Chronic unstable angina, also known as 'refractory angina pectoris,' is a persistent form of unstable angina that is characterized by disabling chest pain at rest or with minimal exercise despite being on maximum medical therapy. Criteria for such a diagnosis include having recurrent episodes of debilitating chest pain, inadequate control with medication, a history of severe significant coronary artery disease, and no possibility of revascularization procedures because of other severe medical problems.

Patients with refractory angina pectoris can perform only a few physical activities because of pain or the fear of pain. They have an extremely restricted lifestyle that can cause an additional psychological stress. Patients with chronic unstable angina are often admitted to the hospital because of the severe pain, and the fear that they may be experiencing a true heart attack. Chronic unstable angina can make it very difficulty to take part in important day to day activities. As a result, they may become more socially withdrawn, sometimes never venturing away from the home.

Reference

DeJongste MJL, Tio RA, Foreman RD. Chronic therapeutically refractory angina pectoris. Heart 2004;90:225-30.