black syndrome

Dx

Third Heart Sound (S3)

Definition

S3 results from the impact of inflowing blood against a distended or incompliant ventricle in mid diastole. It is a low-frequency soundoccurring ~120-150 msec after S2.

Listening Areas

Heard with the stethoscope bell over the LV apex (usually 5LICS) or the RV apex (usually over 4LICS or LMPC).

Associated Conditions

• Normal: High Cardiac Output (Athletes, Pregnancy)
• Mitral regurgitation
• Hypertrophic Cardiomyopathy
• Ischemic Cardiomyopathy
• Constrictive Pericarditis (S3 as pericardial knock)
• Anemia
• Hyperthyroidism
• Myxoma (Tumor Plop)

See Also:

Extra sounds near S2

• Split Second Sound (Split S2)
• Opening Snap (OS)
• Early Diastolic Sound of Mitral Prolapse
  (this is not common)

Notes

S3 is sometimes referred to as a gallop sound.

S3 is felt on the ear drums as much as it is heard when listening with a stethoscope. Thebell of your stethoscope is necessary to hear an S3, lightly applied to the patient's skin. You will not hear an S3 with the diaphragm, and you may not hear it at all with a bad stethoscope.

To improve your chances of hearing an S3, roll the patient on his or her left side (the left lateral decubitus position) to swing the cardiac apex against the chest wall, bringing it closer to your stethoscope chest piece. A sarcastic mnemonic: to remember the timing of S1 S2 S3, mutter under your breath in weary frustration, "What the hell..." almost whispering the last word.

During ventricular filling, the quantity of the inflowing blood can be either absolutely or relatively excessive for the ventricle as the ventricle approaches its maximal volume.

Absolutely excessive (i.e., LV is not the culprit):

• Severe mitral regurgitation

Relatively excessive (LV with impaired filling):

• Dysfunctional left ventricle with low ejection fraction
• Restrictive cardiomyopathy
• Constrictive pericarditis

SCLERODERMA

Scleroderma is a disease affecting the skin and other organs of the body. Scleroderma is one of the autoimmune rheumatic diseases, meaning that the body's immune system is acting abnormally. The main finding in scleroderma is thickening and tightening of the skin, and inflammation and scarring of many body parts leading to problems in the lungs, kidneys, heart, intestinal system and other areas. There is still no cure for scleroderma but effective treatments for some forms of the disease are available.

FAST FACTS

• Scleroderma is relatively rare. Only 75,000 to 100,000 people in the US have it. More than 75 percent of people with scleroderma are women.
• The condition affects adults and children, but it is most common in women aged 30 to 50.
• There are several types of scleroderma and related diseases and the names can be confusing. The two main types are localized (which affects the skin on the face, hands and feet) and systemic (which can also affect blood vessels and major internal organs).
• Although the underlying cause is unknown, promising research is shedding light on the relationship between the immune system and scleroderma.

WHAT IS SCLERODERMA?

Scleroderma (also known as systemic sclerosis) is a chronic disease that causes the skin to become thick and hard; a buildup of scar tissue; and damage to internal organs such as the heart and blood vessels, lungs, stomach and kidneys. The effects of scleroderma vary widely and range from minor to life-threatening, depending on how widespread the disease is and which parts of the body are affected.

The two main types of scleroderma are:

• Localized scleroderma, which usually affects only the skin, although it can spread to the muscles, joints and bones. It does not affect other organs. Symptoms include discolored patches on the skin (a condition called morphea); or streaks or bands of thick, hard skin on the arms and legs (called linear scleroderma). When linear scleroderma occurs on the face and forehead, it is called en coup de sabre.
• Systemic scleroderma, which is the most serious form of the disease, affects the skin, muscles, joints, blood vessels, lungs, kidneys, heart and other organs.

WHAT CAUSES SCLERODERMA?

The cause of scleroderma is not known. Genetic factors (different genes) appear be important in the disease. Although exposure to certain chemicals may play a role in some people having scleroderma, the vast majority of patients with scleroderma do not have a history of exposure to any suspicious toxins. The cause of scleroderma is likely quite complicated.

WHO GETS SCLERODERMA?

Scleroderma is relatively rare. About 75,000 to 100,000 people in the U.S. have this disease; most are women between the ages of 30 and 50. Twins and family members of those with scleroderma or other autoimmune connective tissue diseases, such as lupus, may have a slightly higher risk of getting scleroderma. Children can also develop scleroderma, but the disease is different in children than in adults.

This image shows diffuse soft-tissue swelling of the digits, characteristic of the early edematous phase of scleroderma.

HOW IS SCLERODERMA DIAGNOSED?

Diagnosis can be tricky because symptoms may be similar to those of other diseases. There is no one blood test or X-ray that can say for sure that you have scleroderma.

To make a diagnosis, a doctor will ask about the patient's medical history, do a physical exam and possibly order lab tests and X-rays. Some symptoms he or she will look for include:

• Raynaud's phenomenon. This term refers to color changes (blue, white and red) that occur in fingers (and sometimes toes), often after exposure to cold temperatures. It occurs when blood flow to the hands and fingers is temporarily reduced. This is one of the earliest signs of the disease; more than 90 percent of patients with scleroderma have Raynaud's. Raynaud's can lead to finger swelling, color changes, numbness, pain, skin ulcers and gangrene on the fingers and toes. People with other diseases can also have Raynaud's and some people with Raynaud's do not have any other disease.
• Skin thickening, swelling and tightening. This is the problem that leads to the name "scleroderma" ("Sclera" means hard and "derma" means skin). The skin may also become glossy or unusually dark or light in places. The disease can sometimes result in changes is personal appearance, especially in the face. When the skin becomes extremely tight, the function of the area affected can be reduced (for example, fingers).
• Enlarged red blood vessels on the hands, face and around nail beds (called "telangiectasias").
• Calcium deposits in the skin or other areas.
• High blood pressure from kidney problems.
• Heartburn; this is an extremely common problem in scleroderma.
• Other problems of the digestive tract such as difficulty swallowing food, bloating and constipation, or problems absorbing food leading to weight loss.
• Shortness of breath.
• Joint pain.

HOW IS SCLERODERMA TREATED?

While some treatments are effective in treating some aspects of this disease, there is no drug that has been clearly proven to stop, or reverse, the key symptom of skin thickening and hardening. Medications that have proven helpful in treating other autoimmune diseases, such as rheumatoid arthritis and lupus, usually don't work for people with scleroderma. Doctors aim to curb individual symptoms and prevent further complications with a combination of drugs and self-care. For example:

Raynaud's phenomenon can be treated with drugs such as calcium channel blockers or drugs called PDE-5 inhibors - sildenafil (Viagra®), tadalafil (Cialis®) - which open up narrowed blood vessels and improve circulation. To prevent further damage, it's important to keep the whole body warm, especially fingers and toes. It's also important to protect fingertips and other skin areas from injury, which can happen even during normal daily activities.

Heartburn (acid reflux) can be treated with antacid drugs, especially proton-pump inhibitors (omeprazole and others). These medications ease gastro-esophageal reflux disease (known as GERD).

Scleroderma kidney disease can be treated with blood pressure medications called "angiotensin converting enzyme inhibitors" (ACE inhibitors). These can often effectively control kidney damage if started early and use of these drugs has been a major advance for treating scleroderma.

Muscle pain and weakness can be treated with anti-inflammatory drugs such as glucocorticoids (prednisone), intravenous immunoglobin (IVIg), and/or immunosuppressive medications. Physical therapy may be useful to maintain joint and skin flexibility.

Lung damage. There are two types of lung disease that patients with scleroderma may develop. The first type is called interstitial lung disease (scarring). There is evidence that cyclophosphamide is somewhat effective in treating the interstitial lung disease in scleroderma. Clinical trials are underway assessing the effectiveness of several other drugs for this problem.

The second type of lung disease seen in scleroderma is pulmonary arterial hypertension (high blood pressure in the arteries in the lungs). In the last 10 years, a number of drugs have become available to treat this condition, including prostacyclin-like drugs (epoprostenol, treprostinol, iloprost), the endothelin receptor antagonists (bosentan, ambrisentan), and PDE-5 inhibitors (sildenafil, vardenafil, tadalafil).

Much research is ongoing into new treatments for scleroderma. Patients and their families should know that experts remain optimistic and take comfort in the fact that work towards a cure will continue.

BROADER HEALTH IMPACT OF SCLERODERMA

Scleroderma can involve almost every organ system in the body. Although symptoms vary greatly from patient to patient, it can dramatically impact someone's life.

Patients should consult a rheumatologist—or a team of specialists---who are experienced in dealing with this complicated disease. Several other diseases that affect the skin are sometimes confused with scleroderma.

LIVING WITH SCLERODERMA

Living with scleroderma is quite challenging. Everyday activities can sometimes be difficult due to physical limitations and pain. Problems with digestion may require changes in diet; patients often have to eat several small meals rather than fewer large meals. Patients must also keep the skin well-moisturized to lessen stiffness and be careful during activities such as gardening, cooking—even opening envelopes---to avoid finger injuries. To keep the body warm, patients should dress in layers; wear socks, boots and gloves; and avoid very cold rooms. Unfortunately, moving to a warmer climate does not necessarily lead to dramatic improvement. Exercise and/or physical therapy may ease stiffness in the joints.

Patients must also deal with the psychological setbacks that come from living with a disease that is chronic, uncommon and currently incurable. Because scleroderma can cause significant changes in appearance, a patient's self-esteem and self-image are almost always affected. The support of family and friends is vital in helping to maintain a good quality of life.

POINTS TO REMEMBER

• Scleroderma differs from person to person but can be very serious.
• There are medications, as well as steps individuals can take, to ease the symptoms of Raynaud's phenomenon, skin problems and heartburn.
• Effective treatments are available for those with severe disease, including acute kidney disease, pulmonary hypertension, lung inflammation and gastrointestinal problems.
• It is important to recognize and treat organ involvement early on to prevent irreversible damage.
• Patients should see physicians with specialized expertise in the care of this complex disease.
• A great deal of research is underway to find better treatments for scleroderma and, hopefully, someday a cure.

TO FIND A RHEUMATOLOGIST

For a listing of rheumatologists in your area, click here.

Learn more about rheumatologists and rheumatology health professionals.

FOR MORE INFORMATION

The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

The Scleroderma Foundation
www.scleroderma.org

International Scleroderma Network
www.sclero.org

Scleroderma Clinical Trials Consortium
www.sctc-online.org

Scleroderma Research Foundation
www.sclerodermaresearch.org

The Arthritis Foundation
www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
www.niams.nih.gov/Health_Info/Scleroderma/default.asp

Discover Myocarditis

Discover Myocarditis Causes, Symptoms, Diagnosis and Treatment

About Myocarditis

Myocarditis is a disease marked by inflammation and damage of the heart muscle. Although the exact incidence of myocarditis is not known, it is estimated that several thousand patients per year are diagnosed in the United States. Myocarditis usually attacks otherwise healthy people. It is believed that 5 to 20% of all cases of sudden death in young adults are due to myocarditis.

There are many causes of myocarditis, including viral infections, autoimmune diseases, environmental toxins, and adverse reactions to medications. The prognosis is variable but chronic heart failure is the major long term complication. Myocarditis and the associated disorder of idiopathic dilated cardiomyopathy are the cause of approximately 45% of heart transplants in the United States.

This information is meant to help you understand myocarditis. If you have questions about this information or about your condition, talk to a member of your health-care team.

More Myocarditis Information

• Myocarditis and Giant Cell Myocarditis Brochure (PDF, 1 MB)
• Pediatric Myocarditis Brochure (PDF, 623 KB)
• Myocarditis and Sudden Death Fact Sheet (PDF, 117 KB)

About Your Heart

Your heart is a four-chambered, muscular pump about the size of an adult fist. Normally, the heart beats 60 to 100 times per minute, pumping blood throughout your body with each beat.

Two upper heart chambers called the right and left atria (each is called an atrium) receive blood that returns to the heart from the body. Veins carry this returning blood to the atria. When the muscles of the atria contract, blood is squeezed into the two larger, lower heart chambers called the right and left ventricles. When the muscles of the ventricles contract, blood is propelled through arteries to the entire body. The pumping of the ventricles creates the pulse you feel in your wrist or neck.

What is Myocarditis?

Myocarditis in a mouse heart. Cardiac inflammation stains purple.

Myocarditis is uncommon and can be caused by a viral infection or a self-directed immune response (this is when the person’s own immune system attacks the body, such as in autoimmune diseases like rheumatoid arthritis or lupus). Some autoimmune diseases can affect the heart and cause myocarditis. Rare cases have also been associated with a variety of infections, toxic injuries, adverse drug reactions, and even cancer.

Most cases of myocarditis have no symptoms and are only identified by an electrocardiogram or by blood tests that detect heart injury.

Because myocarditis is rare, the best way to diagnose and treat the disease is not known, but research is being done.

What Causes Myocarditis?

Myocarditis can be caused by many viruses, but the most common are those associated with upper respiratory tract infections. Less commonly, other contagious diseases, including Lyme disease, may cause myocarditis. Rarely, myocarditis has been caused by cocaine use or exposure to toxic agents including metal poisons or snake or spider bites.

Most cases of myocarditis are not infectious. There is no known risk of infection to family members of people with myocarditis.

What are the Symptoms of Myocarditis?

The most common symptom of myocarditis is shortness of breath during exercise or exertion. This symptom usually develops 7 to 14 days after a viral illness and can progress to shortness of breath at night, which may require that you sit up to breathe.

Other symptoms may include fatigue, heart palpitations and chest pain or pressure. The legs also may swell. Rarely, myocarditis causes a sudden loss of consciousness that may be due to abnormal heart rhythms. In summary, patients may experience some, all or none of the following symptoms: shortness of breath, chest pain, lightheadedness, irregular heartbeat, sudden loss of consciousness.

How is Myocarditis Diagnosed?

The majority of cases of myocarditis have no symptoms and are not diagnosed.  However, when a person develops symptoms, common tests for myocarditis include the following:

• An Electrocardiogram
  Electrical activity of your heart is detected by electrodes taped to your skin. This activity is recorded as waves that represent the electrical forces in the different parts of the heart.
• A Chest X-Ray
  A chest X-ray produces an image on film that outlines your heart, lungs and other structures in your chest. From a chest X-ray, your physician learns information such as the size and shape of your heart.
• An Echocardiogram (abbreviated echo)
  Sound waves (too high-pitched to be heard) are used to make an image of your heart or analyze blood flow. The sound waves are sent into your body from a transducer, a small plastic device. The sound waves are reflected back from internal structures, returning to the transducer and producing images of the heart and its structures.
• Less frequently, a cardiac magnetic resonance imaging (MRI) scan may be done to diagnose myocarditis. An MRI creates images using a magnetic field and radio waves.
• Occasionally, a heart biopsy is required to confirm the diagnosis.

How is Myocarditis Treated?

Myocarditis is commonly treated with medications used to treat heart failure. Rest and a low-salt diet are often recommended. Steroids and other medications also may be used to reduce heart inflammation.

More rarely, if an abnormal heart rhythm is present, treatment may require additional medications, a pacemaker or even a defibrillator.

Discuss treatment options with your health-care team.

What are the Long-Term Effects of Myocarditis?

The long-term effects of myocarditis are highly variable. Many people recover heart function without long-term negative health effects and without a return of symptoms. In a minority of cases, heart function may not improve after myocarditis, and the individual can require long-term medical therapy and sometimes heart transplantation.

Can Myocarditis Recur?

Yes, myocarditis can recur, and in some cases can lead to a chronically enlarged heart (called dilated cardiomyopathy). There is no known way to prevent recurrence of myocarditis. However, the risk of recurrence is low (probably about 10 to 15 percent).

What Can be Done to Prevent Myocarditis?

No lifestyle changes or medical treatments are known to prevent viral myocarditis.

Because myocarditis is rare, information is limited regarding its causes and effective treatments. Myocarditis is not believed to be inherited. No genes are known to predispose people to myocarditis

Ejection Fraction - Explanation of Normal and Abnormal Range

Ejection Fraction (EF) is one of the measurements used by physicians to assess how well a patient's heart is functioning. "Ejection" refers to the amount of blood that is pumped out of the heart's main pumping chamber during each heartbeat. "Fraction" refers to the fact that, even in a healthy heart, some blood always remains within this chamber after each heartbeat. Therefore an ejection fraction is a percentage of the blood within the chamber that is pumped out with every heartbeat. Knowing your ejection fraction can save your life - because there are numerous treatment options.

Do You Know Your Ejection Fraction?

Heart failure occurs when one of the heart's pumping chambers is not pumping well enough to meet the body's needs.

Ejection fraction is an important tool in the diagnosis and monitoring of the heart and certain types of cardiomyopathies. Cardiomyopathy is a condition in which the heart is abnormally enlarged, thickened or stiffened.

