How do you manage stable angina?
Most people who have stable angina can control their symptoms by taking medications as prescribed and nitroglycerin when needed.
What makes angina worse?
Other health problems, such as fever or infection, anemia, or other heart problems, can make angina symptoms worse. They may also cause unstable angina.
Angina may get worse when another condition:
- Forces the heart to work harder, which increases the amount of oxygen it needs
- Decreases the amount of oxygen the heart receives
In either case, there is an imbalance between the amount of oxygen that the heart needs and the amount that it receives through the blood supply from the coronary arteries. If the heart can't get enough oxygen, symptoms of stable angina may get worse.
What problems does atherosclerosis cause?
Coronary artery disease. When atherosclerosis affects the arteries that supply blood to the heart, the coronary arteries, it can restrict blood flow to the heart muscle.
Heart attack. Plaque, caused by atherosclerosis, is surrounded by a fibrous cap. This fibrous cap may tear or rupture. A tear or rupture tells the body to repair the injured artery lining, much as it might heal a cut on the skin by forming a blood clot to seal the area. A blood clot that forms in an artery can completely block blood flow to the heart muscle and cause a heart attack.
Stroke or transient ischemic attack (TIA). When atherosclerosis affects the arteries that supply blood to the brain, it may cause a transient ischemic attack (TIA) or stroke.
Peripheral arterial disease. Atherosclerosis can affect arteries in other parts of the body, such as the pelvis and legs, causing poor circulation.
Abdominal aortic aneurysm. Atherosclerosis can make the walls of the aorta weak. The aorta is the large artery that carries blood from the heart to the rest of the body.
When do I need to see my provider?
Do not wait if you think you are having a heart attack. Some people aren't sure whether they're having one, or they don't want to bother others, so they wait. But getting help fast can save your life.
Call 911 or other emergency services immediately if you have symptoms of a heart attack or are with someone who has symptoms. Symptoms may include:
- Chest pain or pressure, or a strange feeling in the chest
- Shortness of breath
- Nausea or vomiting
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms
- Lightheadedness or sudden weakness
- A fast or irregular heartbeat
After you call, the operator may tell you to chew one (1) adult-strength or two to four (2 to 4) low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. By taking an ambulance, you may be able to start treatment before you arrive at the hospital.
If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within five minutes, call. Do not wait to call for help.
Call your provider if your angina symptoms are different, more frequent, or severe.
Who to see
To see if you are at risk for heart disease, have symptoms of heart disease, or need long-term care for existing heart disease, see your primary care provider or internist. For diagnosis of coronary artery disease, you may see a cardiologist. For ongoing care of stable angina, you will likely see your primary care provider or an internist. For angioplasty or surgery, you will be referred to an interventional cardiologist or cardiovascular surgeon.
What are some prevention myths?
There are lots of things you can do to lower your risk for coronary artery disease. But some diets and dietary supplements do not lower risk. It's not clear if vitamins, minerals, and multivitamins can lower risk.
Talk with your provider about the best ways to lower your risk of heart disease. By eating heart-healthy foods, most people can lower their risk and get all of the nutrients they need. Other proven ways to lower risk include being active, staying at a healthy weight, and not smoking.
Heart-healthy eating can help lower risk of heart disease, heart attack, and stroke.
Do not use these diets to lower risk:
- Low-carbohydrate diets. These diets could cause serious medical problems, especially if you have heart disease, type 2 diabetes, high cholesterol, or high blood pressure. The Academy of Nutrition and Dietetics and the American Heart Association do not recommend these diets.
- High-protein diets. These diets limit healthy foods such as fruits and vegetables. And they don't include essential vitamins, minerals, and fiber. The American Heart Association does not recommend high-protein diets.
Vitamins and supplements
By eating heart-healthy foods, most people can lower their risk and get all of the vitamins and nutrients they need.
It is clear that some vitamins and supplements do not lower risk of heart disease, heart attack, and stroke.
Do not take these supplements to lower risk:
- Coenzyme Q10
- Fish oil or omega-3 fatty acids
- Vitamin B or folic acid
- Vitamin C
- Vitamin E
It is not clear if taking other vitamins, multivitamins, or supplements can lower risk. There is not enough evidence to show that they work or don't work.
Doctors used to think that hormone therapy for women could lower the risk of getting heart disease. But hormone therapy does not prevent heart disease. So experts no longer recommend this use of hormone therapy.
How can I get started on an exercise program?
- Have a thorough physical exam before you begin any exercise program. Your provider may do an electrocardiogram (ECG or EKG) to measure the electrical signals that control the rhythm of your heartbeat, and they may do an exercise stress test to assess what level of activity your heart can handle.
- Before your appointment, make a list of questions to discuss with your provider.
- Make an exercise plan together with your provider. An exercise program usually consists of stretching, activities that increase your heart rate (aerobic exercise), and strength training (lifting light weights). Join a health club or walking group.
- Learn how to find the right intensity of exercise. To improve your aerobic power, you don't need to submit yourself to strenuous and uncomfortable exercise. In fact, an intensity of exercise called "conversational exercise" (where you can comfortably have a conversation while you are exercising) can be very beneficial.
- Start out slowly. Try parking farther away from the store or walk the mall before shopping. Over time, you will increase your ability to do more.
- Keep a record of your daily exercise. It is okay to skip a day occasionally or to cut back on your exercise if you are too tired or not feeling well.
How do I measure the intensity of my exercise?
Exercise intensity can be measured in many ways, for example as your:
- Rate of perceived exertion (RPE)
- Heart rate (HR)
Your provider can tell you the correct rate of perceived exertion or how fast your pulse (target heart rate) should be when you exercise.
An easy way to check whether you are exercising enough, but not too much, is to note how hard you are breathing:
- If you can't talk and exercise at the same time, you are exercising too hard.
- If you can talk while you exercise, you are doing fine.
- If you can sing while you exercise, you may not be exercising hard enough.
How often should I exercise?
Most experts recommend moderate-intensity physical activity for at least 150 minutes, or two and a half hours, per week. One way to do this is to be active 30 minutes a day, at least five days a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. The best number of days for you may depend upon your time availability, your exercise intensity, the duration of each session, and of course, your overall goals. If you exercise at a lower intensity level, you may want to exercise more frequently. Studies have shown that no significant differences in aerobic capacity are found whether these are consecutive or alternate days. If you are trying to lose weight, talk to your provider about how much exercise you need.