What are the characteristics of stable angina?

The occurrence of stable angina pectoris actually has a strong negative impact on the heart. Stable angina pectoris is relatively stable because the attacks of angina pectoris are relatively regular or stable. The nature of angina pectoris actually varies for each patient in terms of the degree of pain, which is determined based on the physical condition of each patient.

Stable angina pectoris is the most common type of angina pectoris in clinical practice. It refers to a relatively stable condition over a considerable period of time (in 1979, WHO stipulated that the course of disease should be stable for more than one month), and the frequency, duration, causes and relief of angina pectoris are all quite fixed. Its stability has two meanings: one is that the condition is stable; the other is that the coronary atherosclerotic plaque is stable, without unstable factors such as ulceration, rupture, dissection and thrombosis. The pathological basis of stable angina pectoris is fixed stenosis caused by atherosclerotic plaques in the coronary arteries.

Typical angina pectoris has the following characteristics:

(1) Nature of angina pectoris: The severity of pain in each attack may vary for the same patient, but the nature of the pain is basically the same. Patients often describe it as "pressure", "squeezing", "suffocation", "constriction", "bursting" and "burning". Knife-like or needle-like pain is usually not angina pectoris. Sometimes patients simply refer to their pain as chest discomfort when they are unable to describe the nature of the pain. The patient generally points to the site of discomfort with his entire palm or fist and rarely with a single finger.

(2) Location and radiation of angina pectoris: Most cases of angina pectoris are located in the left chest area behind the sternum, but can also be anywhere between the upper abdomen and pharynx and between the bilateral anterior axillary lines. More than half of patients have radiating pain. The inner upper arm is a common location (this is very helpful in distinguishing angina pectoris from cervical spondylosis, as the pain of the latter radiates to the outer side of the upper arm). In a few cases, the pain starts in the upper arm and then radiates to the front chest. In the same patient during the same period, the location of pain is mostly fixed. If the location enlarges and the number of radiating sites increases, it indicates that the disease is worsening; variable locations of chest pain do not support angina pectoris. The area of ​​angina pectoris can be as small as a fist, or as large as a whole area, or even spread over the entire chest; if the chest pain is distributed in dots or lines, it does not support angina pectoris.

(3) Causes of angina pectoris: The most common triggers of angina pectoris are physical stress or emotional excitement, such as walking up stairs or uphill in a hurry. This chest pain occurs when exertion occurs rather than afterward, and the symptoms often disappear quickly after cessation of activity. Angina pectoris often worsens when walking against the wind, in the cold, or after a full meal. Angina pectoris tends to worsen under physical stress with emotional factors. It should be pointed out that the intensity of exertion that is sufficient to induce angina pectoris in the same patient may vary from day to day and may also be different on the same day. The reasons for this can be explained by careful inquiry into the medical history, such as mealtimes, weather, emotional excitement, etc.

The threshold for angina pectoris is lower in the morning than at any other time of the day. Therefore, patients often find that they can experience angina pectoris when they first engage in a certain activity in the morning, but not when they engage in the same activity at other times or later. If the threshold for any type of angina pectoris varies greatly and is more pronounced at rest, the possibility of coronary artery spasm should be considered. Therefore, a careful history may reveal not only the cause of the pain (eg, myocardial ischemia) but also clues to the mechanism of ischemia (eg, coronary artery spasm and/or organic obstruction).