Stable Angina

Description of the Disease

Stable angina (angina pectoris) is a clinical syndrome characterized by short episodes of chest pain or discomfort caused by a temporary imbalance between the heart muscle’s oxygen demand and oxygen supply. There are two main types of angina: stable angina and unstable angina. Stable angina is usually predictable and typically occurs during physical exertion or emotional stress. It may also be triggered by cold weather, wind, or sexual activity. Episodes of chest pain may recur over weeks, months, or even years. The annual incidence of stable angina is approximately 200 cases per 100,000 people over the age of 30, and its prevalence increases with age.

Causes of the Disease

The primary cause of stable angina is atherosclerosis of the coronary arteries, resulting from various cardiovascular risk factors. Modifiable risk factors include smoking, hypertension, diabetes mellitus, obesity, physical inactivity, and chronic stress. Non-modifiable risk factors include a family history of cardiovascular disease, older age, and male sex, although the prevalence in women increases after menopause. Symptoms usually develop when atherosclerotic plaques significantly reduce blood flow through the coronary arteries.

Symptoms

Stable angina typically presents as episodes of chest pain or discomfort during physical activity or emotional stress. Many people describe the sensation as pressure, tightness, heaviness, or squeezing behind the breastbone rather than pain. The discomfort may begin gradually and increase in intensity during an episode. It may radiate to the arm (most commonly the inner aspect of the left arm), neck, or lower jaw. Associated symptoms may include sweating, anxiety, and trembling. Episodes usually last from 30 seconds to 5 minutes, rarely up to 10–20 minutes. Symptoms typically resolve with rest or after taking nitroglycerin. Episodes of stable angina are generally consistent and similar from one occurrence to another.

Classification

Stable angina is classified into four functional classes:

• Class I: Angina occurs only during unusually strenuous physical activity.
• Class II: Angina occurs during ordinary but relatively vigorous physical activity, such as walking more than 500 meters or climbing two to three flights of stairs.
• Class III: Angina occurs during moderate physical activity, such as walking 100–500 meters or climbing one flight of stairs.
• Class IV: Angina occurs during minimal physical activity or even at rest.

Diagnosis

Diagnosis is based on the patient’s symptoms and the results of diagnostic tests. An exercise electrocardiogram (exercise stress test) is commonly performed. Resting and stress echocardiography, including dobutamine stress echocardiography, may also be used. In some cases, coronary angiography is performed to assess the severity of coronary artery disease.

Treatment

Acute angina attacks are relieved with nitrates, most commonly sublingual nitroglycerin. Long-term treatment is individualized according to the severity of the disease and the presence of other medical conditions. Effective management also includes controlling cardiovascular risk factors through lifestyle modification and appropriate medical therapy.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology