Watch for Angina Symptoms

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Aching and pressure right below the breastbone are classic angina symptoms. But pain might radiate along your left shoulder, up your neck and jaw, or down the left arm and into the fingers. Instead of pain, you may experience:

  • tingling,
  • sweating,
  • breathlessness, and
  • nausea and fatigue (especially in women).

"Pain from heart disease can be very vague," explains Stephen A. Siegel, M.D., clinical assistant professor of cardiology at the NYU Langone Medical Center in New York City. "That’s why many people with indigestion think they are having a heart attack." Unfortunately, this works both ways. "Some people who die from a heart attack didn't get help because they thought it was only indigestion," Dr. Siegel adds.

Stable Angina

If a coronary artery is narrowed about 60 to 70 percent, it's likely you have "stable" angina. While a blockage of 70 percent may sound frightening, an episode can usually be managed with rest and medication. Stable angina that's triggered by activity and goes away with rest generally signals that your heart is getting enough oxygenated blood, so you don't experience symptoms during leisurely activities. Often, when symptoms do arise, the triggers are very predictable and manageable.

The most common trigger for angina is activity. Emotional factors such as anger, fear or anxiety can also set off angina, particularly in women. In fact, any form of excitement that increases the heart's demand for oxygen and the rate of blood flow can cause an episode.

You'll learn to gauge the level of exertion that causes your symptoms. You can be active enough to get close to—but not beyond—this level, and use medication to stop pain on occasions when you overdo it.

If you notice that angina is coming on in new situations, however, call your doctor. An example: You find that walking across the room causes pain when it didn't two months ago. Your blockage is likely getting worse. If you have any doubt about why pain is occurring, call 911 and take emergency steps.

When to Get Help—Unstable Angina

When a blood clot or spasm of the coronary artery causes severe narrowing, you're likely to experience "unstable" angina. It may be a signal that a heart attack is occurring or may happen soon. "Approximately 20 percent of people will have a full-blown heart attack within two weeks of first experiencing unstable angina," says Dr. Siegel.

In unstable angina, your heart's not getting enough blood even when oxygen demand is low. The three key signs of unstable anginaare:

  • symptoms that follow no pattern and occur at rest and with exertion
  • an angina episode that lasts longer than 20 minutes
  • pain that is not relieved by rest or use of fast-acting nitrates.

What to Do in an Emergency

If you experience unstable angina, call 911 immediately. Don't drive yourself to the hospital unless you have no other choice. Emergency personnel can start treating a blockage as soon as they arrive.

Take one or two full-strength adult aspirins or four 81 mg children's aspirins if that's what's handy. Don't swallow—chew the tablets for 30 seconds. This gets the aspirin into your bloodstream quickly.

In addition, take a fast-acting nitrate to help widen the blocked artery. If it doesn't ease pain immediately, you can take up to two more, with five minutes between each dose.

Lie down, breathe deeply and slowly, and try to relax until help arrives. You should also take emergency measures if an episode of angina is accompanied by:

  • sweating
  • dizziness
  • nausea
  • vomiting
  • difficulty breathing

These warning signs can indicate a heart attack.

And, "If you're feeling chest discomfort for the first time or something seems very different or intense about your angina, you should get to the emergency room," says Dr. Lerman. "Don't feel like you are bothering anybody."

Publication Review By: the Editorial Staff at

Published: 17 Mar 2011

Last Modified: 28 Aug 2015