Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Stable CAD and Chronic Angina

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In one line

·Stable coronary artery disease (CAD) means plaque has narrowed the heart's arteries, causing chest pain or pressure with exercise that stops when you rest — fix it with aspirin, a statin, blood-pressure control, and sometimes a procedure to open the artery.

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Normal physiology

·The heart is a muscular pump that works every second of your life, and it feeds itself through three main arteries (the right coronary artery, the left anterior descending artery, and the left circumflex artery) that branch off the aorta and wrap around the heart like a crown — delivering oxygen-rich blood to every squeeze.

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What goes wrong

·Fatty plaque builds up on the inside walls of the coronary arteries, narrowing the channel and blocking extra blood from reaching the heart muscle when demand goes up.

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Hallmark signs

·Chest pressure or tightness that starts with effort and stops with rest
·Pain or heaviness that spreads to the left arm, jaw, neck, or back
·Shortness of breath during activity
·Symptoms that go away within a few minutes of stopping the activity
·Symptoms triggered the same way each time — for example, always after climbing two flights of stairs or walking uphill
·Relief within minutes of taking nitroglycerin under the tongue
·A resting EKG that looks normal
·Chest pain that happens at rest, lasts longer than usual, or comes on with less effort than before

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Red flags · escalate now

·Chest pain that starts at rest or wakes you from sleep
·Pain that lasts longer than 10–15 minutes or does not go away with rest or nitroglycerin
·New shortness of breath at rest, sweating, nausea, or feeling like you might pass out
·Pain that is suddenly much worse or comes on with far less effort than your usual pattern

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Workup

·Lipid panel (total cholesterol, LDL, HDL, triglycerides)
·Hemoglobin A1c
·Basic metabolic panel (sodium, potassium, creatinine, eGFR)
·Thyroid-stimulating hormone (TSH)
·Exercise stress EKG (treadmill test) or pharmacologic stress test (if the patient cannot exercise)
·Coronary CT angiography (CCTA) or invasive coronary angiography
·High-sensitivity troponin (if chest pain is new, changing, or not clearly stable)

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Treatment

·Aspirin 81 mg once daily (or clopidogrel 75 mg if aspirin allergy)
·High-intensity statin: atorvastatin 40–80 mg or rosuvastatin 20–40 mg once daily
·Beta-blocker (e.g., metoprolol succinate 25–200 mg daily or carvedilol 3.125–25 mg twice daily)
·Sublingual nitroglycerin 0.4 mg as needed for acute chest pain (patient keeps it in pocket), plus long-acting nitrate (e.g., isosorbide mononitrate 30–120 mg daily) if symptoms are frequent
·ACE inhibitor (e.g., lisinopril 5–40 mg daily) or ARB (e.g., losartan 25–100 mg daily) if the patient also has high blood pressure, diabetes, reduced heart function (EF < 40%), or prior heart attack
·Calcium channel blocker (e.g., amlodipine 5–10 mg daily or diltiazem 120–360 mg daily) if beta-blockers are not tolerated or if symptoms persist despite beta-blocker
·Coronary revascularization: percutaneous coronary intervention (PCI with stent placement) or coronary artery bypass grafting (CABG) if angina does not respond to maximum medicine, or if coronary angiography shows high-risk anatomy (e.g., left main narrowing (stenosis) ≥ 50%, three-vessel disease, or proximal LAD narrowing ≥ 70%)

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NCLEX trap

·The resting EKG is often completely normal in stable CAD — the changes (ST depression, T-wave flips) only show up when the heart is working hard or during active chest pain. A normal EKG at rest does NOT rule out coronary artery disease.
·Figure out the diagnosis first. Then give medicines in the right order: aspirin to stop new clots, a statin to shrink plaque, blood pressure control (ACE inhibitor or ARB), and a beta-blocker to reduce the heart's workload and chest pain. Nitroglycerin eases symptoms but does not treat the disease.
·Stable CAD and chronic angina is a chronic condition that is controlled, not an emergency. It needs long-term medicines (aspirin, statin, blood pressure control, beta-blocker), lifestyle changes (quit smoking, exercise, heart-healthy diet), and regular follow-up — not emergency bypass or ICU care.
·Stable angina can feel like pressure, squeezing, heaviness, tightness, or aching in the chest, shoulders, neck, jaw, or arms. Ask what triggers it (walking, climbing stairs, stress) and what makes it stop (rest, nitroglycerin). The pattern matters more than the exact words the patient uses.
·Aspirin and a statin slow plaque buildup but do NOT stop it or reverse it completely. The patient also needs blood pressure control (goal <130/80), often a beta-blocker, strict lifestyle changes (quit smoking, exercise, low saturated fat diet), and regular checkups to watch for worsening blockages that might need angioplasty (PCI) or bypass surgery.
·A negative stress test is reassuring but does NOT prove there is no plaque. If the patient has typical symptoms (chest pain with effort that stops with rest) and major risk factors (smoking, diabetes, high cholesterol, family history), stable CAD is still the diagnosis — the blockage might just be too small (less than 50-70%) to cause stress test changes yet.

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