stable angina


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angina

 [an-ji´nah, an´jĭ-nah]
spasmodic, choking, or suffocative pain; now used almost exclusively to denote angina pectoris. adj., adj an´ginal.
agranulocytic angina agranulocytosis.
crescendo angina old term for unstable angina.
angina cru´ris intermittent claudication.
herpes angina (angina herpe´tica) herpangina.
intestinal angina generalized cramping abdominal pain occurring shortly after a meal and persisting for one to three hours, due to ischemia of the smooth muscle of the bowel.
Ludwig's angina see ludwig's angina.
angina pec´toris acute pain in the chest resulting from myocardial ischemia (decreased blood supply to the heart muscle); the condition has also been called cardiac pain of effort and emotion because the pain is brought on by physical activity or emotional stress that places an added burden on the heart and increases the need for blood being supplied to the myocardium. Some patients can predict the kinds of events that will precipitate an attack while others are unaware of any relationship between onset of an attack and any particular situation in their lives.

Angina pectoris occurs more frequently in men than in women, and in older persons than in younger persons. It is not a disease entity but a symptom of an underlying disease process involving the arteries that supply blood to the heart muscle. About 90 per cent of all cases can be attributed to coronary atherosclerosis. Studies have shown that at least one of the three major coronary arteries usually is stenosed before angina develops. In most cases, all of the major coronary arteries are involved.

Angina pectoris also can result from stenosis of the aorta, pulmonary stenosis and ventricular hypertrophy, or connective tissue disorders such as systemic lupus erythematosus and periarteritis nodosa that affect the smaller coronary arteries.
Symptoms. The chief symptom is chest pain, usually unmistakably distinguished by the patient as different from other types of pain such as that caused by indigestion. It is generally described as a feeling of tightness, strangling, heaviness, or suffocation and is usually concentrated on the left side, beginning just under the sternum; it sometimes radiates to the neck, throat, and lower jaw and down the left arm, and occasionally to the stomach, back, or across to the right side of the chest. The pain seldom lasts more than 15 minutes and is usually relieved by rest and relaxation or by administration of nitrates. If it is not relieved in 10 to 15 minutes, the physician should be notified and the patient taken to a cardiac care unit. The decreased blood supply to the heart makes it especially vulnerable to arrhythmias and myocardial infarction, which are the cause of death in about one third of all cases.

Coronary arteriography and ventriculography are valuable in determining the prognosis for angina pectoris. The mortality rate for patients having a narrowing of all three main coronary arteries is higher than for those who have only one vessel involved. Severity of pain is not a good prognostic indicator; some patients with severe discomfort live for many years, while others with mild symptoms die suddenly. An enlarged heart, a third heart sound, ECG abnormalities at rest, and hypertension are all indicative of a poor prognosis.
Treatment and Patient Care. Relief from pain by rest and prevention of attacks by avoiding situations which precipitate them are the first steps in the care of the patient with angina. In most cases patients are eager to learn about the disease process causing the pain and want to know how they can participate in control of their attacks. However, compliance with the prescribed regimen usually requires a change in life style and the breaking of some lifelong habits. The known risk factors for coronary heart disease are explained to the patient, and a regimen designed to avoid further damage to the arteries is prescribed.

Organic nitrates may be administered orally or sublingually for relief from anginal pain. They act by dilating the arteries and may be used to treat acute attacks, for long-term prophylaxis and management, or for prophylaxis in situations likely to provoke an attack. Commonly used nitrates are erythrityl tetranitrate, isosorbide dinitrate, and nitroglycerin.

Beta-adrenergic blocking agents, such as propranolol, are used to treat patients who do not respond to weight control and treatment with vasodilators and whose angina significantly limits their activities. These agents decrease the heart rate, blood pressure, and myocardial oxygen consumption and increase the patient's exercise tolerance.