An EF of 55 to 75 percent is considered normal. A higher than normal ejection fraction could indicate the presence of certain heart conditions, such as hypertrophic cardiomyopathy.

A low ejection fraction could be a sign that the heart is weakened. A low ejection fraction may result from some kind of cardiomyopathy, a condition in which the heart is abnormally enlarged, thickened or stiffened. Low EF is an important risk factor for sudden cardiac death (SCD), a condition that occurs when the heart stops abruptly (cardiac arrest). Patients with a low EF are significantly more likely to suffer sudden cardiac death within two years than patients with a normal ejection fraction.

Normal Ejection Fraction and Heart Failure

While an ejection fraction is a tool to diagnose systolic heart failure, or heart failure that occurs during the pumping phase of the heart beat, it is possible for a person to have heart failure without having an abnormal ejection fraction.

There are two phases to the heart's pumping motion. First is the filling phase (diastole) in which the heart chamber fills with blood. Second is the emptying phase (systole) in which the blood is pumped out of the chamber to the body. An ejection fraction is a measurement of the amount of blood pumped out during this second, emptying stage.

Heart failure may be caused by problems with the heart's emptying phase, its filling phase or with both phases. Therefore, a person whose heart failure is caused by a problem with the filling phase (diastolic heart failure) could have a normal ejection fraction. Diastolic heart failure is the most common form of heart failure.

An ejection fraction of less than 40 may indicate heat failure, a chronic condition in which at least one heart chamber is not pumping well enough to meet the body's needs. Heart failure leads to congestion of blood vessels and fluid backup and swelling in the lungs, legs and ankles, shortness of breath and fatigue. An ejection fraction lower than 40 percent may indicate damage to the heart muscle (e.g., from a prior heart attack). Typically, this EF level alone is not low enough to lead to heart failure.

How to Measure Your EF

An ejection fraction is most commonly measured during anechocardiogram. This painless and noninvasive test uses high-frequency sound waves (ultrasound) to get a picture of the four heart chambers and the four heart valves.

Ejection fraction can also be measured as part of other diagnostic testing, such as:

• MUGA Scan: A type of radionuclide imaging test that provides clear pictures of blood flow through the heart's chambers and blood vessels.


• Cardiac Catheterization: A test in which a catheter is inserted into a blood vessel and guided all the way to the heart in order to obtain information about the heart and the coronary arteries, increasingly, this test is being replaced by noninvasive methods to measure ejection fraction.


• Nuclear Stress Test: An exercise stress test performed before and after the administration of a radionuclide tracer. It creates images of the heart before, during and after physical exertion. Therefore, an ejection fraction may be obtained at both rest and during exercise. This approach offers a very sensitive way to identify heart pump function.


• Cardiac Magnetic Resonance Imaging (MRI): A test that uses powerful magnets to visualize the heart's structure. This test has very good resolution, but the patient is required to hold their breath during the test, a feat that may be difficult for patients with heart failure Also, because this is newly adapted technology to measuring ejection fraction, it remains an expensive test that requires specialized training.

Signs and Symptoms of Low EF

Knowing the signs and symptoms of your EF is important, as low EF can be an indication of impending heart failure. Those symptoms include:

• Shortness of breath or inability to exercise
• Swelling (edema) of the feet and lower legs
• Fatigue and weakness
• Rapid, forceful, uncomfortable or obviously irregular heartbeat (palpitation)
• Abdominal discomfort such as swelling, pain or nausea
• Mental confusion

Some patients have a very low EF (less or equal to 30) and still show minimal or even no symptoms.

Other signs of heart failure or cardiomyopathy may also accompany a low ejection fraction. These include:

• An abnormal heart murmur (due to a heart valve disorder)
• A crackling sound of fluid in the lungs (rates) due to pulmonary congestion
• A rapid heartbeat (tachycardia) or other abnormal heart rhythms (arrhythmia)
• Hypertrophy or enlargement of the heart
• Liver malfunction
• Congestion of the lungs
• Swollen neck veins due to fluid retention with accompanying weight gain and ankle swelling

Acute Coronary Syndrome

So you’ve never heard of an acute coronary syndrome. But what aboutheart attack, or unstable angina? Those well-known conditions are both acute coronary syndromes, an umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked.

