Chest pain: Angina or a heart attack?

Am I having a heart attack?

The chest pain or discomfort that you feel during a heart attack may be very similar to what you feel during an episode of angina. In many cases, however, there are important differences. The table below summarizes these differences.

Symptoms that may indicate angina or a heart attack

Characteristic of symptom	Angina	Heart attack
How long chest pain lasts	Less than 5 minutes	5 minutes or longer
Consistency of chest pain	Comes and goes	Constant
How bad the chest pain is	Less intense	More intense
Other symptoms, such as nausea, sweating, or difficulty breathing	Less likely	More likely
Resolves with medication (nitroglycerin) or rest	Yes	No

Although the pain of a heart attack is usually severe, it can vary greatly. In fact, some heart attacks are never recognized (silent infarctions) because the symptoms are mild, not typical, or even absent. This is a major reason why some people don't come to the hospital when they have a heart attack. If you have angina and notice that it is happening more often or lasting longer, you should contact your doctor.

Call 911 or other emergency services immediately if:

• Your chest pain gets worse or lasts more than 5 minutes, especially if you are short of breath or feel weak, nauseated, or light-headed.
• Your chest pain doesn't improve or gets worse within 5 minutes after taking 1 dose of nitroglycerin.

If you have chest pain that lasts more than 5 minutes, you should go to the emergency room.

Are my symptoms caused by angina or a heart attack?

It is very important to distinguish between angina and a heart attack. Although coronary artery disease can cause both, some treatments are the same, while others are very different. The sooner your doctor can determine which one is causing your symptoms, the sooner you can receive potentially life-saving treatment.

What is the difference between angina and a heart attack?

With both a heart attack and angina, part of your heart muscle is not getting enough oxygen because of reduced or blocked blood flow in your coronary arteries. With angina, the lack of oxygen is temporary, and permanent heart damage does not occur. During a heart attack, the lack of oxygen lasts longer and causes permanent heart damage.

With stable angina, you may notice the problem only when your heart is working harder and needs more oxygen, such as during exercise. The pain or discomfort goes away when you rest because your heart no longer needs as much oxygen.

With unstable angina, a clot partly blocks your coronary artery or completely blocks it for a short period of time. However, the clot either breaks up by itself or breaks up after treatment with medicines, so permanent heart damage does not occur. During a heart attack, the blockage lasts long enough to permanently damage part of your heart muscle. The longer your heart muscle goes without oxygen, the larger the heart attack. Your doctor will consider three important factors in deciding whether you are having a heart attack:

• Your description of your symptoms
• Your electrocardiography (EKG, ECG) results
• Your blood tests (cardiac enzymes)

Author:	Douglas Dana Robin Parks, MS	Last Updated August 15, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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