Dr. Nissen discusses symptoms of coronary artery disease.

The most common symptom of coronary artery disease is angina (also called angina pectoris). Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw.

If you have angina or any of the symptoms listed below that last for more than 5 minutes, SEEK EMERGENCY TREATMENT (CALL 9-1-1) WITHOUT DELAY. These symptoms could be the signs of a heart attack (also called myocardial infarction or MI) and immediate treatment is essential.

  • Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach
  • Difficulty breathing or shortness of breath
  • Sweating or "cold sweat"
  • Fullness, indigestion, or choking feeling (may feel like "heartburn")
  • Nausea or vomiting
  • Light-headedness, dizziness, extreme weakness or anxiety
  • Rapid or irregular heart beats

Shaded areas show where you may have symptoms

Shaded areas show where you may have symptoms

Symptoms of coronary artery disease in women:

Studies show that women's symptoms are less likely identified as heart disease related. The symptoms of coronary artery disease and heart attack can be different for women than they are in men. Women are also less likely to recognize the symptoms of a heart attack and seek treatment. By learning and recognizing the symptoms, women can become assertive in their treatment. The most common symptoms of heart disease in women are:

  • Pain or pressure over the chest that travels to the arm or jaw
  • A burning sensation in the chest or upper abdomen
  • Shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea.

On average, symptoms of heart disease appear 10 years later in women than men. Women tend to have heart attacks 10 years later than men do.

In addition, women often report their symptoms before having a heart attack, although the symptoms are not typical "heart" symptoms. In a multi-center study of 515 women who had an acute myocardial infarction (MI), the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. The majority of women (78%) reported at least one symptom for more than one month before their heart attack. Only 30% reported chest discomfort, which was described as an aching, tightness, pressure, sharpness, burning, fullness or tingling.

Types of Angina

Stable angina

A type of angina brought on by an imbalance between the heart's need for oxygen-rich blood and the amount available. It is "stable," which means the same activities bring it on; it feels the same way each time; and is relieved by rest and/or oral medications. Stable angina is a warning sign of heart disease and should be evaluated by a doctor. If the pattern of angina changes, it may progress to unstable angina.

Unstable angina

This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. The angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this angina can often be relieved with oral medications, it is unstable and may progress to a full-blown heart attack. Usually more intense medical treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should be treated as an emergency.

Variant angina (also called Prinzmetal's angina or coronary spasm)

A coronary artery can go into spasm, disrupting blood flow to the heart muscle (ischemia). It can occur in people without significant coronary artery disease. However, two thirds of people with variant angina have severe disease in at least one vessel, and the spasm occurs at the site of blockage. This type of angina is not common and almost always occurs when a person is at rest. You are at increased risk for coronary spasm if you have: underlying coronary artery disease, smoke, or use stimulants or illicit drugs (such as cocaine). If a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.

What's the difference between angina and a heart attack?

Angina is a warning symptom of heart disease – but it is not a heart attack. The symptoms of a heart attack (also called myocardial infarction or "MI") are similar to angina.

Angina

  • Is brought on by a brief period of poor blood supply to the heart muscle.
  • Does not cause permanent damage to the heart.
  • Symptoms last just a few minutes and are usually relieved by rest and/or medications. Symptoms include chest pain or discomfort, shortness of breath, palpitations, faster heart rate, dizziness, nausea, extreme weakness and sweating.
  • Does not require emergency medical attention; however, it is important to call your doctor if this is the first time you've experienced angina, if you have new symptoms or if they become more frequent or severe.

Heart Attack

  • Occurs when the blood supply to the heart muscle is blocked for an extended period of time (often due to a clot forming in a blocked coronary artery).
  • Could result in permanent damage to the heart muscle.
  • Symptoms usually last more than a few minutes and include chest pain or discomfort that lasts for more than a few minutes and does not completely resolve with nitroglycerin; pain or discomfort in other areas of the upper body; difficulty breathing or shortness of breath; sweating or "cold" sweat; fullness, indigestion or choking feeling; nausea or vomiting; light-headedness; extreme weakness; anxiety; rapid or irregular heartbeats.
  • Requires emergency medical attention if symptoms last longer than 5 minutes.

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