From the Guidelines
Stable angina is characterized by chest pain or discomfort that typically feels like pressure, squeezing, fullness, or burning in the center or left side of the chest, often radiating to the shoulders, arms, neck, jaw, or back, and is usually triggered by physical exertion or emotional stress and relieved by rest or nitroglycerin. The symptoms of stable angina can be predictable and typically last 3-5 minutes before subsiding with rest or nitroglycerin 1. Associated symptoms may include shortness of breath, fatigue, nausea, sweating, dizziness, and anxiety. What distinguishes stable angina from unstable variants is its consistent pattern - the pain occurs at similar levels of exertion and resolves predictably with rest. These symptoms occur because coronary artery narrowing limits blood flow to the heart muscle during increased demand, creating a temporary oxygen deficit that triggers pain signals. Patients experiencing these symptoms should seek medical evaluation promptly, as stable angina indicates underlying coronary artery disease that requires proper diagnosis and management to prevent progression to more serious cardiac events. Some key points to consider in the diagnosis of stable angina include:
- A carefully taken history and physical examination, a comprehensive risk factor evaluation and a resting electrocardiogram are essential for every patient with suspected stable angina 2.
- An initial non-invasive strategy, using exercise ECG, stress echo, or myocardial perfusion scintigraphy is most appropriate to confirm the diagnosis and plan further management 2.
- The exercise ECG should be interpreted with attention to haemodynamic response, workload achieved, and clinical features of the individual as well as symptoms and ST-segment response 2.
- Myocardial perfusion scintigraphy and stress echocardiography are of particular value in demonstrating the extent and localization of myocardial ischaemia 2. It is also important to note that the interpretation of chest pain is particularly difficult in young and middle-aged women, and that the classical symptom complex of chronic stable angina is not a reliable indicator of obstructive coronary disease in women 2.
From the Research
Stable Angina Symptoms
The most common symptoms of stable angina are not explicitly stated in the provided studies. However, the studies discuss the management and treatment of stable angina, which can be used to infer the symptoms.
Treatment and Management
- The treatment of stable angina typically involves pharmacological therapy with drugs such as beta blockers, calcium channel blockers, and nitrates 3, 4, 5.
- These drugs are used to reduce the frequency and severity of angina attacks, and to improve overall clinical outcomes 4, 5.
- The choice of treatment depends on the individual patient's needs and medical history, and may involve a combination of different drugs 3, 6.
Common Anti-Anginal Drugs
- Beta blockers, such as atenolol, are commonly used to treat stable angina 3, 4, 5.
- Calcium channel blockers, such as amlodipine and nifedipine, are also widely used 3, 5.
- Nitrates, such as short-acting and long-acting nitrates, are used to relieve angina symptoms 3, 6.
Efficacy of Anti-Anginal Drugs
- There is limited evidence to suggest that one anti-anginal drug is superior to another in the treatment of stable angina 3, 4.
- Studies have shown that beta blockers, calcium channel blockers, and nitrates are all effective in reducing the frequency and severity of angina attacks, but the choice of treatment depends on individual patient needs 3, 4, 5.