What Are The Different Types Of Angina?

Based on an article title “Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group” 

Originally written by Shimokawa et al.


By Murielle Nsiela 

Angina, or angina pectoris, is chest pain caused by reduced blood flow to the heart. It is defined as a feeling of squeezing, pressure, tightness, or pain in the chest. Angina itself is a symptom of coronary artery disease, which is caused by the build-up of plaque in the arteries. There are two main types of angina: the first is stable, and the second is unstable. Stable angina is the most common type and usually occurs when your heart is working harder than usual, such as when exercising or due to emotional stress. This type of angina lasts for a short duration of time and usually goes away when resting or when taking angina medication.1 

Unstable angina does not have a pattern and tends to worsen; it can occur without warning or when doing mild physical activity, resting, or sleeping. Unstable angina increases the risk of an individual suffering from a heart attack if not treated quickly. Symptoms of unstable angina can range from crushing pain in the chest to chest pains that don’t get better with medication.2

In addition, there are two other rare or less common types of angina. The first is prinzmetal or variant angina which occurs due to a spasm in the coronary artery, resulting in reduced blood flow. This type of angina occurs mainly when at rest. It can be extremely painful and occurs between midnight and 8:00 AM. This type is also more common amongst people assigned female at birth (AFAB).1,3 

The second rare type of angina, known as microvascular angina, has only been discovered recently. Individuals with this type of angina usually experience chest pains. However, they may not have any apparent blockage of the coronary artery. It is thought that the pain is due to the poor function of small blood vessels that nourish the heart, legs, and arms. Microvascular angina is also more common in people AFAB.3

It is also suggested that microvascular angina may be the underlying cause of many angina patients. A multinational, multiethnic, and multicentre study was conducted to determine the clinical characteristics of patients with microvascular angina.4 The study, conducted over seven different countries from four continents, showed that patients with microvascular angina are at a greater risk of suffering from major cardiovascular problems, such as heart attacks, strokes, and heart failure. In addition, the study showed no sex differences in the outcome of patients with microvascular angina, even though the people AFAB in the study had a lower quality of life.4

In conclusion, there is a significant unmet need to treat and manage microvascular angina. However, treatments with statins (which lower cholesterol), low-dose aspirin, and some anti-anginal medication can help with the symptoms and potential outcome of the disease.5,6 


  1. Angina - Symptoms and causes [Internet]. Mayo Clinic. 2022 [cited 6 February 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373
  2. Unstable Angina: Causes, Symptoms and Treatment [Internet]. Cleveland Clinic. 2022 [cited 6 February 2022]. Available from: https://my.clevelandclinic.org/health/diseases/21744-unstable-angina 
  3. Angina Pectoris [Internet]. Hopkinsmedicine.org. 2022 [cited 6 February 2022]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/angina-pectoris 
  4. Shimokawa H, Suda A, Takahashi J, Berry C, Camici P, Crea F et al. Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group. European Heart Journal. 2021;42(44):4592-4600. 
  5. Pizzi C, Manfrini O, Fontana F, Bugiardini R. Angiotensin-converting enzyme inhibitors and 3-hydroxy-3-methylglutaryl coenzyme A reductase in cardiac syndrome X: role of superoxide dismutase activity. Circulation 2004; 109:53–58
  6. Sütsch G, Oechslin E, Mayer I, Hess OM. Effect of diltiazem on coronary flow reserve in patients with microvascular angina. Int J Cardiol 1995; 52: 135–143.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Murielle Nsiela

MSc Graduate in Medical Engineering - Bachelor's degree, Pharmaceutical Science, Keele University, Staffordshire UK

MSc in Medical Engineering Design, Keele University Modules included: Advanced engineering applications, Engineering for medical applications report, Bioreactors and Growth environment, Creative engineering design, Experimental research methodology and research projects

BSc (Hons) Pharmaceutical Science, Technology and Business, Keele University Modules included: Core topics in pharmaceutical science, Laboratory studies - tabletting and liposomes report, applied Pharmaceutical Science 2, Pharmaceutical research project

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