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.
Shaded areas show where you may have symptoms
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:
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.
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.
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.
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.
There are many causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Non-invasive tests to diagnose coronary artery disease are not all perfect in picking up reduced blood flow to the heart in all people; especially in those with increased body mass index or special populations. Therefore, if you have symptoms of coronary disease but have been told they are not cardiac in nature, you may want to get a second opinion at a center with experience in diagnostic testing. Once coronary disease is truly ruled out the work-up can proceed at a more leisurely pace.
*Please note: If you have chest pain that lasts longer than 5 minutes and is not relieved by rest or medication, please seek emergency assistance (call 911).*
Cardiac causes of chest pain are:
Gastrointestinal causes of chest pain include:
Pulmonary (lung) causes include:
Other potential causes are:
Psychological causes of chest pain are common and include:
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.
A good internal medicine doctor or cardiologist can work through the potential causes of your symptoms.
The good news about heart attacks:
Advances in technology over the past decade or so have dramatically lowered the death rate from acute heart attacks (myocardial infarction, or MI).
The bad news:
Many people never get to the hospital in time ** to take advantage of these life-saving advances. In fact, about 40% of the 1.1 million heart attacks that occur annually in the U.S. are fatal. That’s about 460,000 deaths from heart attack. Many more patients who survive their heart attacks do so with chronically damaged hearts.
When an acute MI occurs, there is a limited amount of time before significant and long-lasting damage is done to the muscle of your heart. If a large area of the heart is injured during the heart attack, full recovery becomes much more difficult. To obtain the greatest benefits of emergency care, anyone who thinks they are having a heart attack should get to the hospital within one hour of the onset of symptoms. The sooner you get to the emergency room, the sooner the appropriate treatment can begin, meaning the lesser the chances of permanent damage.
Sadly, only one in five patients actually gets to the hospital within this time frame. Therefore, many people who survive the MI are unnecessarily left with large portions of the heart scarred by the heart attack. This decreases the heart’s ability to pump blood effectively. Such patients may experience lifelong problems such as shortness of breath and angina (chest discomfort). Patients are also at an increased risk of developing heart failure, in which the heart weakens progressively over time.
Calling 911 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they reach you. And they are trained to revive someone whose heart has stopped. Also, you’re likelier to get treated faster at the hospital if you arrive by ambulance.
If you are having symptoms of a heart attack, do not drive yourself.
What is Nitroglycerin?
Nitroglycerin is the most common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body.
This combination of effects decreases the amount of work for the heart. Nitroglycerin comes in tablet or spray form. If you have angina, it is important that you keep this medication with you at all times.
If you have been prescribed nitroglycerin and experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 911 to get emergency help.
For patients diagnosed with chronic stable angina: If you experience angina, take one nitroglycerin tablet and let it dissolve under your tongue. If chest discomfort or pain is unimproved or is worsening 5 min after one dose, it is recommended that the patient or family member/friend/caregiver call 9-1-1 immediately to access EMS before taking additional NTG. In patients with chronic stable angina, if symptoms are significantly improved by 1 dose of NTG, it is appropriate to instruct the patient or family member/friend/caregiver to repeat NTG every 5 min for a maximum of 3 doses and call 9-1-1 if symptoms have not resolved completely.
Use of Aspirin with unstable chest pain: After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one full (325 mg) aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms.
Do not drive yourself to the hospital. In many cases, the emergency personnel can begin to give you heart-saving care right away.
To prevent damage to your heart muscle, do not delay seeking medical treatment.
Many people don’t recognize the symptoms of a heart attack (see list). The image we get from TV and movies is that a heart attack is a dramatic, chest-clutching event, yet this is rarely the case. Arm pain may signal a heart attack. Or shortness of breath. Or even an awareness of sweating.
Some people mistake heart attack symptoms for heartburn, take an antacid and wait for it to work. Many people will call 911 for someone else, but not for themselves.
Many people feel they will be embarrassed if they call 911 and they are not in fact having a heart attack. But don’t be embarrassed to death – heart attacks are the leading cause of death in both men and women.
Share this information with your family members and caregivers so they can recognize the symptoms of a heart attack and when to seek emergency treatment.
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Choosing a doctor to treat your coronary artery disease depends on where you are in your diagnosis and treatment.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 04/25/2019