Coronary artery disease due to atherosclerosis is the most common cause of unstable angina. Atherosclerosis is the buildup of fatty material, called plaque, along the walls of the arteries. This causes arteries to become narrowed and less flexible. The narrowing can reduce blood flow to the heart, causing chest pain.
Coronary artery disease
Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also cal...
The provider will do a physical exam and check your blood pressure. The provider may hear abnormal sounds, such as a heart murmur or irregular heartbeat, when listening to your chest with a stethoscope.
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
You may need to check into the hospital to get some rest, have more tests, and prevent complications.
Blood thinners (antiplatelet drugs) are used to treat and prevent unstable angina. You will receive these drugs as soon as possible if you can take them safely. Medicines include aspirin and the prescription drug clopidogrel or something similar (ticagrelor, prasugrel). These medicines may be able to reduce the chance of a heart attack or the severity of a heart attack that occurs.
During an unstable angina event:
You may get heparin (or another blood thinner) and nitroglycerin (under the tongue or through an IV).
Other treatments may include medicines to control blood pressure, anxiety, abnormal heart rhythms, and cholesterol (such as a statin drug).
Abnormal heart rhythms
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart.
A coronary artery stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is often placed after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine in it that helps prevent the artery from closing over time.
A stent is a tiny tube placed into a hollow structure in your body. This structure can be an artery, a blood vessel, or something such as the tube t...
Some studies have shown that making a few lifestyle changes can prevent blockages from getting worse and may actually improve them. Lifestyle changes can also help prevent some angina attacks. Your provider may tell you to:
Lose weight if you are overweight
Drink alcohol in moderation only
Eat a healthy diet that is high in vegetables, fruits, whole grains, fish, and lean meats
Your provider will also recommend that you keep other health conditions such as high blood pressure, diabetes, and high cholesterol levels under control.
If you have one or more risk factors for heart disease, talk to your provider about taking aspirin or other medicines to help prevent a heart attack. Aspirin therapy (75 to 325 mg a day) or drugs such as clopidogrel, ticagrelor or prasugrel may help prevent heart attacks in some people. Aspirin and other blood thinning therapies are recommended if the benefit is likely to outweigh the risk of side effects.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. PMID: 25260718 www.ncbi.nlm.nih.gov/pubmed/25260718.
Giugliano RP, Braunwald E. Non-ST elevation acute coronary syndromes. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 60.
Jang JS, Spertus JA, Arnold SV, et al. Impact of multivessel revascularization on health status outcomes in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. J Am Coll Cardiol. 2015;66(19):2104-2113. PMID: 26541921 www.ncbi.nlm.nih.gov/pubmed/26541921.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.