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A Guide To Managing Chronic Stable Angina

  • Stable angina refers to short-lived, predictable chest pain during specific activities.
  • Stable angina differs from unstable angina which is unpredictable, occurs even at rest, and does not go away with typical management strategies.
  • There are many medications that can both prevent and treat the symptoms of stable angina.

What is Chronic Stable Angina?

Chronic stable angina (angina pectoris) is chest pain or discomfort that occurs when the heart muscle doesn't get enough blood. Angina can be a symptom of coronary artery disease (CAD) in which the arteries that supply the heart with blood become blocked by a buildup of plaque.

Angina causes pain that's often described as crushing, squeezing, burning, or tight in the chest. Stable angina doesn't come as a surprise though. Symptoms are predictable to each individual and usually last less than 5 minutes.

For example, they may occur every time you go up the stairs or get overwhelmed at work. This is often when the heart is asking for an increased supply of blood, but your body is unable to meet that request.

While it is very uncomfortable, stable angina is not “dangerous” and can be managed with medication.

If you feel as though you may have angina, speak with a healthcare provider to diagnose the condition and rule out any other conditions that may be causing your symptoms.


Diagnosing Chronic Stable Angina

Angina can be classified into many different classes. The most important classification is between stable and unstable angina.

Stable angina is more common and is predictable and short in duration. It will occur with the same activities and feel the same when it occurs.

Unstable angina, on the other hand, is unpredictable. This means that it will occur at rest, or during activities that normally do not bring on chest pain for you. This pain will not go away quickly, or even with typical medications that relive angina. If left untreated, unstable angina can result in a heart attack, and is therefore a medical emergency.

For a clear diagnosis, your healthcare provider will rely on your personally reported symptoms and tests such as blood work, imaging of your heart, and/or a stress test. A stress test measures how your heart works under physical stress, such as running on a treadmill. They will then rule out any other possible conditions or events such as heart failure or a heart attack before coming to a diagnosis.

Once your healthcare provider has classified your angina as stable, it can be further categorized based on how much it impacts your life.

Class I
  • Symptoms occur only druing strenuous or prolonged physical activity
  • Treatment:

    Lifestyle modifications: regular exercise, quitting smoking, and a heart-healthy diet

    Medication: aspirin or antiplatelet agents

Class I
  • Symptoms occur only druing strenuous or prolonged physical activity
  • Treatment:

    Lifestyle modifications: regular exercise, quitting smoking, and a heart-healthy diet

    Medication: aspirin or antiplatelet agents

Class II
  • Symptoms occur with moderate physical activity
  • Treatment:

    Lifestyle modifications: regular exercise, quitting smoking, and a heart-healthy diet

    Medication: beta-blockers or calcium channel blockers

Class III
  • Symptoms occur with mild physical activity or even at rest
  • Treatment:

    Medication: nitrates
    Procedures: angioplasty or bypass surgery

Class IV
  • Symptoms occur even with minimal physical activity or at rest
  • Treatment: combination of medications, lifestyle modifications and surgery

Chronic Stable Angina Treatment

All patients with chronic stable angina will be recommended to make lifestyle adjustments and given short acting “rescue” medications to resolve symptoms. Lifestyle changes are very important to prevent angina from getting worse or developing into a more serious condition.

These changes can include:

  • Cessation of dangerous activities, such as excessive drinking and smoking cigarettes.
  • Exercise

    Regular exercise such as swimming jogging, or even walking can improve your heart’s health. It is important to continue exercising, though ensuring to pace yourself in order to prevent angina from interfering with exercise.

  • Diet

    Eating a balanced diet full of fruits, vegetables, and grains is essential in order to maintain a healthy heart. It is also important to reduce salt intake from processed foods and beverages.

All patients with chronic angina should be given a short-acting nitroglycerin tablet or spray. This medication is often given to individuals following a heart-related event, such as a heart attack or stroke. However, it is also available over-the-counter to purchase without a prescription. If bought over the counter, it is important to ensure you have spoken to a healthcare provider about your angina and about the medication’s proper use before beginning self-treatment.

The purpose of a nitroglycerin spray is to quickly relieve the presence of angina when it is to occur. Other prescription medication treatments are preventative, and work to prevent the symptoms of angina before they occur.

If you have chronic angina, and the rescue medication such as nitroglycerin does not improve the chest pain after 5 minutes, seek emergency medical attention.

Medications for Chronic Stable Angina

There are 3 main medication types used to treat chronic statble angina. These include:


By hindering the release of these hormones that increase heart beat and blood pressure, beta-blockers reduce the stress placed on your heart and the force of heart muscle contractions. As a result, the blood vessels in your heart, brain, and the rest of your body are relieved of that pressure.

Calcium channel blockers (CCBs)

Calcium channel blockers decrease the amount of calcium that enter the heart and blood vessel walls. This relaxes the blood vessels and makes it easier for the heart to pump, resulting in decreased blood pressure.


The nitroglycerin works by opening up the blood vessels and increasing the blood flow to the heart, which reduces the pain of angina.