Types of Angina

If your heart muscle isn’t getting enough oxygen-rich blood, you can feel chest pain, or angina. It happens when your coronary arteries can’t supply enough blood to the heart muscle. This condition is usually due to coronary artery disease. It causes four main types of angina.

Stable Angina

Stable angina is the most common type. It occurs when a waxy substance—or plaque—forms inside a coronary artery. Plaque builds up and in time reduces blood flow by narrowing the artery. Symptoms, like chest pain, occur when your heart works harder and needs more oxygen than normal. This could happen when you climb stairs or exercise. Angina happens because the oxygen supply can’t meet the demand. However, stable angina goes away in about five minutes if you rest or take medication. Stress, very hot, or cold weather, and smoking also can be triggers.

Having stable angina does not mean you are in immediate danger of having a heart attack. However, it does mean you are more at risk of a heart attack in the future.

Unstable Angina

Unstable angina is less common than stable angina, but it's more dangerous. The cause is a coronary artery disease plaque that ruptures. To repair the rupture, your body forms a blood clot over the plaque, which may completely block the flow of blood. This type of angina may occur without any triggers. You may be resting or sleeping. Symptoms are similar to stable angina, but they may be worse. The main difference is symptoms do not go away by resting or taking medicine.

Unstable angina is a medical emergency. It means you are in immediate danger of a heart attack. Call 911, but do not try to drive yourself to the emergency room.

Microvascular Angina

Microvascular angina is most common in women and younger people. The cause of microvascular angina is not a plaque or clot. Instead, coronary artery disease causes damage to the smallest branches of coronary arteries. Other names for microvascular angina are nonobstructive coronary artery disease and cardiac syndrome X. Routine activities and stress can trigger this type of angina. You may be at higher risk if you have high blood pressure or diabetes. Shortness of breath and fatigue are common symptoms, along with chest pain. Symptoms may be more severe and last longer than symptoms of stable angina.

Having this type of angina does not mean you are likely to have a heart attack right away. However, it does increase your risk for a future heart attack.

Variant Angina

Variant angina is the least common type of angina, but is more common in young people. Other names for it are Prinzmetal angina and angina inversa. It occurs when coronary arteries go into spasms, squeezing down of the artery. There is usually no plaque or blood clot.

This type of angina usually occurs at rest and at night. Smoking or using cocaine may trigger it. Symptoms are severe but get better with medication. Attacks of variant angina usually occur in cycles that come and go. Treatment may break the cycles. Variant angina rarely leads to a heart attack.

What You Need to Know

All types of angina are caused by coronary artery disease, which can lead to a heart attack. In a heart attack, your heart muscle starts to die from lack of oxygen. Symptoms of a heart attack include: