Stable Angina

What is stable angina?

Stable angina (angina pectoris) is a type of chest pain that happens when your heart muscle needs more oxygen than usual but it’s not getting it at that moment because of heart disease. This can happen when it’s cold outside or you’re exercising, for example. Stable angina is a temporary chest pain, but it can eventually lead to acute coronary syndrome.

How common is stable angina?

About 10 million Americans have angina. Stable angina is the most common type.

Older adults who have heart disease usually get stable angina.

The difference between stable vs. unstable angina

Stable angina

• Lasts the same length of time each time it happens.
• Has the same cause each time.
• Happens regularly.

Unstable angina

• Doesn’t have the same length or cause each time.
• Is unpredictable.
• Can happen when you’re not moving.

Stable angina can turn into unstable angina. Signs of this include having chest pain that:

• Happens when you’re at rest.
• Goes on for at least 15 minutes.
• Doesn’t go away after you take nitroglycerin. (You may need a bigger dose of nitroglycerin to relieve it.)

What are the symptoms?

Stable angina symptoms include:

• Chest pain that feels like pressure or indigestion.
• Pain that radiates to your left shoulder or down your left arm.
• Shortness of breath.
• Dizziness.
• Nausea.
• Exhaustion.

What causes stable angina?

In most cases, coronary artery disease causes stable angina when you exert yourself or feel stressed. If a blood clot or atherosclerosis creates a block or obstacle in your coronary artery, this limits the amount of blood that can get to your heart muscle.

Other causes include:

• Heart failure.
• Problems with your heart valves.
• Problems with your heart rhythm.
• Hyperthyroidism.
• Anemia.

What are the risk factors for coronary artery disease, which most often causes stable angina?

Risk factors for coronary artery disease include:

• Aging.
• Smoking or using tobacco products.
• Not exercising.
• Having high cholesterol.
• Having high blood pressure.
• Having diabetes.
• Having a family history of coronary artery disease at a young age (younger than 45 in men and 55 in women).

How is stable angina diagnosed?

Your provider will do a physical exam.

What tests will be done to diagnose stable angina?

Your healthcare provider may order:

• Blood tests.
• Electrocardiogram (EKG).
• Stress test (regular stress test, nuclear stress test or stress echocardiogram test).
• Coronary angiography.
• CT (Computed Tomography) scan.

How is stable angina treated?

You’ll need to rest and/or take nitroglycerin when you’re experiencing stable angina. Your provider may want you to make some changes, like eating healthier.

Stable angina treatment may also include:

• Coronary artery bypass surgery.
• Coronary angiography and stent insertion.

What medications are used for stable angina?

You can take nitroglycerin when you’re experiencing stable angina. To help prevent stable angina from happening again, your provider may order:

• Blood pressure medicines.
• Ranolazine.
• Nitrates.

Complications/side effects of the treatment

Any medicine can have side effects, but your provider considers the benefits and the risks before prescribing medicine for you. Surgical risks can vary depending on your age and which other health problems you have.

How do I take care of myself?

Keep taking medicines for your other health problems, such as high cholesterol. Take nitroglycerin when you’re having stable angina.

How soon after treatment will I feel better?

Nitroglycerin should work in a few minutes.

How can I reduce my risk?

Preventing heart disease can reduce your risk of stable angina.

Ways you can do this include:

• Eating a healthy diet.
• Exercising regularly.
• Quitting smoking.
• Keeping diabetes, high blood pressure and high cholesterol well managed.

How can I prevent stable angina?

Once you know what sets off your stable angina, you may be able to prevent it from happening again.

For example, you can:

• Do better at managing your stress.
• Stay inside during very cold or very hot weather.
• Take a break during exercise.

What can I expect if I have stable angina?

If you had stable angina after exerting yourself, you can expect it to happen again when you repeat that exercise or activity. You should feel better when you move more slowly or stop moving.

Angina happens more frequently in the early morning hours.

How long does stable angina last?

The pain lasts a few minutes.

What is the outlook for stable angina?

Most people’s stable angina gets better after they take medicine and rest. However, having stable angina means you have a higher risk of having a heart attack.

How do I take care of myself?

Be sure to keep taking the medicines your provider ordered. If your provider asks you to eat healthier or stop smoking, do it to improve your health. It can be helpful to keep a record of each time your stable angina happens.

When should I see my healthcare provider?

Contact your provider when:

• Your heartbeat is too fast or too slow.
• You get angina when you aren’t exerting yourself.
• You get stable angina a lot.
• You get lightheaded.

When should I go to the ER?

You should call 911 when:

• The nitroglycerin you took doesn’t help after three doses (waiting five minutes between doses).
• The pain you had comes back or worsens.
• The chest pain you’re having feels different than usual.

What questions should I ask my doctor?

• What activities are safe for me to do?
• Do I need a blood thinner?
• What lifestyle changes do I need to make?

Is stable angina dangerous?

Stable angina can be dangerous, but it’s mostly a warning sign that you could be at risk for a heart attack. You probably need to make some lifestyle changes.

Can stable angina lead to a heart attack?

Yes, if you have stable angina, you could have a heart attack in the future if you don’t reduce your risk.

A note from Cleveland Clinic

Because your stable angina can become unstable angina or lead to a heart attack, it’s important to keep taking your medicines and keep going to your medical appointments. You may also need to make changes to how you live, such as finding ways to handle stress, exercising, cutting fast food out of your diet and quitting smoking. Stable angina is a warning sign that you already have heart disease, but you can work with your provider to get healthier.