Angina affects around 2 million people in the UK, with roughly 20,000 new cases diagnosed each year. If you've been told you have angina, or suspect you might have it, understanding the difference between stable and unstable forms can help you know what to expect and when to seek urgent help.
Both types stem from the same underlying problem: coronary heart disease. This happens when fatty deposits build up inside the arteries that supply blood to your heart muscle. These deposits, called plaques, gradually narrow the arteries and reduce blood flow to the heart.
What causes angina pain?
Your heart is a muscle that works constantly, pumping blood around your body. Like any muscle, it needs a steady supply of oxygen-rich blood to function properly. When the coronary arteries become narrowed, less blood can get through to feed the heart muscle.
This shortage of blood and oxygen causes the heart muscle to struggle, particularly when it's working harder than usual. The result is the characteristic chest pain or discomfort we call angina. People describe it in different ways: a tight band around the chest, a heavy weight pressing down, or a dull ache that may spread to the arms, neck, jaw or back.
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Try our Heart Risk Checker free, here on this site →Stable angina follows a predictable pattern
Stable angina comes on during physical activity or emotional stress, when your heart needs to work harder. You might notice it when climbing stairs, walking uphill, carrying heavy shopping, or during stressful situations.
The pain typically eases with rest and responds well to medication like glyceryl trinitrate (GTN) spray or tablets. It usually lasts just a few minutes and follows the same pattern each time. Many people with stable angina learn to manage their condition by pacing themselves and using their medication when needed.
While chest pain is always concerning, stable angina doesn't usually represent an immediate emergency. Your GP will typically prescribe medication to help prevent angina attacks and reduce your risk of more serious problems. This might include drugs to lower blood pressure, reduce cholesterol, or prevent blood clots.
Always consult your GP or healthcare provider for advice tailored to your specific condition.
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When angina becomes unstable
Unstable angina is a different story altogether. This is when the usual pattern changes and becomes more unpredictable and severe. The pain might start happening when you're resting, wake you from sleep, or come on with much less exertion than before.
Be concerned if your angina pain becomes more frequent, lasts longer than usual, feels more severe, or doesn't ease with rest and your usual medication. Sometimes unstable angina develops suddenly in someone who's never had chest pain before.
Unstable angina happens when a plaque in one of your coronary arteries becomes unstable and may rupture or develop a blood clot. This can suddenly and severely reduce blood flow to part of your heart muscle. Doctors consider it part of what they call acute coronary syndrome, along with heart attacks.
Unstable angina is a medical emergency. If you experience chest pain that's new, getting worse, or happening at rest, you should call 999 immediately. Don't wait to see if it gets better, and don't feel embarrassed about calling an ambulance. If you're unsure about your symptoms, you can also contact NHS 111 for guidance.
Managing your condition long term
Being diagnosed with any form of angina can feel worrying, but many people manage their condition successfully for years. The key is understanding your symptoms, taking medication as prescribed, and making lifestyle changes that can help.
Regular exercise, when done safely and gradually, can actually help improve your condition. Your GP or a cardiac rehabilitation program can advise you on the right type and amount of activity. The NHS provides access to cardiac rehabilitation programs, which can be valuable for those diagnosed with angina.
If you smoke, stopping is one of the most effective steps you can take. The NHS provides free support through local stop smoking services, and your GP can prescribe medication to help if needed.
Diet changes can help too, though they don't need to be dramatic. Reducing saturated fat, eating more fruit and vegetables, and cutting down on processed foods all help. Discuss any lifestyle changes with your healthcare provider to ensure they're suitable for your health status.
If you're ever in doubt about chest pain, especially if it's new or different from your usual pattern, don't hesitate to seek medical help. It's always better to be safe when it comes to your heart.
Your GP, practice nurse, or cardiac rehabilitation team are all good sources of ongoing support and advice. Many areas also have cardiac support groups where you can meet others managing similar conditions.
This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider for advice about your specific condition.
Bit of a puzzler. Was admitted by ambulance after becoming ill. Was grey, soaking with sweat, threw up twice, chest pain, shoulder pain and aching arm. Had a low BP, oxygen saturation was low and pulse was weak, low heart output. Hospital said was nothing wrong and sent home. My GP says that I must have a naturally low heart rate and low B.P. Funny was normal enough to serve in the forces. Any ideas? Thanks
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