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Type of angina Etiology Clinical manifestations

Stable Angina Myocardial ischemia, usually secondary to Provoked by physical exertion or emotional stress
coronary artery disease
Usually lasts a short time (15 minutes or less)

Relieved by rest or nitroglycerin


See Clinical Manifestation section

Unstable Angina Rupture of thickened plague, exposing Unexpected chest pain, usually occurs while
thrombogenic surface resting or with minimal exertion

Angina of increasing frequency, duration or


severity

Pain unrelieved by rest or nitroglycerin

Can lead to a myocardial infarction


Prinzmetals angina Coronary vasospasm, usually in a major Occurs primarily at rest
artery
Triggers include increased myocardial oxygen
demand and increased levels of certain
substances (e.g., histamine, angiotensin,
epinephrine, norepinephrine, prostaglandins).
Can be triggered by smoking.

May occur in presence or absence of coronary


artery disease.

Patient usually has a history of migraine


headaches and Raynauds phenomenon.

Pain is relieved by moderate exercise, or it may


disappear spontaneously. It is usually treated with
calcium channel blockers, nitrates, or both.

Silent angina Ischemia occurs in the absence of any There is objective evidence of ischemia but
subjective symptoms patient reports no pain

Patients with diabetes are at increased risk Patients can be monitored (e.g., Holter monitor)
of silent ischemia, possibly related to to detect ECG changes as silent ischemia occurs.
diabetic neuropathy affect the nerves that Ischemia with or without pain has the same
innervate the cardiovascular system. prognosis.
Nocturnal Angina and Etiology is believed to be the result of Occurs only at night; the person does not need to
Angina Decubitus increased myocardial oxygen demand be sleeping or in the recumbent position to
(possible due to increased demand during experience symptoms
REM sleep).
Angina decubitus is chest pain that occurs only
Most clinicians consider this to be a stable while the person is lying down and is usually
type of angina. relieved by standing or sitting