A distinction is made between different types of angina pectoris. There is stable angina pectoris and unstable angina pectoris. Stable angina pectoris is defined as a condition in which the symptoms are similar each time they occur and last approximately the same length of time.
An example of stable angina pectoris is Prinzmetal angina, in which spasm of the vessels occurs. Stable angina pectoris usually occurs without changes in the ECG. This form of angina pectoris can be treated well with nitrogylcerin.
In unstable angina pectoris, there is either a change in the symptoms or a new onset of angina pectoris. This form is usually caused by a heart attack or a coronary artery disease at the base of arteriosclerosis. The occurrence of an unstable angina pectoris represents an emergency.
In contrast to stable angina pectoris, the basis of unstable angina pectoris is usually visible in the ECG. The symptoms of stable angina pectoris are characterized in particular by the fact that they do not change over a long period of time. In general, the disease causes mainly chest pain.
These are often located directly behind the sternum and occur in attacks. They usually last for one to five minutes and can be relieved by the administration of nitroglycerine (nitro spray). However, the pain can also radiate to other parts of the body.
This can be accompanied by nausea and vomiting. In contrast to unstable angina pectoris, the symptoms of stable angina remain constant. Over a long period of time, the above-mentioned symptoms occur in attacks, but the pain does not worsen.
These symptoms suggest that a stenosis (narrowing) of the affected coronary vessel is present, but does not progress any further. Unstable angina pectoris is the typical pectanginous complaint. These include pain in the chest area, especially behind the sternum (breastbone).
The pain can also radiate into the upper abdomen and stomach. This is often accompanied by nausea and vomiting. It is also possible for the pain to be shifted to the left arm, the back or the jaw/teeth/neck.
The underlying cause of the pain is coronary heart disease. This means that at least one of the coronary arteries is blocked or constricted by plaque. A worsening of the symptoms is characteristic of unstable angina pectoris.
Over a certain period of time, several angina attacks occur, which gradually become stronger. From this it can be concluded that the stenosis (constriction) of the affected coronary vessels continues to progress. Therefore, unstable angina pectoris is associated with a high risk of heart attack.
Every first-time occurrence of angina pectoris also falls under the definition of unstable angina, as in this case the symptoms deteriorate from “no symptoms” to “angina pectoris symptoms”. The Prinzmetal angina also describes seizure-like chest pain. These are triggered by a spasm (sudden contraction) of the coronary arteries.
Similar to coronary artery disease, this leads to reduced blood supply to the vessels, so that the heart muscles behind the spasming vessel section are no longer supplied with sufficient blood. This results in an undersupply of oxygen and other nutrients, which in turn leads to chest pain. These vascular spasms occur in attacks and thus also cause attack-like pain in the chest area.