Angina - when you have chest pain
Acute coronary syndrome - chest pain; Coronary artery disease - chest pain; CAD - chest pain; Coronary heart disease - chest pain; ACS - chest pain; Heart attack - chest pain; Myocardial infarction - chest pain; MI - chest pain
Signs and Symptoms of Angina
You may feel pressure, squeezing, burning, or tightness in your chest. You may also have pressure, squeezing, burning, or tightness in your arms, shoulders, neck, jaw, throat, or back.
Some people may have different symptoms, including shortness of breath, fatigue, weakness, and back, arm, or neck pain. This applies particularly to women, older people, and people with diabetes.
You may also have indigestion or be sick to your stomach. You may feel tired. You may be short of breath, sweaty, lightheaded, or weak.
Some people have angina when they are exposed to cold weather. People also may feel it during physical activity. Examples are climbing stairs, walking uphill, lifting something heavy, or having sex.
Angina, or angina pectoris, is temporary chest pain or a sensation of pressure that occurs when the heart’s need for oxygen is not satisfied by the amount of blood supplied to the heart. Blood flow can be limited when the arteries are narrowed by atherosclerosis, or because of coronary artery spasms. Symptoms of angina may also include discomfort in the shoulders, inside the arms, through the back and in the throat, jaw, or teeth. Angina due to atherosclerosis usually occurs during physical exertion or emotional distress, or at rest if the artery is narrowed by more than 70%.
How to Treat Your Chest Pain
Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity.
If you are lying down, sit up in bed. Try deep breathing to help with stress or anxiety.
If you do not have nitroglycerin and your symptoms are not gone after resting, call 911 or the local emergency number right away.
Your health care provider may have prescribed nitroglycerin tablets or spray for severe attacks. Sit or lie down when you use your tablets or spray.
When using your tablet, place the pill between your cheek and gum. You can also put it under your tongue. Allow it to dissolve. Do not swallow it.
When using your spray, do not shake the container. Hold the container close to your open mouth. Spray the medicine onto or under your tongue. Do not inhale or swallow the medicine.
Wait for 5 minutes after the first dose of nitroglycerin. If your symptoms are not better, are worse, or return after going away, call 911 or the local emergency number right away. The operator who answers will give you further advice about what to do.
(Note: your provider may have given you different advice about taking nitroglycerin when you have chest pain or pressure. Some people will be told to try 3 nitroglycerin doses 5 minutes apart before calling 911 or the local emergency number. In this case, follow your provider's instructions).
Do not smoke, eat, or drink for 5 to 10 minutes after taking nitroglycerin. If you do smoke, you should try to quit. Your provider can help.
Know Your Risk Factors
After your symptoms have gone away, write down a few details about the event. Write down:
- What time of day the event took place
- What you were doing at the time
- How long the pain lasted
- What the pain felt like
- What you did to relieve your pain
Ask yourself some questions:
- Did you take all of your regular heart medicines the right way before you had symptoms?
- Were you more active than normal?
- Did you just have a large meal?
Share this information with your provider at your regular visits.
Try not to do activities that strain your heart. Your provider may prescribe medicine for you to take before an activity. This can prevent symptoms.
When to Call the Doctor
Call 911 or the local emergency number if your angina pain:
- Is not better 5 minutes after taking nitroglycerin
- Does not go away after 3 doses of the medicine (or as directed by your provider)
- Is getting worse
- Returns after the medicine had helped
Also contact your provider if:
- You are having symptoms more often.
- You are having angina when you are sitting quietly or are not active. This is called rest angina.
- You are feeling tired more often.
- You are feeling faint or lightheaded.
- Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady.
- You are having trouble taking your heart medicines.
- You have any other unusual symptoms.
When people have chest pain, they're often concerned they're having a heart attack. I'm Dr. Alan Greene and I'd like to talk to you for a moment about the different kinds of chest pain and when it may be an emergency. It turns out, there are lots of different kinds of chest pain. In fact, almost everything in the chest can hurt in one way or another. Some of the causes are really nothing more than a minor inconvenience. Some of them though are quite serious, even life threatening. You can have chest pain sure from the heart, but also from pneumonia. You can have chest pain from asthma. You can have chest pain from a blood clot in the lungs. It can be from nothing more than a strain of some of the muscles between the ribs, or nerves. You can also have chest pain that comes from acid reflux of from a stomach ulcer, gallstones. Many, many things can cause chest pain. You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting. You want to call 911 if you know you have heart disease and you do occasionally have pain but your pain is getting significantly worse than it is ordinarily. Or comes on with less activity than it does otherwise. But whatever the cause of chest pain, unless you're sure what causing it, it's worth contacting your physician to find out what may be going on. It's not a symptom to ignore.
References
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Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 62.
Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 35.
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg. 2015;149(3):e5-23. PMID: 25827388
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368–e454. PMID: 34709928
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;127(4):529-555. PMID: 23247303
Version Info
Last reviewed on: 8/16/2022
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
