chronic%20stable%20angina
CHRONIC STABLE ANGINA
Chronic stable angina is a clinical syndrome characterized by squeezing, heaviness or pressure discomfort in the chest, neck, jaw, shoulder, back, or arms which is usually precipitated by exertion and/or emotional stress and relieved by rest and/or Nitroglycerin.
It is caused by myocardial ischemia that is commonly associated with narrowing of the coronary arteries.
Angina is stable when it is not a new symptom and when there is no deterioration in frequency, duration or severity of episodes.

Introduction

  • Clinical syndrome characterized by constricting discomfort in the chest, neck, jaw, shoulder, back or arms which is precipitated by exertion and/or emotional stress and relieved by rest and/or Nitroglycerin
  • Can be attributed to myocardial ischemia of which atherosclerotic coronary artery disease is the most common cause
  • Angina is stable when it is not a new symptom and when there is no deterioration in frequency, duration or severity of episodes

Signs and Symptoms

  • Quality of chest pain
    • Described as squeezing, grip-like, suffocating and heavy pain but rarely sharp or stabbing and typically does not vary with position or respiration
    • Occasionally, the patient may demonstrate a Levine’s sign in which a clenched fist is placed over the precordium to describe the pain
    • Many patients do not describe angina as frank pain but as tightness, pressure or discomfort
    • Other patients, particularly women and elderly, can manifest with atypical symptoms such as nausea, vomiting, midepigastric discomfort or sharp (atypical) chest pain
  • Location of pain or discomfort
    • Usually substernal and pain can radiate to the neck, jaw, epigastrium, shoulders, back or arms
    • Pain above the mandible, localized to a small area over the left lateral chest wall or below the epigastrium is rarely anginal
  • Duration of pain
    • Lasts for minutes, usually not >20 minutes
  • Precipitating factors
    • Often precipitated by exertion, emotional stress, heavy meal or cold weather
  • Alleviating factors
    • Typically relieved by rest
    • Sublingual Nitroglycerin also relieves angina within 30 seconds to several minutes

Risk Factors

Conditions that Exacerbate or Provoke Ischemia

Noncardiac Diseases
  • Hyperthyroidism
  • Hyperthermia
  • Anxiety
  • Anemia
  • Hyperviscosity
  • Leukemia
  • Hypertension
  • Sympathomimetic toxicity (eg cocaine toxicity)
  • Arteriovenous fistulae
  • Sickle cell disease
  • Polycythemia
  • Thrombocytosis
  • Hypergammaglobulinemia
  • Hypoxemia secondary to pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary hypertension, obstructive sleep apnea, interstitial pulmonary fibrosis
Cardiac Diseases  
  • Aortic stenosis
  • Dilated cardiomyopathy
  • Arrhythmias (eg supraventricular tachycardia, ventricular tachycardia)
  • Hypertrophic cardiomyopathy
  • Significant coronary obstruction
  • Microvascular disease
Rule Out Unstable Angina
  • Unstable angina is defined as angina of new onset, increases in frequency, intensity or duration, or occurs at rest
  • Presence of unstable angina predicts a higher short-term risk of acute coronary event
  • Moderate- to high-risk patients should be promptly evaluated and treated in the emergency department because of higher risk of coronary artery plaque rupture and death
  • Low-risk patients are comparable to those patients with stable angina and their evaluation can be performed safely and expeditiously in an outpatient setting
  • Please see Acute Coronary Syndromes w/out Persistent ST-Segment Elevation disease management chart for further information
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 20 Nov 2019
The trade-off between the risk of ischaemic vs bleeding events may be different between Asian and non-Asian patients, which warrants careful consideration when deciding on the duration of antiplatelet therapy following a percutaneous coronary intervention (PCI), according to a presentation at ESC Asia Congress 2019.
3 days ago
Participating in a long-distance skiing event may help lower the risk of hypertension, with the number of completed races showing a weak association with the risk, a study has found.
06 Sep 2019
Hypertensive adults with lower plasma zinc concentration are at increased risk of haemorrhagic stroke, especially those with higher body mass index or lower plasma copper levels, a study has found.
06 Jan 2020
Target organ damage appears to be more noticeable in patients affected by primary aldosteronism than those affected by arterial hypertension without primary aldosteronism, suggests a study, adding that specific treatment can ease such condition.