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Cardiac surgeon, thoracic surgeon

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Stable angina pectoris

Alexey Kryvenko, medical expert
Last reviewed: 05.07.2025

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Stable angina is a chronic heart disease caused by the inability of narrowed coronary arteries to provide the necessary increase in blood flow when the work performed by the heart increases.

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What causes stable angina?

When the diameter of the main coronary artery is narrowed by an atherosclerotic plaque by 70% or more, the reduced blood flow may still be sufficient to provide the low oxygen demand of the myocardium at rest, but insufficient to increase this demand under the influence of physical or psycho-emotional stress. The lower the throughput of the coronary arteries, the less work that can be done without developing ischemia. The level of stress that causes an attack of angina is the most important criterion in determining the severity of coronary disease.

How does stable angina manifest itself?

Stable angina is felt by the patient as a squeezing, pressure, burning, piercing pain or numbness localized behind the sternum, with irradiation to the left shoulder, shoulder blade, neck or lower jaw. These manifestations occur during physical exertion and require a decrease in its intensity or complete cessation. The duration of such attacks, as a rule, does not exceed ten minutes and the attacks are similar to each other. Based on the tolerance of physical exertion, stable angina is divided into functional classes.

Class I. Normal physical activity is tolerated well, angina attacks occur only with heavy loads.
Class II. There is a slight limitation of normal physical activity. Stable angina occurs when walking on level ground for a distance of more than 500 meters or when climbing stairs more than one floor.
Class III. There is a marked limitation of normal physical activity. Stable angina when walking at a normal pace on level ground for a distance of 100 to 500 meters and/or when climbing stairs no more than one floor.
Class IV. Pain occurs even with minor physical exertion (walking on level ground for a distance of less than 100 meters). Attacks of angina at rest are typical.

Treatment of stable angina

Anything outside these four classes should be considered unstable angina, treated with intensive therapy, and continued until proven otherwise.