“This is an absolute medical emergency. Something dramatic, right this minute is going on in the arteries that is hurting the blood flow to the heart,” said Ann Bolger, M.D., a cardiologist at San Francisco General Hospital and a member of the American Heart Association’s Council on Clinical Cardiology. 

The blockage can be sudden and complete, or it can come and go – clot, break open, then clot again. “In either case, the heart tissue is dying, even if it’s just a few cells or a whole big section of the heart,” Bolger said.

Doctors use the broad term regularly, but usually only among themselves and in the medical literature. “It’s like describing a North American state rather than just saying Texas,” Bolger said. “I don’t think too many doctors say, ‘You’re having an acute coronary syndrome.’ They say, ‘You’re having a heart attack.’”

What are the symptoms?
Chest pain or discomfort may immediately signal to you that something’s wrong with your heart. Other symptoms, however, may leave you unsure of what’s wrong. Take note of these common signs of an acute coronary syndrome:

• Chest pain or discomfort, which may involve pressure, tightness or fullness
• Pain or discomfort in one or both arms, the jaw, neck, back or stomach
• Shortness of breath
• Feeling dizzy or lightheaded
• Nausea
• Sweating

These symptoms should be taken seriously. If you experience chest pain or other symptoms, call 9-1-1 immediately. “People are in denial and they’re sitting there thinking, ‘This can’t really be happening to me,’” Bolger said. “We want them to feel entitled to call 9-1-1. They’re not being alarmist.”

Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain can be unpredictable or get worse even with rest, both hallmark symptoms of unstable angina. People who experience chronic chest pain resulting from years of cholesterol buildup in their arteries can develop an acute coronary syndrome if a blood clot forms on top of the plaque buildup.

How is it diagnosed and treated?
To determine what’s causing your symptoms, a doctor will take a careful medical history and give you a physical examination. If the doctor suspects an acute coronary syndrome, the following tests will be performed:

• A blood test can show evidence that heart cells are dying.
• An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring the heart’s electrical activity.

If tests confirm blood flow to the heart has been blocked, doctors will work quickly to reopen the artery. “Minute by minute, the heart is accumulating irreversible damage. So time is myocardium – myocardium being the heart muscle itself,” Bolger said.

At San Francisco General Hospital, the goal is to have the artery reopened within an hour of the patient entering the hospital, Bolger said. Generally, patients do best when the artery is reopened within four hours of the first symptoms.

Treatment for acute coronary syndrome includes medicines and a procedure known as angioplasty, during which doctors inflate a small balloon to open the artery (View an illustration of coronary arteries). A stent, a wire mesh tube, may be permanently placed in the artery to keep it open. For hospitals not equipped to do angioplasty quickly, drugs may be used to dissolve blood clots, but more hospitals are making the procedure available in a timely manner, Bolger said.

Am I at risk?
Acute coronary syndromes, just like heart failure and stroke, are much more likely in people who have certain risk factors. These include:

• Smoking
• High blood pressure
• High blood cholesterol
• Diabetes
• Physical inactivity
• Being overweight or obese
• A family history of chest pain, heart disease or stroke

Your primary care doctor can help you understand your personal risk and what you can do about it. “[The physician] should also be the one to say, ‘By the way, if you ever have any of these symptoms, I want you to call 9-1-1,’” Bolger said. “If someone has told you that in advance, you’re much more likely to do it.”

What Is Stable Angina

What Is Stable Angina?

Angina is a type of chest pain caused by reduced blood flow to the heart. Lower blood flow means your heart isn’t getting enough oxygen. This pain often occurs with physical activity or stress.

Stable angina, also called angina pectoris, is the most common kind of angina. Stable angina is a predictable pattern of chest pain. You can usually track the pattern based on what you are doing when you feel chest pain. Tracking stable angina can help you manage your symptoms more easily.

Unstable angina is another condition, which does not follow a predictable pattern. Both forms of angina can be a symptom of an underlying heart disease.

Part 2 of 6: Causes

Causes of Stable Angina

Stable angina occurs when the heart does not get the oxygen it needs to do the work it is being asked to do. When you exercise, lift heavy items, or otherwise stress your body, your heart works harder to accommodate the additional exertion.

Certain factors can impede your heart from receiving more oxygen, such as a narrowing of thearteries (atherosclerosis). Your arteries can become narrow when plaque (a substance made of fat, cholesterol, calcium, and other substances found in blood) builds up inside them, usually due to high cholesterol. Blood clots can also block your arteries and reduce the flow of oxygen-rich blood to the heart.

