Table of ContentsView AllTable of ContentsMain DifferencesTreatmentPhysical ActivityLong-Term Management
Table of ContentsView All
View All
Table of Contents
Main Differences
Treatment
Physical Activity
Long-Term Management
Stable angina follows a pattern and occurs during physical exertion, while unstable angina doesn’t follow a pattern and can occur without physical exertion. Unstable angina is more dangerous and may be a warning that a person is at imminent risk of a heart attack.
Read on to learn what you need to know about the difference between stable and unstable angina, including common versus emergency symptoms, why unstable angina is more intense and serious than stable angina, tests doctors use to confirm unstable angina, treatment options, and more.
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Angina
Stable vs. Unstable Angina: Main Differences
Chest pain near the heart
Symptom of heart disease
Less serious, more common
Not always an emergency
Predictable
“Stable” consistent pattern
Rest, relaxation, and calmness typically relieve symptoms
Usually lasts one to five minutes; rarely lasts longer than 15 minutes
Not classified as acute coronary syndrome (ACS)
More serious, deadlier
Always an emergency
Unpredictable
“Unstable” nonexistent pattern
Rest and relaxation do not quickly resolve symptoms
Often lasts longer than 15 minutes; can last 30 minutes or more
Classified as acute coronary syndrome (ACS)
Although stable angina isn’t considered an ACS, it can become unstable angina if you don’t take steps to slow it.
Common Symptoms
Angina feels like a heavy pressure and tightness in the chest, but the pain or squeezing sensation can also be felt in other locations near the heart, such as the arms, shoulders, neck, or jaw.
Stable and unstable angina cause defects in the heart’s functioning and its ability to sufficiently supply the heart with blood. But their seriousness and potential deadliness are different: Unstable angina is much more dangerous and should always be treated with life-or-death urgency as a medical emergency.
Potential Angina Complications
Emergency Symptoms
Causes and Risk Factors
Risk factors for both stable and unstable angina include:
Mini Heart Attack: Don’t Doubt Yourself With Suspected Symptoms
How Is Stable vs. Unstable Angina Treated?
Vasodilatorsare medications that dilate the arteries and veins; they are first-line treatments for both stable and unstable angina. Common vasodilators for treating angina are nitroglycerin and a nitrate medication called Imdur (isosorbide mononitrate).Another relatively new anti-angina drug is Ranexa (ranolazine).
People experiencing chronic angina are usually prescribed two or more of the following types of drugs:
Vasodilation vs. Vasoconstriction
Because unstable angina is more serious than stable angina, it requires more aggressive treatment. Most people with stable angina don’t need surgery. The gold standard for most people with stable angina is non-invasive medical treatment such as medications and heart-healthy lifestyle changes.
People with unstable angina usually require an invasive surgical procedure such asangioplastywith stenting to unblock clogged arteries. In addition to making lifestyle changes and having a surgical procedure, unstable angina treatment often includes different prescription drugs, including anti-ischemic agents, anticoagulants, and antiplatelets.
What Are the Treatment Options for Angina?
Physical Activity and Rehabilitation With Angina
Physical activity is key to making heart-healthy lifestyle choices that reduce angina risk. That said, because strenuous exercise can trigger angina symptoms, it’s important to work closely with a trained professional when using physical activity as part of rehabilitation with angina.
Because stable angina symptoms tend to be predictable, the American Heart Association has a downloadable"Cardiac Rehabilitation Angina Log"for tracking the date of any angina attacks, what triggered it, its intensity rating (1–4), how long it lasted, and what you did to alleviate its symptoms.You should share this log with your healthcare provider during follow-up visits.
Long-term management of stable and unstable angina aims to prevent the progression of blockages and to avoid severe consequences associated with coronary artery disease, such as deadly heart attacks.
Summary
Unstable angina is unpredictable and more serious than stable angina. Strenuous exercise and strong emotions can trigger stable angina. But unstable angina doesn’t have clear triggers; it can happen anytime, even when someone’s relaxed or sleeping.
Sitting down or resting usually relieves stable angina symptoms in less than five minutes. However, taking it easy or relaxing doesn’t relieve unstable angina symptoms, which generally last longer than 15 minutes and can lead to a heart attack or death.
