The NICE British National Formulary (BNF) site is only available to users in the UK (England, Scotland, Wales and Northern Ireland). Show If you are outside the UK, you can access BNF content by subscribing to Medicines Complete. If you believe you are seeing this page in error, please contact us. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/. Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 62. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929-1949. PMID: 25077860 pubmed.ncbi.nlm.nih.gov/25077860/. Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19)2199-2269. PMID: 29146533 pubmed.ncbi.nlm.nih.gov/29146533/. Writing Committee Members, Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;78(22):e187-e285. PMID: 34756653 pubmed.ncbi.nlm.nih.gov/34756653/. Page 2Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. PMID: 25260718 pubmed.ncbi.nlm.nih.gov/25260718/. Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 56. Brown JE. Chest pain. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 23. Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 45. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140. PMID: 23256914 pubmed.ncbi.nlm.nih.gov/23256914/. Page 3Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 62. Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 35. Lange RA, Mukherjee D. Acute coronary syndrome: unstable angina and non-ST elevation myocardial infarction. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 63. Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40. What is unstable angina? Angina is another word for heart-related chest pain. You may also feel pain in other parts of your body, such as: The pain is due to inadequate blood supply to your heart muscle, which deprives your heart of oxygen. There are two types of angina: stable and unstable. Stable angina occurs predictably. It happens when you exert yourself physically or feel considerable stress. Stable angina doesn’t typically change in frequency and it doesn’t worsen over time. Unstable angina is chest pain that occurs at rest or with exertion or stress. The pain worsens in frequency and severity. Unstable angina means that blockages in the arteries supplying your heart with blood and oxygen have reached a critical level. An attack of unstable angina is an emergency and you should seek immediate medical treatment. If left untreated, unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heart rhythms). These can be life-threatening conditions. The principal cause of unstable angina is coronary heart disease caused by a buildup of plaque along the walls of your arteries. The plaque causes your arteries to narrow and become rigid. This reduces the blood flow to your heart muscle. When the heart muscle doesn’t have enough blood and oxygen, you feel chest pain. The main symptom of angina is chest discomfort or pain. The sensation can vary depending on the person. Angina symptoms include:
It’s possible for stable angina to progress to unstable angina. If you have stable angina, be aware of any chest pains you feel even when at rest. Also watch for chest pains that last longer than they typically do or that simply feel different to you. If you take nitroglycerin, a medication that enhances blood flow, for relief during a stable angina attack, you may find the medicine doesn’t work during an unstable angina attack. You doctor will perform a physical exam that includes checking your blood pressure. They may use other tests to confirm unstable angina, such as:
Because coronary angiography helps your doctor visualize any artery narrowing and blockages, it’s one of the most common tests they use to diagnose unstable angina. Treatment for unstable angina depends on the severity of your condition. MedicationOne of the first treatments your doctor may recommend is a blood thinner, such as aspirin, heparin, or clopidogrel. When your blood isn’t as thick, it can flow more freely through your arteries. may use other medications to reduce angina symptoms, including drugs that reduce:
SurgeryIf 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. This procedure reroutes blood flow away from a blocked artery to help improve blood flow to your heart. Lifestyle changesNo matter the severity of your condition, you may need to change your long-term lifestyle. Lifestyle changes that can improve your heart health include: All of these changes can lessen your chance of an angina attack and reduce your risk of heart attack. Talk to your doctor about appropriate changes to your lifestyle, including a healthy diet and exercise routine. The best apps of the year for quitting smoking » Nonmedical self-care options include taking steps to lose weight, giving up tobacco use, and exercising more regularly. Working toward a healthier lifestyle can improve your heart health and reduce your risk of future unstable angina episodes. |