Cardiology
Stable Angina
안정형협심증
Predictable exertional chest pain relieved by rest
- How common
- 30-40% of CAD patients
- Typical age
- Ages 50-70
What is it?
Stable plaque causing fixed stenosis (>70%) → demand-supply mismatch with exertion → transient ischemia.
Commonly affected: Myocardium supplied by stenotic artery
How it develops
- Stable plaqueThick fibrous cap, small lipid core
- Fixed stenosis70-90% stenosis (adequate at rest)
- Exertional demandHR and BP rise with exertion
- Supply-demand mismatchCoronary dilation limited → ischemia
Symptoms
- Exertional chest painStairs, brisk walking
- Relief within 5 minWith rest or nitroglycerin
- Predictable thresholdConsistent exertion threshold
- Possible radiationL arm, jaw
How it is examined
- Resting ECGOften normal; Q waves/ST changes possible
- Exercise stress testST depression ≥1mm = positive
- EchocardiogramWall motion, EF assessment
Imaging
Exercise stress test first; pharmacologic stress also possible.
- Positive ST depression
Coronary CTA or invasive angiography.
- Stenosis location/severity
Non-surgical care
- Aspirin + statinAntiplatelet + high-intensity statin
- Beta-blockerHR control, reduce O2 demand
- Sublingual NTGUse during attacks
- ACE inhibitorCardiovascular protection
- Lifestyle modificationSmoking cessation, exercise, weight loss, diet
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed medical therapy or left main/multivessel disease
Procedures that may be discussed
- PCI (1-2 vessel disease)
- CABG (left main, 3VD, DM)
Outlook
~95% 5-yr survival with medical therapy; aggressive risk factor control essential.