Risk factors for stable angina include

• being overweight
• having a history of heart disease
• having high cholesterol or blood pressure
• being diabetic
• smoking
• not exercising enough

Additional risk factors can include any situation that requires your heart to need more oxygen. Big meals, prolonged exposure to extreme hot or cold weather, vigorous physical workouts, and emotional stress can also induce stable angina in some cases.

You can develop stable angina even if you do not have any of the signs of heart disease, such as shortness of breath and pain, numbness, weakness, or coldness in legs and arms. According to the National Institutes of Health, men are more likely to develop stable angina than women (NIH, 2011).

Part 3 of 6: Symptoms

Symptoms of Stable Angina

Many people who have stable angina describe the pain as a large area of pressure on the chest. The pain can feel like a vice squeezing your chest and can radiate to your neck, arms, shoulders, and jaw. During an episode of stable angina, you may also experience

• shortness of breath
• nausea
• fatigue
• dizziness
• profuse sweating
• anxiety

Stable angina most often happens after you have exerted yourself physically. The symptoms tend to be short-lived, lasting up to 15 minutes in most cases. This is different from other forms of angina, in which the pain can be more severe and long-lasting.

The NIH explains that you can have an episode of stable angina at any time of day. However, you are more likely to experience symptoms in the morning (NIH, 2011).

Part 4 of 6: Diagnosis

Diagnosing Stable Angina

Your doctor will take your medical history and run some tests to diagnose stable angina: Anelectrocardiogram test measures your heart’s electrical activity and beating pattern; anangiography is a type of X-ray that lets your doctor see how blood flows to your heart.

These tests can determine if your heart is functioning properly and if any arteries are blocked.

You may also be asked to take a stress test to diagnose stable angina. During a stress test, you exercise while your heart function is measured. Because stable angina usually happens while you participate in physical activity, this type of test helps your doctor see what triggers your symptoms.

Your doctor also might run blood tests to measure your cholesterol and levels of a protein called C-reactive protein (CRP). According to the National Heart Lung and Blood Institute, high levels of CRP can increase your risk of developing heart disease (NHLBI, 2011).

Part 5 of 6: Treatment

Treatment of Stable Angina

Stable angina is treated through medical measures and lifestyle changes. You can usually predict when the pain will occur, so you can scale back on physical exertion as needed to manage your chest pain. Discuss your diet and exercise routine with your healthcare provider to determine how you can adjust your lifestyle in a healthy manner.

Lifestyle

Daily exercise can help you lose weight if needed, which also reduces your risk for chronic illness. Diabetes, heart disease, high cholesterol, and hypertension (high blood pressure) can all affect stable angina and other forms of heart disease. Quit smoking if you are a current smoker.

Medication

A medication called nitroglycerin is effective in relieving the pain of stable angina. Your doctor will tell you how much nitroglycerin to take when you have an angina attack. Place the nitroglycerin under your tongue, and let it dissolve to be absorbed into your body.

You might need to take other drugs to manage underlying conditions that contribute to stable angina. Consult your doctor if you have high blood pressure, high cholesterol, or diabetes. Medications to stabilize your blood pressure, cholesterol, and glucose levels can reduce your risk of angina. Blood-thinning medication can prevent blood clots, a contributing factor in stable angina.

Surgery

Arteries that are blocked may need to be repaired to prevent angina pain. During a procedure called angioplasty, a surgeon threads a very thin tube through your artery. At the end of the tube is a piece of mesh called a stent. The stent is permanently placed in your artery to keep the passageway open.

Part 6 of 6: Outlook

Long-Term Outlook for Patients With Stable Angina

Stable angina usually responds well to lifestyle modification and medication. Patients who are unable to transition to a healthier lifestyle may continue to struggle with angina pain and an increased risk of heart disease. Possible complications include

• heart attack
• sudden death caused by abnormal heart rhythms
• unstable angina

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Article Sources:

• Angina (2011, June 24). Mayo Clinic. Retrieved June 28, 2012, fromhttp://www.mayoclinic.com/health/angina/DS00994
• Heart Disease. (2011, Jan. 12). Mayo Clinic. Retrieved July 3, 2012, fromhttp://www.mayoclinic.com/health/heart-disease/ds01120/dsection=symptoms
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