Stable And Unstable Angina: What’s The Difference?

By Ashley Henshaw. May 7th 2016

Many have heard of individuals suffering from stable or unstable angina, but the difference between the two is often murky and unclear. Angina is often a symptom of one of the most common types of heart disease in adults: coronary heart disease (CHD). The two types of angina actually have quite a few differences, and knowing those disparities is essential for distinguishing how much of a threat this symptom may be to your health.

Stable VS Unstable Angina

Angina is not a disease. It’s actually a symptom of an underlying heart problem (usually CHD). Angina is a feeling of chest pain or discomfort caused by an area of the heart that isn’t receiving enough oxygen-rich blood. So what determines whether angina is stable or unstable?

Stable angina occurs:

  • When the heart is working harder than usual. This could be while exercising, doing yard work, eating a large meal, going out in cold weather or experiencing emotional stress. These situations are considered to be triggers for stable angina.
  • In a pattern. The pattern includes how often the angina attacks occur, what triggers it and how severe the attack is. There isn’t a set pattern that applies to every person with angina – each person’s pattern may be a little different, but the fact that there is a pattern is what makes it stable rather than unstable.
  • For short periods of time. The pain associated with a stable angina attack usually goes away after a few minutes of rest or after taking a medication for angina. Most stable angina attacks last for between 1 and 15 minutes.

Unstable angina occurs:

  • At random. An unstable angina attack can happen at any time, even when a person is at rest. It can occur with or without physical exertion.
  • In no particular pattern. Unstable angina is unpredictable, and the attacks may vary widely in how often they occur, what triggers them and how severe the pain is. In general, however, unstable angina attacks tend to be more severe and occur more often than those of stable angina.
  • For longer periods of time. Resting or taking angina medicine does not always relieve the pain associated with an unstable angina attack, which usually lasts more than 15-20 minutes. Emergency treatment should be sought immediately since unstable angina may indicate that a heart attack may happen soon.

Common Risk Factors

Stable and unstable angina share many of the same risk factors, including:

  • Family history of CHD before age 50
  • High blood pressure
  • High LDL cholesterol and low HDL cholesterol
  • Diabetes
  • Obesity
  • Smoking
  • Lack of exercise
  • Being male

In addition, older age increases the risk for developing unstable angina. Although CHD is usually the cause for angina attacks to occur, they can also be caused by other heart conditions, such as a pulmonary embolism, aortic dissection or stenosis, pericarditis or hypertrophic cardiomyopathy.

How To Tell Which One You Have

If you feel chest pain or discomfort, you may wonder whether you have stable or unstable angina. The following symptoms point to stable angina:

  • Attacks occurring during periods of exertion (exercise, stress, etc.)
  • Pain which begins slowly and gets worse over the next few minutes
  • Pain relieved by rest or medication
  • Tightness, pressure or squeezing feeling in the chest, which may spread to other areas of the torso, neck and jaw)
  • Other possible symptoms, such as shortness of breath, dizziness, light-headedness, nausea, vomiting, sweating or a feeling of indigestion or heartburn

The following symptoms point to unstable angina:

  • Attacks which occur randomly, with or without exertion
  • Pain which occurs suddenly and is severe
  • Tightness, burning, squeezing or aching feeling in the chest, which may spread to other areas of the torso, neck and jaw)
  • Pain not relieved by rest or medication
  • Other possible symptoms, such as shortness of breath, sweating or a drop in blood pressure

Keep in mind that those with stable angina may start to develop unstable angina over time. Pay close attention to the timing and severity of your stable angina attacks. If they start to get worse and happen more suddenly, then you may be developing unstable angina.

Treatment Options

Any type of chest pain needs to be treated right away. Get medical assistance immediately if you feel significant pain or discomfort in your chest.

For stable angina, initial treatment may lead to a doctor prescribing medication to help treat future attacks. A doctor will likely recommend lifestyle changes to improve your heart health as well. In some cases, surgery is needed to fix a blockage or narrowing in the arteries. After a diagnosis, patients may be able to deal with stable angina attacks on their own. However, it’s critical to speak with your doctor about how to recognize signs of a heart attack and when you should call 911 rather than trying to deal with an attack on your own. In many cases, stable angina improves with medication and lifestyle changes.

Unstable angina attacks are much more serious and require immediate medical attention. Once the attack has been successfully treated, a doctor may prescribe medications, lifestyle changes or surgeries to improve your heart health. Future attacks may be treated with nitroglycerin, but if the medication doesn’t take effect within a few minutes then immediate medical treatment is necessary. Unstable angina attacks are a sign of more severe heart disease, and they may lead to abnormal heart rhythms, a heart attack or even heart failure.

Taking care of your health now is the best way to prevent stable and unstable angina. If you currently suffer from one of these conditions, be sure that you are fully aware of the signs of a heart attack and see your doctor regularly to monitor your heart health.


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