Stable Angina Treatment in Delhi, India

Some symptoms associated with stable angina or angina equivalent, are

• Feeling of gas or indigestion
• Fatigue
• Weakness
• Palpitations
• Shortness of breath
• Dizziness or light-headedness
• Nausea, vomiting
• Sweating
• Pain in the chest that

• comes on with activity or stress
• can last an average of 1 to 15 minutes
• is relieved with rest or on taking nitroglycerin
• Angina attacks tend to occur at any time during the day.

A stable angina attack occurs when the heart muscles don't receive enough oxygen at the time of increased requirement during stress or exertion . This may occur due to:

• Cold weather
• Anaemia

• Heart failure
• Exercise
• Hyperthyroidism (overactive thyroid)
• Emotional stress
• Large meals
• Abnormal heart rhythms 
• Heart valve disease
• Coronary artery spasm (also called Prinzmetal angina)

Doctors assess the symptoms and medical history, perform a physical exam, and check the blood pressure. The doctor may hear abnormal sounds like a heart murmur or irregular heartbeat when listening to the chest sounds with a stethoscope.

Tests for angina include:

• Blood tests: to show heart tissue damage or high risk for heart attack

• Electrocardiography (ECG): Electrocardiography is a procedure in which the electrical activities of the heart are recorded. Tiny patches are connected to the machine and placed over specific places on the chest.
• Echocardiography : echocardiography is like ultrasound of the heart to assess the functioning and structure of the heart including heart valves

• Event monitoring: When long-term heart functioning readings need recording, event monitoring is advisable.

• Stress tests: include exercise tolerance tests (or treadmill tests), nuclear stress tests, or stress echocardiograms.

• Holter monitoring: continuous monitoring of the heart rhythm can be done using this portable device. It can be used for several weeks.

• Coronary angiography: It is the gold standard test to diagnose the blockage or narrowing of arteries of the heart.

• Serial cardiac biomarker assays
• Complete blood count (CBC) with haemoglobin level
• Serum chemistry panel (including magnesium and potassium)
• Lipid panel
• Creatinine level
• CT coronary angiography
• Magnetic resonance angiography or cardiac MRI
• Single-photon emission computed tomography.
• Chest radiography

Stable angina can be treated with the following approaches:

• Making lifestyle changes
• Medicines
• Intervention in the form of -

• Angioplasty and stenting
• Open-heart surgery (coronary bypass surgery)

The treatment of stable angina aims to reduce the severity and frequency of the symptoms. Additionally, it lowers the risk of heart attack and sudden death. Immediate treatment is essential for patients with stable and unstable angina pain that presents differently than usual.

Lifestyle Changes After Stable Angina

Regardless of the treatment chosen, doctors recommend making heart-healthy lifestyle changes. The chances of preventing or reducing angina are better by monitoring heart disease-causing risk factors. These factors include:

• Smoking
• Unhealthy diet: Eating a healthy diet with a limited quantity of saturated fat, trans fat, salt, and sugar lowers blood cholesterol levels. One must add a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy products to the diet.

• Lack of physical activity

• Excess weight

• Medical conditions: Treatment of pre-existing medical conditions such as diabetes, high blood pressure, and high blood cholesterol , anemia, may lower the risk of developing unstable angina.
• Stress: One must learn to manage stress effectively to prevent seeing its effects on the body.

Medications of Stable Angina

Medicines that may help treat angina may include:

• Nitrates: Nitrates are the mainstay medicines that relieve anginal pain. It relaxes and widens the blood vessels, improving blood flow to the heart. Nitroglycerine commonly treats angina. The pill is placed under the tongue, where it melts, and is directly absorbed into the bloodstream to provide instant action. Avoid getting up suddenly after taking nitrates as it ciuld reduce BP.
• Aspirin: Aspirin prevents the clotting of the blood, thereby thinning the blood and improving its flow. This, in turn, reduces the risk of a heart attack.
• Clot-preventing drugs: Blood-thinning drugs such as clopidogrel, prasugrel, and ticagrelor prevent blood clotting.
• Beta-blockers: Beta-blockers cause the heart to beat more slowly and with less force, lowering blood pressure, heart rate and stress on heart. Additionally, they relax blood vessels and improve blood flow.
• Statins: Statins lower cholesterol levels in the blood. High cholesterol is directly associated with heart disease and angina. Additionally, they help prevent the formation of blockages in the blood vessels.
• Calcium channel blockers: Calcium channel blockers relax and widen the blood vessels to improve the flow of blood.
• Other blood pressure medications: Other medicines such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) help lower blood pressure.
• Ranolazine:This is prescribed for chronic stable angina that fails to respond to other medicines. It can be taken alone or combined with other medicines, such as beta-blockers, nitroglycerin, or calcium channel blockers.

Therapies for Stable Angina

• Enhanced external counterpulsation (EECP) therapy

EECP therapy may be recommended for some people who do not respond to other treatment modalities and where revascularisation is not possible. In this procedure, large cuffs are wrapped around the legs. The air pressure inflates the cuffs and deflates in time to the heartbeat. This procedure is done five times for one-hour a week for seven weeks.

• Angioplasty and Stent placement

Angioplasty increases the flow of blood through a blocked artery to reduce anginal pain. The procedure is also called percutaneous coronary intervention.

During an angioplasty, the doctor threads a tiny, deflated balloon attached to special tubing up through the artery. It is inserted through the wrist or groin and into the narrowed coronary artery. The balloon is then inflated to widen the artery. A small metal tube or stent is inserted to keep the artery from collapsing. The procedure may take 30 minutes to several hours and requires hospital admission. Routine life can be resumed within a few days after the operation with continued medications.

• CABG/ Bypass surgery 

With multiple blocakges or if blocakges are not treatable by angioplasty, cabg/ heart bypass surgery is required for the treatment.

Possible complications of stable angina include 

• Heart attack
• Sudden death caused by abnormal heart rhythms
• Unstable angina

These complications develop if stable angina is ignored and not treated on time. Therefore, it's crucial to inform the doctor as soon as any signs of stable angina become evident.

Some risk factors for stable angina include:

• Obesity
• lack of physical activity
• Eating large meals or unhealthy dietary habits 
• Vigorous physical workouts
• History of heart disease
• Using tobacco products
• High blood pressure or hypertension
• History of diabetes
• Excessive smoking
• High cholesterol 
• Extremely hot or cold weather 
• Aging
• Having a family history of coronary artery disease at a young age (younger than 45 in men and 55 in women)