Types of Angina: Stable, Unstable & Prinzmetal's

Instructor: Lacey Russell

Lacey has a Master's of Science in Nursing with a specialization in Acute Care Nurse Practitioner

Today we will learn what angina is and discuss the three different types of angina: stable, unstable, and Prinzmetal's. We will learn how to tell the three apart as well as how to treat each type.

What is Angina?

Angina is the medical term for chest pain and is caused when the heart muscle does not have enough oxygen. This is usually caused from a blockage in the arteries of the heart. Angina can feel like pressure on the chest, heartburn, or pain that radiates from the chest and down the left arm. There are three types of angina: Stable, Unstable, and Prinzmetal's.

Stable Angina

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Joe is outside mowing his yard. He has one section that he has to use a push mower on because the hill is too steep. When he finishes the section he is out of breath and feels like something is sitting on his chest. This happens every time he exerts himself so he knows what to do. Joe takes his nitroglycerin, which his doctor prescribed for his episodes of chest pain. He goes inside to rest and within 5 minutes the pain is gone.

Joe shows classic signs of stable angina. It occurs when the heart's workload is heavier. His pain is the same every time he has it, and medication and rest relieve the pain in a short period of time. Joe's pain is caused because he has blockages in his arteries that allow enough oxygen to pass when he is at rest. When he exerts himself, the oxygen is insufficient. This doesn't mean that he will have a heart attack, but it does mean Joe has a higher chance of having one than someone with no chest pain.

Unstable Angina

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A few months later Joe is watching TV and begins to have severe chest pain that radiates down his left arm. It is far worse than his normal chest pain. He takes a nitroglycerin and waits, but the pain does not get better and seems to be getting worse. His wife calls 911, and he is taken to the emergency room.

Joe has now progressed to unstable angina which occurs while resting and comes as a surprise to the patient. The pain is typically worse and lasts longer than stable angina, rest and medication do not help relieve the pain. This typically means that an artery has become completely blocked and a heart attack is imminent. It is treated by finding the blockage and then removing it or bypassing it with surgery.

Prinzmetal's Angina

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Jack is Joe's son. He has been stressed about his father's open heart surgery to restore blood flow to his heart. Jack wakes up in the middle of the night with severe chest pain. He is worried that he may have inherited his father's heart disease so he goes to the hospital. They give him nitroglycerin and it relieves the pain. They rule out any blockages, and he is eventually diagnosed with Prinzmetal's angina.

Prinzmetal's angina is also known as variant angina. It occurs when the coronary arteries spasm and cut off blood supply to the heart muscle. The spasms occur in cycles and can be caused by stress, cold weather, or smoking just to name a few. The pain usually occurs while the person is at rest in the middle of the night. Medication will relieve the pain.

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