Stable heart disease - Choosing Wisely

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Stable heart disease When you need an angiogram—and when you don’t

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arge blood vessels called arteries supply blood to your heart. They can become narrowed or blocked. This is called heart disease. As a result, less blood and oxygen may flow to your heart. This can cause chest pain, shortness of breath, or other symptoms. An angiogram is a test for heart disease. The doctor places a thin tube into your heart to take X-rays. It can tell your doctor if you’re at high risk of having a heart attack, or if you need surgery to repair your arteries. But you may not need this test if you have stable heart disease. Here’s why. Heart disease can be stable or unstable. Stable heart disease usually causes symptoms only when you exercise or feel stressed. If you rest or take medicine, the symptoms usually stop soon afterward. With unstable heart disease, symptoms can happen anytime, even when you’re resting. They may last longer than a few minutes, or go away and come back. For people with unstable heart disease, an angiogram may be needed.

Stress tests are more common for stable heart disease When you have stable heart disease, your doctor will likely have you take a stress test. A stress test takes pictures of your heart while it is working hard. This usually tells your doctor if your stable heart disease is mild, moderate or severe.

Lifestyle changes and medications are the first steps. If you have stable heart disease, your doctor will probably prescribe certain medicines and recommend lifestyle changes. This is called medical therapy. With these changes, you may not need an angiogram. When heart disease is not severe, medical therapy may work as well as more invasive procedures, such as stent placement and open heart surgery, in preventing heart attacks and saving lives. An angiogram will not be useful If: • You don’t want a stent or open heart surgery to fix your arteries. • A stent or open heart surgery would be too risky for you. When do you need an angiogram with stable heart disease? You may need an angiogram if you can’t take the medicines recommended for your heart disease, or they don’t control your symptoms. Other reasons you should have an angiogram include: • A serious heart rhythm disorder. • Other tests, such as a stress test, that show moderate-risk, high-risk, or uncertain results. • Symptoms of heart failure. An angiogram can have side effects and risks. An angiogram is a minimally invasive procedure, but can have side effects and risks, including: • Bleeding • Infection • Soreness where the tube is inserted • Allergic reaction • Irregular heartbeats • Radiation exposure • More serious complications that can occur in rare circumstances, such as heart attack, stroke, kidney damage, and death. This report is for you to use when talking with your health-care provider.  It is not a substitute for medical advice and treatment. Use of this report is at your own risk. © 2015 Consumer Reports. Developed in cooperation with the Society for Cardiovascular Angiography and Interventions Foundation. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.

7/2015

Advice from Consumer Reports 

Living with stable heart disease For most people with stable heart disease, treatment includes the following medicines: • Aspirin. • A statin drug to lower cholesterol. • Blood pressure medicine, if needed. • Nitroglycerin, a drug to relieve chest pain. Also, work with your doctor to: • Follow a diet rich in fruits, vegetables, and whole grains. • Keep a healthy body weight. • Exercise regularly (30 to 60 minutes at least 5 days a week). • Learn how to manage stress and depression. • Quit smoking. Call 911 if you have warning signs of a heart attack: • Chest pain • Pain in your arms, back, stomach, neck, or jaw • A cold sweat • Fainting or lightheadedness • Nausea • Rapid heartbeat • Shortness of breath Also, call 911 if chest pain or other symptoms: • Become more frequent or severe. • Occur at rest or with less physical activity. • Don’t go away a few minutes after you rest or take nitroglycerin. • Last longer than a few minutes or go away and come back.