Stable and Unstable Angina

Stable angina

Angina pectoris, commonly known as angina, is the sensation of chest pain , pressure, or squeezing, often due to not enough blood flow to the heart muscle as a result of obstruction or spasm of the coronary arteries

Risk factors : 

  • High blood pressure (hypertension), High levels of cholesterol and other fats in the blood, Diabetes, Smoking, Male gender, Inactive (sedentary) lifestyle, Family history of coronary heart disease, Aging, Regular use of stimulants especially nicotine, cocaine, or amphetamines, Other stimulants include theophyllines, inhaled beta-agonists, caffeine, diet pills, and decongestants.


  • Clinical picture : 

Subcostal chest pain ( precipitated by stress or exertion and relieved by rest or nitrates and there is radiation of the pain to the left shoulder and arm ), Dyspnea, Nausea, Vomiting, Lightheadedness, Diaphoresis.

investigations :

ECG shows ST segment depression with T inversion or flat.

Treatment :

ASA( aspirin ), O2, nitroglycerine, morphine, B- blockers, ACEI. 


Unstable angina ( or called non ST elevation MI)

Is a type of angina pectoris that is irregular. It is also classifiedas a type of acute coronarysyndrome (ACS).  Itcan be difficult to distinguish unstable angina from non-ST elevation (non-Q wave) myocardial infarction (NSTEMI). They differ primarilyin whether the ischemia is severe enough to cause sufficientdamage to the heart's muscularcells to release detectablequantities of a marker of injury (typically troponinT or troponin I). 

Risk factors : 

  • The same as stable angina : High blood pressure (hypertension), High levels of cholesterol and other fats in the blood, Diabetes, Smoking, Male gender, Inactive (sedentary) lifestyle, Family history of coronary heart disease, Aging, Regular use of stimulants especially nicotine, cocaine, or amphetamines, Other stimulants include theophyllines, inhaled beta-agonists, caffeine, diet pills, and decongestants.

  • Clinical picture : 

  • Chest pain which occur with less exertion , last longer than stable angina , less responsive to medications , the pain also occurs at rest.

investigations :

ECG shows ST segment depression with T inversion or flat.

Treatment :

ASA( aspirin ), O2, nitroglycerine, morphine, B- blockers, ACEI. hiparine.

By Dr. Mustafa Aljubbawy


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