Causes and Symptoms of Stable Angina

Senior woman holding chest in pain

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Angina (also called angina pectoris) refers to the symptoms caused by ischemia of a portion of the heart muscle—that is, when the heart muscle is not receiving enough oxygen, usually because of coronary artery disease (CAD). The most common symptom seen with angina is chest pain or chest discomfort, but angina can produce several other symptoms as well.

Healthcare providers talk about two different kinds of angina: stable and unstable angina. Stable angina is more common. Unstable angina is considered a medical emergency.

This article discusses the causes, risk factors, symptoms, diagnosis, and treatment of stable angina.

What Is Stable Angina?

Coronary artery disease often causes blockages in the coronary arteries, which can restrict blood flow to the heart muscle. When the heart muscle is not receiving enough blood flow, symptoms may result. These symptoms are called angina.

Stable angina is caused by a stable blockage in a coronary artery. The blockage is considered “stable” because it generally stays the same (or gets worse only gradually). For this reason, the angina it produces also stays roughly the same.

Angina symptoms tend to occur after about the same amount of exertion or stress, in a generally predictable manner. In other words, the angina occurs in a reasonably stable pattern.

Stable angina is caused by a stable blockage in a coronary artery. Angina symptoms tend to occur after about the same amount of exertion or stress, in a generally predictable manner.

Causes of Stable Angina

Stable angina is caused by an atherosclerotic plaque that has developed in a coronary artery and has produced a partial, fixed blockage of the artery. This partial blockage usually permits adequate blood flow to the heart muscle during periods of rest, so at rest, there is no angina.

However, the partial blockage also limits the maximum amount of blood the artery is able to provide. So, at times when the heart muscle needs to work harder, such as during physical exertion or emotional stress, the blood flow cannot increase sufficiently to meet the increased demands on the heart muscle. The oxygen-starved muscle becomes ischemic and angina occurs.

Once physical exertion is stopped—likely because symptoms of angina cause the person to stop—the oxygen needed by the heart muscle drops down to its baseline level. Within a few minutes, the ischemia resolves, and the angina goes away.

Differences Between Stable and Unstable Angina

The differences between stable angina and unstable angina include:

Stable Angina  Unstable Angina
Happens when the heart works harder Can happen at rest or with exertion
Has a regular or predictable pattern Does not follow a pattern
Goes away with rest and/or medicine Does not go away with rest or medicine
Most common Most dangerous

Stable Angina Symptoms

People with stable angina usually have no symptoms at all while they are at rest or during mild activity since the blood flow to their heart muscle is adequate under these conditions.

Angina typically occurs with exertion, and often in a way that is fairly reproducible and predictable. For instance, a person with stable angina may notice symptoms only when climbing the second flight of stairs, or after walking more than three blocks.

Typical Symptoms

Symptoms of angina can include chest pressure or pain, sometimes squeezing or “heavy” in nature, and often radiating to the jaw or left arm. Other symptoms may include:

  • Shortness of breath
  • Nausea
  • Fatigue that is out of proportion to the activity level

Mild Symptoms

Many people with angina do not have typical chest pain symptoms. The discomfort they experience might be quite mild and may be relatively easy for them to brush off as being nothing to worry about. And if a healthcare provider asks them whether they have ever had chest pain, they may answer, “No.” 

Other Symptoms

Some people may have discomfort localized to the back, abdomen, shoulders, jaw, or either or both arms. Furthermore, they may not have any real pain or discomfort at all. Nausea, breathlessness, or “heartburn” may be their only symptom.

Again, in a person with stable angina, these symptoms generally occur during periods of exertion or stress, and they tend to be reproducible. 

It is important to realize that the significance of angina has little to do with whether or not the symptoms are severe or tolerable. Angina is significant because it indicates that the heart muscle is not getting enough oxygen, and the heart is therefore at risk of damage. So even mild symptoms caused by angina have major significance.

If you have any unusual symptoms, located anywhere above your waist, that repeatedly occurs with exertion or stress, it is important to be evaluated by a healthcare provider. 

Risk Factors

Any symptoms that might represent angina should never be ignored, particularly in a person who is middle-aged or older, and especially if they have one or more risk factors for coronary artery disease. Risk factors of CAD include:

  • Advancing age
  • Smoking or using tobacco products
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Overweight or obesity
  • Sedentary lifestyle
  • 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?

When a person describes any recurring pain, discomfort, or unusual feelings originating anywhere above the waist that is associated with exertion or stress, a healthcare provider will perform a physical exam and take a medical history.

Tests the provider may recommend include:

  • Electrocardiogram (ECG) to look at the heart’s functioning
  • Computed tomography (CT) scans to get an image of the heart
  • Stress test, also called an exercise tolerance test, performed on a treadmill
  • Blood work, such as a cholesterol profile and C-reactive protein (CRP) to assess risk factors
  • Coronary angiogram to visualize the coronary arteries and assess blood flow through the arteries

Treatment of Stable Angina

The goal in treating stable angina is threefold:

  • Relieve or reduce the symptoms of angina
  • Try to prevent the further progression of atherosclerotic plaques
  • Try to prevent the more severe consequences of CAD: myocardial infarction, heart failure, and death

Treatment options that will be considered for stable angina include lifestyle changes, medication, and surgery to prevent further progression of CAD.

Lifestyle Factors

Since angina is a symptom of heart disease, following a heart-healthy lifestyle can help slow the progression of CAD. Recommended lifestyle changes include:

  • Following a healthy eating plan and limiting alcohol
  • Aiming for a healthy weight
  • Being physically active (based on your healthcare provider's recommendations) on triggers angina
  • Managing stress
  • Quitting smoking
  • Getting enough good-quality sleep

A healthy lifestyle can also reduce the risk of chronic health conditions, such as high blood pressure, high cholesterol, and diabetes—health conditions that can affect stable angina and may eventually lead to heart disease.

Medication

Unstable angina is usually relieved with rest, nitroglycerin, or both. Other medications a healthcare provider may prescribe to reduce angina episodes and treat high blood pressure or cholesterol include:

  • Beta-blockers
  • Calcium channel blockers
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers
  • Statin medications 
  • Blood thinners

These medications are a primary tool for reducing plaque progression, heart attacks, and strokes.

Surgery

In a person with stable angina, surgery is considered only when medications do not adequately control symptoms.

There are two main types of surgery for angina:

Coping With Stable Angina

The main goal of angina treatment is to allow you to engage in the activities of daily life and exercise without undue discomfort. It may take some time and trial and error to eliminate your angina.

These strategies can help:

  • Take all your medications as prescribed. Contact your healthcare provider right away if you are having trouble doing that.
  • Keep a record of any angina episodes. Record what you were doing when it began and how long it lasted.
  • Minimize stress. Try to avoid situations that you know ahead of time are likely to cause stress.
  • If large meals cause angina, then eat smaller, more frequent meals.
  • Talk to your healthcare provider about what, specifically, you should do when you experience an episode of angina—when to take nitroglycerin, how many to take, and how long to wait before calling 911.

Summary

Stable angina occurs when plaque build-up is producing a significant amount of blockage in a coronary artery that causes cardiac ischemia when the heart is stressed. It is important for stable angina to be diagnosed and treated in order to avoid permanent cardiac damage or death.

If you have symptoms of chest discomfort or any unusual symptoms above the waist that recur with exercise or stress, see a healthcare provider right away.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Richard N. Fogoros, MD

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.