Symptoms

Pain and discomfort are the main symptoms of angina. These symptoms

• Are often described as pressure, squeezing, burning, or tightness in the chest
• Usually start in the chest behind the breastbone
• May also occur in the arms, shoulders, neck, jaw, throat, or back
• May feel like indigestion

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

Symptoms vary based on the type of angina.

Stable Angina

The pain or discomfort:

• Occurs when the heart must work harder, usually during physical exertion
• Is expected, and episodes of pain tend to be alike
• Usually lasts a short time (5 minutes or less)
• Is relieved by rest or angina medicine
• May feel like gas or indigestion
• May feel like chest pain that spreads to the arms, back, or other areas

Unstable Angina

The pain or discomfort:

• Often occurs at rest, while sleeping at night, or with little physical exertion
• Is unexpected
• Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
• Is usually not relieved with rest or angina medicine
• May get continuously worse
• May signal that a heart attack will happen soon

Variant Angina

The pain or discomfort:

• Usually occurs at rest and during the night or early morning hours
• Tends to be severe
• Is relieved by angina medicine

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having—or are about to have—a heart attack. Call 911 right away.

Diagnosis

To find out if you have angina, your doctor will:

• Do a physical exam
• Ask about your symptoms
• Ask about your risk factors and your family history of coronary artery disease (CAD) or other heart disease

If your doctor suspects that you have unstable angina or that your angina is related to a serious heart condition, he or she may order one or more tests.

EKG (electrocardiogram)

An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart. Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack. However, some people with angina have a normal EKG.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.

During exercise stress testing, your blood pressure and EKG readings are checked while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time.

If you're unable to exercise, a medicine can be injected into your bloodstream to make your heart work hard and beat fast. Nuclear heart scanning or echocardiography is then usually done.

When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs.

A stress test can show possible signs of CAD, such as:

• Abnormal changes in your heart rate or blood pressure
• Symptoms such as shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart's electrical activity

Chest X ray.

A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Coronary Angiography and Cardiac Catheterization

Your doctor may ask you to have coronary angiography if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries.

Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.

Your doctor may order a blood test to check the level of C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CAD and heart attack.

Your doctor also may order a blood test to check for low hemoglobin in your blood. Hemoglobin is an iron-rich protein in the red blood cells that carries oxygen from the lungs to all parts of your body. If you have low hemoglobin, you may have a condition called anemia.