What Is Unstable Angina?
Angina is a condition marked by a crushing pain in your chest.
You may also feel pain in your:
The pain is due to inadequate blood supply to your heart muscle,
which deprives your heart of oxygen.
There are several types of angina. Stable angina occurs when you
exert yourself physically or feel considerable stress. Stable angina doesn’t
typically occur more frequently or worsen over time.
Unstable angina is chest pain that happens suddenly and becomes
worse over time. It occurs seemingly without cause. It can happen when you’re at
rest or even asleep. An attack of unstable angina may lead to a heart attack.
For this reason, an attack of unstable angina is an emergency and you should
seek immediate medical treatment.
Unstable angina is a signal that your arteries are becoming very
narrow and that you could experience a heart attack. If left untreated, unstable
angina can lead to heart attack, heart failure, or arrhythmias (irregular heart
rhythm). These can be life-threatening conditions.
What Causes Unstable Angina?
Coronary heart disease caused by a buildup of plaque along the
walls of your arteries is the principal cause of unstable angina. The plaque
causes your arteries to narrow and become rigid. This constricts blood flow to
your heart muscle. When the heart muscle doesn’t have enough blood and oxygen,
you feel chest pain.
Who Is at Risk for Unstable Angina?
Risk factors for coronary heart disease include:
- a family history of heart disease
- high blood pressure
- high low-density lipoprotein (LDL) cholesterol
- low high-density lipoprotein (HDL) cholesterol
- being male
- using any form of tobacco
- leading a sedentary life
Men 45 and older and women 55 and older are more likely to
experience unstable angina.
What Are the Symptoms of Unstable Angina?
The main symptom of angina is chest discomfort or pain, but this
sensation can vary depending on the person. Unstable angina sometimes causes
sensations that feel as if you’re having a heart attack.
Angina symptoms include:
- squeezing or sharp chest pains
- pain that radiates to your extremities or back
- shortness of breath
- unexplained fatigue
If you have stable angina, it’s possible your angina can progress
to unstable angina. Be aware of any chest pains you feel even when at rest,
chest pains that last longer than yours typically do, or chest pains that
simply feel different to you.
If you take nitroglycerin, a medication that enhances blood flow,
during a stable angina attack, you may find the medicine doesn’t work during an
unstable angina attack.
How Is Unstable Angina Diagnosed?
You doctor will perform a physical exam that includes checking
your blood pressure. They may use other tests to confirm unstable angina.
Some tests they may perform include:
- blood tests to check for cardiac biomarkers
(troponin) and enzymes creatine kinase (CK) that leak from your heart muscle if
it has been damaged.
- electrocardiogram to see patterns in your
heartbeats that indicate reduced blood flow
- echocardiography to produce images of your heart
that your doctor can check for angina-related problems
- stress tests to cause your heart to work harder
and make angina easier to detect
- computed tomography angiography
- coronary angiography and heart catheterization to
study the health and caliber of your arteries
Because coronary angiography helps your doctor visualize any
artery narrowing and blockages, it’s one of the most common tests to diagnose
How Is Unstable Angina Treated?
Treatment for unstable angina depends on the severity of your
condition. One of the first treatments your doctor may recommend is a blood
thinner such as heparin or clopidogrel. When your blood isn’t as thick, it can
flow more freely through your arteries.
Your doctor may use other medications to reduce angina symptoms,
including those that reduce:
- blood pressure
If you have a blockage or severe narrowing in an artery, your doctor
may recommend more invasive procedures. These include angioplasty, where they open
up an artery that was previously blocked. Your doctor also may insert a small
tube known as a stent to keep your artery open.
In severe instances, you may need heart bypass surgery, which
reroutes blood flow away from a blocked artery to help improve blood flow to
How Can I Prevent Unstable Angina?
Some nonmedical self-care options are often recommended. These
include taking steps to lose weight, giving up tobacco use, and exercising more
regularly. Taking steps toward a healthier lifestyle can improve your heart
health and reduce the risk for future unstable angina episodes.