Unstable angina is a medical emergency that almost always requires surgery to remove the heart’s blockage. Stable angina doesn’t necessarily require surgery and is primarily treated with medicine and heart-healthy lifestyle changes.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.European Society of Cardiology.Angina pectoris: how has the clinical presentation evolved? Is it still the same today as it was several years ago?MedlinePlus.Angina.American Heart Association.Angina pectoris (stable angina).American Heart Association.Unstable angina.Bhatt DL, Lopes RD, Harrington RA.Diagnosis and treatment of acute coronary syndromes: a review.JAMA. 2022;327(7):662. doi:10.1001/jama.2022.0358National Health Service.Angina.Mount Sinai.Stable angina.National Heart, Lung, and Blood Institute.What causes angina?Tan Z, Shang X, Li L, et al.Clinical study of isosorbide mononitrate treatment for angina pectoris in coronary heart disease.Experimental and Therapeutic Medicine. 2013;5(4):1133-1136. doi:10.3892/etm.2013.958Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al.Ranolazine for stable angina pectoris. Cochrane Heart Group, ed.Cochrane Database of Systematic Reviews. 2017;2019(1). doi:10.1002/14651858.CD011747.pub2Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA.Antiplatelet and anticoagulation therapy for acute coronary syndromes.Circ Res. 2014;114(12):1929-1943. doi:10.1161/CIRCRESAHA.114.302737American Heart Association.Cardiac Rehabilitation Angina Log.Additional ReadingBraunwald E, Morrow DA.Unstable angina: is it time for a requiem?Circulation. 2013;127(24):2452-2457. doi:10.1161/CIRCULATIONAHA.113.001258
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.European Society of Cardiology.Angina pectoris: how has the clinical presentation evolved? Is it still the same today as it was several years ago?MedlinePlus.Angina.American Heart Association.Angina pectoris (stable angina).American Heart Association.Unstable angina.Bhatt DL, Lopes RD, Harrington RA.Diagnosis and treatment of acute coronary syndromes: a review.JAMA. 2022;327(7):662. doi:10.1001/jama.2022.0358National Health Service.Angina.Mount Sinai.Stable angina.National Heart, Lung, and Blood Institute.What causes angina?Tan Z, Shang X, Li L, et al.Clinical study of isosorbide mononitrate treatment for angina pectoris in coronary heart disease.Experimental and Therapeutic Medicine. 2013;5(4):1133-1136. doi:10.3892/etm.2013.958Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al.Ranolazine for stable angina pectoris. Cochrane Heart Group, ed.Cochrane Database of Systematic Reviews. 2017;2019(1). doi:10.1002/14651858.CD011747.pub2Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA.Antiplatelet and anticoagulation therapy for acute coronary syndromes.Circ Res. 2014;114(12):1929-1943. doi:10.1161/CIRCRESAHA.114.302737American Heart Association.Cardiac Rehabilitation Angina Log.Additional ReadingBraunwald E, Morrow DA.Unstable angina: is it time for a requiem?Circulation. 2013;127(24):2452-2457. doi:10.1161/CIRCULATIONAHA.113.001258
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
European Society of Cardiology.Angina pectoris: how has the clinical presentation evolved? Is it still the same today as it was several years ago?MedlinePlus.Angina.American Heart Association.Angina pectoris (stable angina).American Heart Association.Unstable angina.Bhatt DL, Lopes RD, Harrington RA.Diagnosis and treatment of acute coronary syndromes: a review.JAMA. 2022;327(7):662. doi:10.1001/jama.2022.0358National Health Service.Angina.Mount Sinai.Stable angina.National Heart, Lung, and Blood Institute.What causes angina?Tan Z, Shang X, Li L, et al.Clinical study of isosorbide mononitrate treatment for angina pectoris in coronary heart disease.Experimental and Therapeutic Medicine. 2013;5(4):1133-1136. doi:10.3892/etm.2013.958Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al.Ranolazine for stable angina pectoris. Cochrane Heart Group, ed.Cochrane Database of Systematic Reviews. 2017;2019(1). doi:10.1002/14651858.CD011747.pub2Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA.Antiplatelet and anticoagulation therapy for acute coronary syndromes.Circ Res. 2014;114(12):1929-1943. doi:10.1161/CIRCRESAHA.114.302737American Heart Association.Cardiac Rehabilitation Angina Log.
European Society of Cardiology.Angina pectoris: how has the clinical presentation evolved? Is it still the same today as it was several years ago?
MedlinePlus.Angina.
American Heart Association.Angina pectoris (stable angina).
American Heart Association.Unstable angina.
Bhatt DL, Lopes RD, Harrington RA.Diagnosis and treatment of acute coronary syndromes: a review.JAMA. 2022;327(7):662. doi:10.1001/jama.2022.0358
National Health Service.Angina.
Mount Sinai.Stable angina.
National Heart, Lung, and Blood Institute.What causes angina?
Tan Z, Shang X, Li L, et al.Clinical study of isosorbide mononitrate treatment for angina pectoris in coronary heart disease.Experimental and Therapeutic Medicine. 2013;5(4):1133-1136. doi:10.3892/etm.2013.958
Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al.Ranolazine for stable angina pectoris. Cochrane Heart Group, ed.Cochrane Database of Systematic Reviews. 2017;2019(1). doi:10.1002/14651858.CD011747.pub2
Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA.Antiplatelet and anticoagulation therapy for acute coronary syndromes.Circ Res. 2014;114(12):1929-1943. doi:10.1161/CIRCRESAHA.114.302737
American Heart Association.Cardiac Rehabilitation Angina Log.
Braunwald E, Morrow DA.Unstable angina: is it time for a requiem?Circulation. 2013;127(24):2452-2457. doi:10.1161/CIRCULATIONAHA.113.001258
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