Stable Angina
Angina is usually the first sign of coronary artery disease. Typical, or stable angina, is predictable. It occurs during exercise, emotional stress, and after heavy meals. These are times when the demand on the heart is high. Resting usually makes the angina better.
Fixed blockages (plaques) in the coronary arteries prevent the heart from pumping enough blood through the coronary arteries. As the heart's demand for oxygen grows the blood flow cannot increase. Angina is felt as the heart muscle starves.
Unstable Angina
Unstable angina is unpredictable. It can occur at rest and is related to new blockages at the site of a plaque. A plaque rupture is a dramatic event that can quickly form a clot inside a coronary artery (thrombosis). The body tries to dissolve dissolve the clot and battle between the bodies systems of forming and dissolving blood clots begins. Unstable angina can come and go. You may experience several minutes of chest discomfort followed by relief, only to have the chest discomfort return.
Heart Attack
If the blood clot formed during plaque rupture fails to dissolve, a heart attack can occur. Heart attacks often cause angina among other symptoms such as shortness of breath (dyspnea), a sense of doom, sweating, and nausea.
Is All Chest Discomfort Angina?
Sometimes it’s not easy to diagnose angina. Many doctors and patients use the term "angina" to describe all chest discomfort. This can include heart burn from acid reflux disease to muscular or rib pain in the chest. Additionally, "pain" means different things to different people. Some think of pain only as stabbing, or "knife-like." Doctors who ask if a patient has "chest pain" can miss a diagnosis of angina if the patient’s definition of “pain” is different from the doctors. The doctor probably means "pressure" while the patient thinks "sharp pain." The more appropriate term I use with my patients is chest "discomfort."
Below is a list of typical symptoms that help me differentiate angina from other causes of chest discomfort. Most people feel each of these symptoms at some point in their lives. For example, everyone has felt sweaty and nauseous at some point. It's the grouping of these symptoms that helps doctors decide whether symptoms are due to angina.
If you feel you are having angina or other symptoms of a heart attack, contact emergency personnel immediately and proceed to the hospital.
Typical Angina:
- Where is the discomfort (location)?: The left side of the chest, behind the sternum (flat bone in the middle of the chest), behind the left breast.
- Where else (radiation)?: The left side of the chest, the left armpit, the left arm, the neck, jaw, and sometimes the back. Rarely, pain is reported in the stomach area as well.
- What does angina feel like (nature)? Often described as a pressure or squeezing. The term "like an elephant sitting on my chest" is one well known to cardiologists.
- How long does it last (duration)? Usually 10 to 30 minutes. It's rare for angina to last a brief second or two. It's also rare for it to last continuously for many hours.
- What makes it worse (exacerbation)? Since angina is cause by ischemia or starvation of heart muscle, increasing the heart's demand for blood by exercising (sometimes so much as walking down the street) will make the chest discomfort worse.
- What makes it better (alleviation)?: Just as exercise can make angina worse, resting makes it better. Many patients will feel chest pain when walking up stairs which quickly resolves when stopping for a break.
- What time of day? A significant amount of angina occurs in the early morning -- upon waking. Morning adrenalin is quite high and may contribute to extra workload for the heart.
- What else will I feel (associated symptoms)? Sweaty, nauseous, tired, short of breath, upset stomach, belching/burping, palpitations (extra heart beats), dizzy, lightheaded.