Unstable angina is a condition in which your heart doesn't get enough blood flow and oxygen. It is a prelude to a heart attack. Most people experience a feeling of chest discomfort or shortness of breath.

See also:

• Stable angina
• Variant angina

Accelerating angina; New-onset angina; Angina - unstable; Progressive angina

Coronary artery disease due to atherosclerosis is by far 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 less flexible and narrow, which interrupts blood flow to the heart, causing chest pain.

At first, angina may be considered stable. The chest pain only occurs with activity or stress. The pain does not change much in frequency or severity over time. Unstable angina is chest pain that is sudden and gets increasingly worse. The chest pain:

• Occurs without cause (for example, it wakes you up from sleep)
• Lasts longer than 15 - 20 minutes
• Responds poorly to a medicine called nitroglycerin
• May occur along with a drop in blood pressure or significant shortness of breath

People with unstable angina are at increased risk of having a heart attack.

Coronary artery spasm is a rare cause of angina.

Risk factors for coronary artery disease include:

• Male gender
• Diabetes
• Older age
• Family history of coronary heart disease before age 50
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Not getting enough exercise
• Smoking
• Obesity

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr., et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157.

Antman EM. ST-Elevation Myocardial Infarction: Management. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.