Department of cardiac muscle pathology and transplantation of organs and tissues

Stable angina

Angina at rest: etiology, clinic, diagnosis and treatment.

Angina at rest (AR) is one of the forms of IHD, in which severe attacks of anginal pain develop for no apparent reason. Pain syndrome occurs in a state of rest, and during sleep. Acute myocardial infarction is a severe consequence of the AR.


The leading factor of the AR development is atherosclerotic lesion of the coronary arterial bed. Occlusion of the vessel lumen by more than 75% in combination with other factors leads to the onset of pain syndrome. An important role in the development of the AR is assigned to parasympathetic hyperstimulation. Angina of rest, accompanying angina pectoris, showes the worsening of ischemic heart disease.
Spontaneous coronarospasm (Prinzmetal's angina), aortic valve (orifices) diseases, coronaryitis, congenital coronary artery disease, hypertrophic cardiomyopathy, primary hypertension of the small and large blood circulation, postinfarction cardiosclerosis can also lead to the development of the AR.
The risk factors are the same as in case of IHD.


Angina at rest is characterized by the development of a severe pain attack in the precardial region with irradiation in the left arm, scapula, left half of the lower jaw, neck, supraclavicular area, and sometimes the upper abdomen. The pain is compressed, burning and accompanied by a fear of death. Also the vegetative reactions in the form of weakness, changes in skin color, nausea, dizziness, changes in heart rate, blood pressure appear. During an attack the patient is motionless, looks at one point, until the pain ceases (" shop window" symptom). The duration of an attack can be from 5 to 15-30 minutes and be stopped with 2-3 tablets of nitroglycerin.


  • Laboratory tests (creatinine, creatine kinaze, transaminases, cholesterol and lipoproteinogram with determination of the Atherogenic Index, coagulation profile);
  • ECG, echocardiography;
  • Holter monitoring;
  • Coronary angiography;
  • Scintigraphy, PET of the heart.


Medicinal treatment consists in an emergency relief of an anginal pain attack with nitrate preparations. If inefficiency the neuroleptanalgesia is used. Antiplatelet agents, beta-blockers, statins are commonly used.
Surgical treatment is performed in accordance with the data of coronary angiography in order to restore the impaired coronary blood flow: stenting of occluded areas, bypassing with an autotransplantation (CABG, MCB) are used.



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