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Ask A Doctor... About Stable and Unstable Angina

September 30, 2016 | By Lisa Schwenk
Published in: Heart, Question Answer

A man holding his chest

Dr. Lewis Siegel
Lewis Siegel, MD, FACC

Answer provided by Lewis Siegel, MD, FACC, a cardiologist with Augusta Health Cardiology in the Heart & Vascular Center at Augusta Health.

Dr. Siegel attended the State University of New York, Downtown Medical Center for medical school, then completed his residency at Tulane University and a fellowship at Albert Einstein College of Medicine. His professional interests are the diagnosing and treatment of patients with cardiovascular disease, using both non-invasive and invasive procedures. Dr. Siegel enjoys hiking, canoeing, gardening, the theater and music, and traveling with his wife.

Contact Augusta Health Cardiology at (540) 332-4278. For general information about the practice, contact Renie Galford, Office Manager, at (540) 245-7088 or rgalford1 [at]

Although angina and unstable angina have similar symptoms, they differ in terms of severity and when the symptoms occur.

Angina, or stable angina, is chest discomfort that happens with a predictable way, such as when you are exerting yourself or stressed. If you stop what you are doing, the pain or discomfort usually stops too. So any activity like exercising or having an argument, that makes your heart rate go up, also makes your blood pressure rise, so your heart need to work harder. To work harder, it needs more oxygen. If it is not getting enough, it can cause the pain and discomfort of angina.

Unstable angina is when the symptoms occur for the first time, or have been happening for less than two weeks. Unstable angina can happen any time, even when you are resting or sitting in front of the television doing nothing. It's hard to ignore. If the symptoms stop, they usually return again soon.

Angina can go from being stable to being unstable. For example, if you usually have chest discomfort every time you walk two blocks, that would be considered stable angina. However, if that predictable pattern of chest discomfort suddenly changes—you get the discomfort after only walking half a block instead of two—your angina that has become unstable.

In short:

Stable Angina

  • is pain or discomfort similar to past episodes of angina with similar amounts of exertion and usually stops in less than five minutes.
  • is chest pain or other symptoms that usually stop after you take medication or stop to rest.
  • is triggered by activities that make the heart work harder—physical and emotional exertion or stress, extreme temperatures, or a big meal.

Unstable Angina or a Possible Heart Attack

  • can happen anytime. You could be taking a nap or having a cup of coffee.
  • may feel different than the pain or discomfort of stable angina.
  • is often more painful or severe and lasts longer than stable angina—more than a few minutes.
  • may not go away with rest or use of angina medication.

Unstable angina is a medical emergency. Call 911 if you, or someone you love, has angina symptoms that last more than five minutes and continue when they stop the activity and rest or take angina medication. This could be a heart attack, and needs to be treated immediately.