Is angina the same thing as a heart attack?
Angina is not the same as a heart attack, but the difference is only one of degree. CAD causes both conditions, but while angina is the result of the gradual development of partial blockages in the coronary arteries, a heart attack is caused by very sudden, total or near-total blockages in these vessels. Because CAD underlies both processes, those with angina are at increased risk for a heart attack, though about 50% of heart attacks occur in individuals who have had no prior angina or symptoms of heart disease.
Are there different degrees or severities of angina?
Yes. A stable pattern of symptoms to which a person has become accustomed over time is called stable angina. With stable angina, a particular level of activity – for example walking up three or more flights of stairs – may predictably bring on a person’s symptoms. When he or she rests or takes a nitroglycerine tablet, the symptoms are relieved over a few minutes. There is no immediate need to treat stable angina (other than resting or using nitroglycerine when symptoms result), and patients with stable angina have been treated with medications only for many years. Increasingly, however, angioplasty or coronary bypass surgery on a non-urgent basis is being used to help reduce symptoms for those with stable angina, especially if angina occurs at a relatively low level of activity.
If the amount of coronary artery blockage increases, lesser levels of exertion can bring on angina, or symptoms may last longer, or take more time to resolve. When this progression happens over a matter of a few hours or days, or when a person experiences recurrent symptoms at rest, it is called unstable angina. Those patients with unstable angina are at high risk for heart attack and therefore require immediate treatment. This rapid progression of symptoms usually occurs because one of the coronary artery plaques or blockages “ruptures” or breaks through the inner artery lining. When the material in the plaque is exposed to the bloodstream, a clot rapidly forms, quickly reducing blood-flow and causing worsening symptoms. When the blockage is total or near total, a heart attack begins. Alternately, a person with long-term stable angina may gradually worsen over time, to the point of having unstable angina just on the basis of gradually worsening CAD.
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