Chest Pain: Angina or a Heart Attack?

Heart attack

Symptoms of a heart attack include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

Call 911 or other emergency services immediately if you think you are having a heart attack.

Nitroglycerin. If you typically use nitroglycerin to relieve angina, call 911 if one dose of nitroglycerin has not relieved your symptoms within 5 minutes. Do not wait to call for help.

See a picture of the areas where you might have pain during a heart attack.

Unstable angina

Unstable angina symptoms are similar to a heart attack.

Call 911 or other emergency services immediately if you think you are having a heart attack or unstable angina.

People who have unstable angina often describe their symptoms as:

• Starting within the past 2 months and becoming more severe.
• Limiting their physical activity.
• Suddenly becoming more frequent, severe, or longer-lasting or being brought on by less exertion than before.
• Occurring at rest with no obvious exertion or stress. It may wake you up.
• Not responding to rest or to nitroglycerin.

The symptoms of stable angina are different from those of unstable angina. Stable angina occurs at predictable times with a specific amount of exertion or activity and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 5 minutes.

Women's symptoms

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Women are more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack, call for help. When you get to the hospital, do not be afraid to speak up for what you need. To get the tests and care you need, be sure your doctors know that you think you might be having a heart attack.

For more information, see Women and Coronary Artery Disease.

Other ways to describe chest pain

People who are having a heart attack often describe their chest pain in various ways. The pain:

• May feel like pressure, heaviness, weight, tightness, squeezing, discomfort, burning, a sharp ache (less common), or a dull ache. People often put their fist to their chest when describing the pain.
• May radiate from the chest down the left shoulder and arm (the most common site) and also to other areas, including the left shoulder, middle of the back, upper portion of the abdomen, right arm, neck, and jaw.
• May be diffuse—the exact location of the pain is usually difficult to point out.
• Is not made worse by taking a deep breath or pressing on the chest.
• Usually begins at a low level, then gradually increases over several minutes to a peak. The discomfort may come and go. Chest pain that reaches its maximum intensity within seconds may represent another serious problem, such as an aortic aneurysm.

It is possible to have a "silent heart attack" without any symptoms, but this is rare.

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	John M. Miller, MD - Electrophysiology
Last Revised	April 4, 2011