Angina, and What Stable and Unstable Chest Pain Mean

Angina is chest pain or pressure that comes on when the heart muscle is not getting enough blood, usually because the coronary arteries have narrowed. It is a warning sign of coronary artery disease, not a stomach or a muscle problem. Stable angina follows a predictable pattern. Unstable angina is an emergency.

What is the difference between stable and unstable angina?

Stable angina is predictable, brought on by effort, and it settles within minutes of rest. Unstable angina breaks that pattern. The pain is new, or more frequent, or it arrives at rest, or it lasts longer than it used to. Stable angina needs a prompt clinic assessment. Unstable angina needs DHQ Hospital Abbottabad Emergency now.

The reason the distinction is drawn so sharply is what is happening inside the artery. In stable angina a fixed narrowing limits flow only when you are working. In unstable angina the fatty plaque has cracked and a clot is forming on it, which is the same process that causes a heart attack.

What are the symptoms of angina?

The classic symptom is heaviness, tightness or squeezing across the chest that starts with effort and eases within minutes of rest. Plenty of patients never call it pain at all. They describe a weight, a pressure, or simply breathlessness when they walk.

Patients commonly describe:

• Chest heaviness or pressure, a weight on the chest, what many call seene par bojh
• Tightness spreading to the left arm, both arms, the jaw, the neck or the back
• Breathlessness walking uphill or climbing stairs
• Burning behind the breastbone, often blamed on gas or acidity
• Unusual tiredness during activity that used to feel easy
• Uneasiness or restlessness that comes on with exertion

In people with diabetes, angina can be muted or missing altogether, and breathlessness or fatigue may be the only clue. If symptoms show up during ordinary things like wuzu, prayer movements or carrying bags uphill from the bazaar, tell your doctor exactly that. The detail is more useful than you think.

What causes angina, and who is at risk?

Angina is almost always caused by atherosclerosis, the slow build-up of cholesterol-rich plaque inside the coronary arteries over years. Once an artery narrows enough, it can still supply a resting heart but not a working one. Effort opens a gap between supply and demand, and that gap is what you feel.

The risk factors are the familiar ones, and in South Asians they arrive early:

• High cholesterol, often with the low-HDL pattern common in our region
• High blood pressure, frequently silent and untreated
• Diabetes, which is extremely common in Pakistani families
• Smoking and naswar use
• Family history of early heart disease
• Physical inactivity and weight gain around the middle, fed by ghee-rich and fried food

The American Heart Association (AHA) reports that South Asians develop coronary artery disease earlier than most other populations. Angina symptoms in your 30s or 40s deserve the same respect as angina symptoms in your 60s.

When does angina become an emergency?

Angina becomes an emergency the moment it stops behaving predictably. Pain at rest, pain that wakes you from sleep, pain lasting beyond ten minutes, pain coming after less and less effort, or pain your usual tablet no longer touches: call 1122 or go to DHQ Hospital Abbottabad Emergency.

The rule is short. Stable angina goes to the clinic urgently. Anything unstable goes to the Emergency immediately. Go straight to emergency as well if chest pain arrives with cold sweat, vomiting, fainting or severe breathlessness, because those point toward a heart attack rather than simple angina. Never test yourself by walking around to see if the pain comes back, and never drive yourself anywhere while the pain is on.

How is angina diagnosed?

Diagnosis starts with your story. What brings the pain on, what settles it, how long it lasts. An ECG and an examination come next. A resting ECG is often completely normal in stable angina, so tests that watch the heart while it works usually give the answer. NICE guidance recommends assessing chest pain in a structured way rather than guessing.

Tests your cardiologist may arrange include:

• An ETT (Exercise Tolerance Test), an ECG recorded while you walk on a treadmill, to see whether effort produces changes.
• Stress echocardiography, ultrasound pictures of the heart under stress that show which wall is running short of blood.
• A resting echocardiography to check pumping strength and valves.
• Angiography, the dye test that maps every narrowing, when non-invasive tests suggest significant disease.

Dr. Muhammad Ali Khan, Consultant Cardiologist, provides structured chest pain evaluation at his Abbottabad clinics, so that angina is neither missed nor over-diagnosed.

How is angina treated?

Treatment has two jobs: relieve the pain, and stop the disease turning into a heart attack. Medicines do most of the work. Procedures reopen arteries when the narrowings are severe. European Society of Cardiology (ESC) guidelines recommend combining both with serious attention to risk factors.

• Sublingual nitrate tablets or spray relax the arteries and relieve an episode within minutes. Carry them everywhere, and sit down before you use them.
• Beta-blockers and calcium channel blockers slow and steady the heart, so effort no longer outruns supply.
• Aspirin and statins guard against clot formation and stabilise plaque. These are the medicines that prevent heart attacks.
• Angioplasty and stenting reopens a severely narrowed artery when symptoms persist despite medicines.
• Bypass surgery is preferred for certain patterns of multi-vessel disease, decided after angiography.

How do you live with angina?

Well-treated stable angina fits around work, travel, prayer congregations and an active life in Abbottabad's hills, as long as you respect the condition. The target is a life where the tablet under your tongue is rarely needed, because the disease itself is properly controlled.

Practical habits that help:

• Know your own pattern. Note what effort brings symptoms on. If that pattern changes, get reviewed quickly.
• Warm up gently before exertion, and avoid sudden heavy effort in cold weather, which tightens arteries.
• Take your preventive medicines daily, not only on the days pain appears.
• Walk regularly at a comfortable pace. Activity trains the heart and improves symptoms over months.
• Cut out smoking and naswar, go easy on ghee and deep-fried food, and keep blood pressure, sugar and cholesterol checked.
• Keep follow-up appointments even during good spells, so treatment can be adjusted before problems return.