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Localized abdominal pain
Have chest pain
Shortness of breath
Chest pain on left side
Heart palpitations
Chest pain caused by exercise
Tight feeling in the chest
Not seeing your symptoms? No worries!
Stable angina is caused by a blockage in the heart arteries, affecting the blood supply to the heart. It is characterized by short episodes of chest pain that go away on their own. It may be triggered by physical exertion and/or stress. Risk factors include high cholesterol, high blood pressure, diabetes, obesity, and smoking.
Your doctor may ask these questions to check for this disease:
Treatment involves medications to relieve pain during an episode. Surgery and other procedures may be needed to treat the artery blockages. Treating or controlling risk factors like diabetes, high blood pressure, and high cholesterol with medication and a healthy lifestyle is important.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Tatsuya Shiraishi, MD (Cardiology)
Dr. Shiraishi graduated from the Kyoto University School of Medicine. He worked as a cardiologist at Edogawa Hospital, and after joining Ubie, he became the Director of East Nihonbashi Internal Medicine Clinic.
Content updated on Jan 14, 2025
Following the Medical Content Editorial Policy
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Q.
Angina Not Improving? Why Ranolazine Works & Your Medical Next Steps
A.
Ranolazine can reduce persistent stable angina by blocking the late sodium current to prevent calcium overload, improving heart relaxation and oxygen efficiency without significantly lowering heart rate or blood pressure, making it a useful add-on when beta blockers, calcium channel blockers, or nitrates are not enough, including in microvascular angina. Next steps include tracking your symptoms, reviewing medications and risk factors with your clinician, asking if you are a candidate for ranolazine and about interactions and QT monitoring, considering stress testing or coronary imaging if symptoms persist, and seeking urgent care for chest pain at rest or that changes; there are several factors to consider, and important details that could change your plan are explained below.
References:
* Chaitman, B. R. (2006). Ranolazine for the treatment of chronic angina pectoris. *Circulation*, *113*(20), 2462-2472.
* Ranade, V., & Das, S. (2014). Ranolazine: a new approach to the treatment of chronic stable angina. *Cardiology in Review*, *22*(1), 40-47.
* Kosiborod, M., et al. (2014). Ranolazine in patients with chronic stable angina: a pooled analysis of six placebo-controlled clinical trials. *Journal of the American College of Cardiology*, *64*(25), 2690-2701.
* Stone, P. H., et al. (2018). Ranolazine for the treatment of refractory angina. *Expert Review of Cardiovascular Therapy*, *16*(3), 209-221.
* Knuuti, J., et al. (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. *European Heart Journal*, *41*(3), 407-477.
Q.
Angina Pain? Why Isosorbide Mononitrate Is Key & Medically Approved Next Steps
A.
Isosorbide mononitrate is a cornerstone, guideline recommended medication that prevents stable angina by relaxing blood vessels, lowering heart workload, and reducing chest pain episodes. It is for prevention only, not for stopping sudden pain; use fast acting nitroglycerin for active symptoms and seek emergency care if pain is new, severe, at rest, or not relieved. There are several factors to consider, including common headaches and dizziness, nitrate free dosing intervals, serious interactions with erectile dysfunction drugs, and the need for broader heart risk management with other meds, lifestyle changes, and possible procedures. See below for complete, medically approved next steps and exactly when to call a doctor.
References:
* Parker JD, et al. Isosorbide mononitrate in the management of stable angina pectoris: a review. Drugs. 2002;62(1):15-30. PMID: 11794273.
* Montalescot G, et al. Long-acting nitrates in stable angina: an historical overview and up-to-date look at the current evidence. Eur Heart J. 2012 Sep;33(18):2298-307. PMID: 22646690.
* Kaski JC, et al. Efficacy of isosorbide mononitrate for chronic stable angina pectoris: a multicenter study. Am J Cardiol. 1996 Dec 15;78(12):1358-63. PMID: 8982461.
* Ferrari R, et al. Oral sustained-release isosorbide mononitrate in patients with stable angina pectoris. Am J Cardiol. 1996 Apr 15;77(10):900-5. PMID: 8617593.
* Jänicke J, et al. The pharmacology and clinical efficacy of isosorbide mononitrate. Clin Pharmacokinet. 1992 Jul;23(1):31-50. PMID: 1376813.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Joshi PH, de Lemos JA. Diagnosis and Management of Stable Angina: A Review. JAMA. 2021 May 4;325(17):1765-1778. doi: 10.1001/jama.2021.1527. PMID: 33944871.
https://jamanetwork.com/journals/jama/article-abstract/2779543Ferraro R, Latina JM, Alfaddagh A, Michos ED, Blaha MJ, Jones SR, Sharma G, Trost JC, Boden WE, Weintraub WS, Lima JAC, Blumenthal RS, Fuster V, Arbab-Zadeh A. Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Nov 10;76(19):2252-2266. doi: 10.1016/j.jacc.2020.08.078. PMID: 33153586.
https://www.sciencedirect.com/science/article/pii/S0735109720371850?via%3DihubAl-Lamee R, Thompson D, Dehbi HM, Sen S, Tang K, Davies J, Keeble T, Mielewczik M, Kaprielian R, Malik IS, Nijjer SS, Petraco R, Cook C, Ahmad Y, Howard J, Baker C, Sharp A, Gerber R, Talwar S, Assomull R, Mayet J, Wensel R, Collier D, Shun-Shin M, Thom SA, Davies JE, Francis DP; ORBITA investigators. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018 Jan 6;391(10115):31-40. doi: 10.1016/S0140-6736(17)32714-9. Epub 2017 Nov 2. Erratum in: Lancet. 2018 Jan 6;391(10115):30. PMID: 29103656.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32714-9/fulltextSalazar CA, Basilio Flores JE, Veramendi Espinoza LE, Mejia Dolores JW, Rey Rodriguez DE, Loza Munárriz C. Stable angina pectoris. Cochrane Database Syst Rev. 2017 Feb 8;2(2):CD011747. doi: 10.1002/14651858.CD011747.pub2. PMID: 28178363; PMCID: PMC6373632.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011747.pub2/full