Pathophysiology of stable angina

The coronary arteries supply the heart muscle. Fatty deposits and changes in the artery wall can narrow the channel, limiting reserve blood flow. At rest, the available supply may be enough. During walking, climbing, emotional stress, or cold exposure, the heart works harder and needs more oxygen; the mismatch can cause pressure, heaviness, or [Chest Tightness](/symptoms/chest-tightness/). Stable symptoms tend to appear with a familiar level of effort and ease with rest or prescribed medicine. A change in that pattern is not stable angina and needs prompt assessment.

Record what brings symptoms on, how long they last, and what relieves them. Use prescribed angina medicine according to your action plan and do not exceed the advised dose. Your clinician may recommend an [Electrocardiogram](/treatments/diagnostics-and-screening/ecg/) or other tests. Treatment can target cholesterol, smoking, diabetes, activity, and blood pressure; [Blood Pressure Medication](/treatments/medical-management/blood-pressure-medication/) and [Statin Therapy](/treatments/medical-management/statin-therapy/) may be part of that plan. Increase activity only as advised, especially if symptoms are new.

Call emergency services if chest pressure is severe, lasts longer than your usual episodes, occurs at rest, or does not improve with your prescribed plan. Also seek immediate help for breathlessness, sweating, fainting, nausea, or pain spreading to the arm, jaw, back, or shoulder. Do not drive yourself. A sudden change can signal a heart attack even when the discomfort feels familiar.

What pattern makes my symptoms stable or unstable? Which medicine should I use during an episode, and when should I call emergency services? What tests assess my coronary arteries? Which activity and risk-factor changes are appropriate for me?