The calcium channel blocking agents (nifedipine, verapamil, diltiazem, and others) are drugs that are particularly beneficial in relieving pain in patients whose angina is the result of coronary artery spasm or constriction. They act by selectively inhibiting the transport of calcium across the cell membrane of myocardial cells and also by reducing myocardial oxygen utilization. Patients most likely to obtain dramatic relief from drugs of this kind are those who experience chest pain while resting or sleeping, upon exposure to cold, or during emotional stress.

Surgical procedures involving arterial bypass and angioplasty have become fairly common as a form of treatment of certain types of ischemic heart disease and resulting angina pectoris. The surgical procedures attempt to bypass the diseased portion of the coronary artery by suturing a vein graft or the internal mammary artery from the aorta to one or more coronary arteries beyond the area of obstruction. In most instances the graft is obtained from the patient's saphenous vein. Angioplasty reestablishes patency of the vessels; in most cases, it is now accompanied by insertion of a stent to help prevent restenosis.

An attitude of calmness and efficiency is most important when caring for a person suffering from an attack of angina pectoris. The pain produces emotional reactions and the strongest of these is fear. Most of these patients know that their pain is resulting from an insufficient supply of oxygen to the heart and they frequently have a feeling of impending death. It usually helps to raise the patient to a sitting position so that breathing is less difficult. The prompt administration of nitroglycerin or the specific drug ordered by the physician should shorten the attack and relieve pain. Above all, the calm presence of someone who knows how to care for them can do much to reassure patients and help them relax, thus lessening the severity of the attack.
preinfarction angina angina that lasts longer than 15 minutes; it is a symptom of worsening cardiac ischemia.
Prinzmetal's angina a variant of angina pectoris in which the attacks occur during rest, exercise capacity is well preserved, and attacks are associated electrocardiographically with elevation of the ST segment. It is cyclic in nature and is believed to be caused by coronary artery spasm.
stable angina chest pain of cardiac origin that has not changed in character, frequency, intensity, or duration for 60 days.
unstable angina chest pain of cardiac origin that is variable, usually increasing in frequency and intensity and with irregular timing.
variant angina Prinzmetal's angina.
Vincent's angina see vincent's angina.

stable angina

angina pectoris in which attacks occur with predictable frequency and duration and are precipitated by circumstances such as exercise or emotional stress that increase myocardial oxygen demands. The same circumstances tend to cause the attacks from one episode to another.

stable angina

Cardiology Chest pain that may extend regionally due to ↓ myocardial blood flow Etiology CAD with stenosis, ↑ blood flow to heart–exercise, heavy meals, stress; other causes of angina include coronary artery spasm–Prinzmetal's angina, heart valve disease, heart failure, arrhythmias Risk factors ♂ sex, cigarette smoking, ↑ LDL-C, ↓ HDL-C, HTN, DM, family Hx of CAD < age 55, sedentary lifestyle, obesity. See Coronary artery disease.

stable angina

Angina that occurs with exercise and is predictable. It is usually promptly relieved by rest or nitroglycerin.
See also: angina
References in periodicals archive ?
Q If you have stable angina, will any procedure help you live longer?
compared the therapeutic benefits of trimetazidine with that of isosorbide dinitrate in the 53 patients with stable angina uncontrolled by propranalol 40 mg BID.
Key clinical point: Rates of acute Ml and all-cause mortality in patients with stable angina pectoris but no obstructive CAD are significantly lower than in the general population.
ACME-1 trial (Angioplasty Compared to MEdicine) was one of the first studies to compare the efficacy of percutaneous coronary intervention with medicine alone in patients with stable angina.
You may have chronic stable angina, and if you change your lifestyle and receive good medical therapy, the angina may go away.
But until the results arrive in 2020, will as many stress imaging studies continue for patients with stable angina when so many referred patients turn out to be negative for more advanced coronary disease?
Chronic stable angina is characterized by chest pain during exertion caused by a narrowing of the coronary arteries.
Increased plasminogen activator inhibitor antigen levels in diabetic patients with stable angina.
Adults with stable angina or ischaemia that appears on stress tests should be offered the best available drugs first.
Coronary plaque ruptures have been shown in 7%-27% of stable angina patients (3, 4) and in 3% of patients dying of noncardiac causes (5).