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What is the difference between stable and unstable angina?

Yolanda Y. Hendley, MD
Cardiology (Cardiovascular Disease)
The most common forms of angina are stable and unstable angina. If the pain happens during certain activities and goes away with rest, it’s called stable angina.  However, if the chest pain becomes more severe or frequent, lasts longer, or occurs while resting it’s called unstable angina.

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site.  In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

The content originally appeared online at Saint Francis Healthcare.
http://www.stfrancishealthcare.org/News/2017/February/Angina-A-Warning-for-Your-Heart.aspx
Your doctor may describe your chest pain as "unstable" or "stable" angina. 

Unstable Angina
With unstable angina, also referred to as acute coronary syndrome, chest pain and other symptoms of cardiovascular disease are of new onset, worsening, becoming more frequent or occurring with less exertion.
If this is your situation, your doctor may adjust drug therapy to stabilize symptoms or may pursue other forms of testing and monitoring.
Depending on the ongoing evaluation, you may be sent to the cardiac catheterization lab (or “cath lab”) for a heart catheterization and ultimately an angioplasty and/or a stent (procedures to open blockages in your arteries). Alternatively, if the blockages are more extensive or severe, you may be referred to a surgeon for bypass surgery.

Stable Angina
With stable angina, you have "predictable" symptoms - symptoms to which you have become accustomed. When you engage in physical activity at various levels of intensity, you have come to expect shortness of breath (more common in women than men), chest pressure, neck, jaw or shoulder pain. When you stop the activity, symptoms also cease.

If you have stable angina, your care team will:
- Ask you questions and listen carefully to your answers to understand your:
-Medical history
-Current symptoms and other current health conditions, such as diabetes and hypertension

Based on this information, your healthcare providers will develop a treatment plan just for you.

Often a person with angina has pain that sets in after a predictable amount of exertion. This is stable angina. Unstable angina happens when the angina worsens. Unstable angina is defined as having more frequent episodes of angina chest pain with less exertion, having angina chest pain when resting or having new onset of severe angina. Typically, the unstable angina is linked to a worsening of the Coronary Artery Disease, with a larger obstruction. The condition can quickly lead to a heart attack. This is especially true if unstable angina is associated with some types of EKG changes. People with unstable angina are admitted to hospitals so doctors can treat the unstable angina and determine if a heart attack has occurred.

Nitrates (like nitroglycerin) are used to relieve chest pain. The nitrates can be given sublingually (under the tongue) or intravenously (through an injection). Heparin, a potent anti-clotting drug, can prevent the obstruction in the coronary artery from becoming a complete obstruction. Recently, a new class of anti-clotting medication has been introduced called IIb/IIIa inhibitors. These are used in unstable angina. Patients also are started on aspirin regimens and often a beta-blocker as well. In the cases when these medications are insufficient, a cardiac catheterization can be performed so a doctor can determine the location and severity of any blockages. In many cases, an angioplasty can be performed at the same time. In cases where an angioplasy is not possible, a coronary artery bypass graft may be necessary.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.