cannot exercise.
- Nuclear scanning
Electron-beam CT scan
(coronary calcium scan, heart scan, CT
- American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.
- Coronary angiography
Nitroglycerin—Usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray.
- Longer-lasting types may be used to prevent angina before an activity—May be given as pills, or applied as patches or ointments.
Blood thinners—A small, daily dose of
has been shown to decrease the risk of heart attack.
- Some may benefit from the addition of warfarin . There is an increased risk of bleeding with this drug.
- Talk to your doctor before taking aspirin daily or warfarin.
- Beta-blockers and calcium-channel blockers—May reduce the occurrence of angina
- Cholesterol-lowering medications—May prevent the progression of CAD; may even improve existing CAD
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—Lower blood pressure and decrease the workload on your heart
- Ranolazine—To treat angina
- Maintain a healthy weight.
- Begin a safe exercise program with the advice of your doctor.
- Stop smoking.
- Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
- Appropriately treat high blood pressure and/or diabetes.
- Appropriately treat abnormal cholesterol levels or high triglycerides .
American Academy of Family Physicians http://familydoctor.org
American Heart Association http://www.heart.org
National Heart Lung and Blood Institute http://www.nhlbi.nih.gov
Canadian Cardiovascular Society http://www.ccs.ca
Colege of Family Physicians of Canada http://www.cfpc.ca
Angina. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary . Updated November 2, 2012. Accessed November 2, 2012.
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Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet . 2002;360:752.
Lopez-Sendon J, Swedberg K, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE-inhibitors of the European Society of Cardiology. Eur Heart J . 2004;25:1454.
Reenan J. Clinical Pearl: Indications for bypass surgery. American Medical Association website. Available at: http://virtualmentor.ama-assn.org/2004/02/cprl1-0402.html . Accessed November 2, 2012.
What is angina? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/angina . Accessed November 2, 2012.
7/14/2006 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us : Andreotti F, Testa L, et al. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J . 2006;27:519-26.
- Reviewer: Michael J. Fucci, DO
- Review Date: 09/2013 -
- Update Date: 09/30/2013 -