Chronic stable angina has been known since the 17th century, long before the 20th century epidemic of heart attacks.
It can go on unchanged for many years.
Fifty years ago, cardiologists had their eyes, ears, hands and ECG to diagnose angina or otherwise².
These days a suspicion of this is often enough to have a cardiologist wanting to arrange a coronary angiogram. There is an old saying that to a man with a hammer, everything starts to look like a nail.
Research published³ in 2012 from Europe found that in a large group of suspects (from clinical and stress electrocardiogram (ECG) evaluation,) instead of the 60% expected to have coronary artery narrowing, only 25% did so.
From this research "Preliminary results suggest that heart disease can be diagnosed in the majority of cases without needing a catheterization and that many patients with chest pain receive unnecessary invasive procedures."(Medscape)
Even non-invasive stress testing or coronary CT angiography has trebled the rate of subsequent invasive "revascularization" with angioplasty and stents. The question is being asked⁴ "Does our current practice lead to the stenting of asymptomatic patients in the inevitable cases where the inciting pain was non-cardiac? And, most importantly, does our practice improve outcomes?" (Medscape)
"The opening gambit – “tight pain across the upper chest,” or “pain when I work relieved by rest” – is immediately suggestive of angina, and several patients have been referred with such a diagnosis.
However, the duration of the pain is never brief (a few minutes or so), but is always longer lasting (half an hour or longer), and sometimes present for days at a time.
The pain of coronary insufficiency may be longer lasting, but when it is described the intensity of the pain always comes through in the description, and there is never much delay in seeking medical advice. However , with these patients the pain is described in a more placid manner while at the same time their underlying nervous state often shows through. When rest, or sometimes trinitrin, is described as giving relief, one finds that it takes half an hour or longer for the pain to disappear, unlike that of angina" (relieved within a few minutes.)