What is Stable and Unstable Angina (Chest Pain)?

 The number of people often visiting doctors complaining of chest pain has increased nowadays. However, there is the possibility of the chest pain turning out to be a diagnosis of angina. For the unversed, the term angina can be confusing as it is a medical term that is not widely understood. In simple terms, angina refers to chest pain caused by reduced blood flow to the heart muscle. However, it's important to distinguish between stable and unstable angina, as the management of these conditions differs significantly.

Understanding Angina

In medical practice, both the patients and doctors have a role to play. Patients report the symptoms, doctors observe them. When patients describe their symptoms, they may not always pinpoint the pain in their chest; it could be in their neck, jaw, or arm. Angina is the term used by doctors to describe this pain, which results from a lack of blood flow to the heart muscle.

When the heart muscle does not receive enough blood, it becomes deprived of oxygen and nutrients, leading to pain or discomfort. This pain is the heart's way of signalling that it is not receiving adequate blood supply. The underlying cause is typically obstruction in the blood vessels supplying the heart, also known as aortic stenosis, leading to reduced blood flow.

Stable Angina: Predictable and Manageable

Stable angina is characterised by chest pain that occurs with exertion or stress and subsides with rest or medication. Patients with stable angina can often predict their symptoms based on their activities. For instance, they might experience chest pain while climbing stairs or walking. This pain typically lasts for a few minutes and goes away with rest or the use of medications like nitroglycerin, which dilates blood vessels and restores normal blood flow.

Patients with stable angina often visit OPDs, seeking advice on managing their symptoms. They can usually continue with their daily activities by following advice from the doctor, which includes lifestyle changes and medications to control blood pressure, cholesterol, and other risk factors. The risk of a heart attack or sudden death in stable angina patients is relatively low if they remain consistent as per the doctor’s advice. Additionally, EECP therapy offers an effective non-surgical alternative to improve blood flow and reduce symptoms, enhancing the overall management strategy for stable angina.

Unstable Angina: A Medical Emergency

Unstable angina is more serious and can be a precursor to a heart attack. Unlike stable angina, the pain associated with unstable angina can occur, even when resting. Its pain is more severe, lasts longer (more than 20 minutes), and does not respond well to nitroglycerin. Unstable angina indicates that a plaque in the coronary artery has ruptured or a blood clot has formed, significantly reducing blood flow to the heart.

Patients with unstable angina often experience a sudden increase in the frequency and severity of chest pain. They may report that their usual activities can trigger pain more easily or that the pain persists despite rest and medication. Because unstable angina can lead to a heart attack, it requires immediate medical attention. Hospitalisation, close monitoring, and potentially urgent procedures like angioplasty or bypass surgery are often necessary. EECP treatment is being increasingly offered as a supportive measure for patients recovering from unstable angina, aiding in improving heart function and preventing further complications.

Why the Distinction Matters

Understanding whether angina is stable or unstable is crucial because it determines the treatment approach. Stable angina can typically be managed with medications and lifestyle changes, reducing the need for invasive procedures. However, unstable angina requires prompt intervention to prevent a heart attack and reduce the risk of complications.

Stable angina focuses on controlling symptoms and preventing disease progression, with the help of medications such as beta-blockers, calcium channel blockers, and nitrates, as well as lifestyle modifications like quitting smoking, eating a heart-healthy diet, and exercising regularly. In contrast, unstable angina often necessitates more aggressive treatments. These can include antiplatelet medications to prevent blood clots, anticoagulants, and procedures to restore blood flow to the heart, such as angioplasty (with or without stent placement) or coronary artery bypass grafting (CABG).

Incorporating EECP for Angina Management

Distinguishing between stable and unstable angina is essential for effective treatment and management. Understanding the differences helps patients communicate symptoms effectively to healthcare providers, alleviating fears about invasive procedures and ensuring appropriate care. Incorporating EECP therapy into the treatment plan offers a promising, non-invasive alternative to support heart health and improve outcomes. Heal Your Heart Clinic, a certified EECP treatment centre, is dedicated to providing this advanced therapy, enhancing cardiac care and patient well-being.