Coronary Artery Disease

Symptoms of coronary artery disease

The most common symptoms of coronary artery disease are:

• Chest pain, also called angina.
• Shortness of breath when exercising or during another vigorous activity.

Other symptoms include:

• A fast heartbeat.
• Weakness, dizziness, and feeling sick to your stomach (nausea).
• Increased sweating.

Symptoms of heart attack

Heart attack symptoms in men and women often differ. Men often have the typical type of chest pain that feels like squeezing or pressure. But the pain is more severe than usual and does not go away with rest. Women, older adults, and people with diabetes may have symptoms different from chest pain. These groups of people may have symptoms like breathlessness, heartburn, nausea, fatigue, jaw pain, or back pain.

In one study, many women reported having warning symptoms 1 month before they had a heart attack. These symptoms included unusual fatigue, trouble sleeping, and shortness of breath. Only 30 out of 100 women reported chest pain, which the majority of men report.² For more information about the differences between coronary artery disease in women and men, see women and coronary artery disease.

Unfortunately, sometimes a heart attack is the first sign of coronary artery disease. According to the large, 50-year Framingham Heart Study, more than 50 out of 100 men and 63 out of 100 women who died suddenly of coronary artery disease (mostly from heart attack) had no previous symptoms of this disease.³

Some people who have coronary artery disease and insufficient blood flow to the heart muscle (ischemia) do not have any symptoms. This is called "silent ischemia." In rare instances, you can even have a "silent heart attack," a heart attack without symptoms.

One Man's Story: Alan, 73 “At some point in my life I was going to have a heart attack. Smoking just sped it up. It happened while I was playing basketball with some guys from work. I started getting pains in my chest. The next thing I knew, I was on the floor.”—Alan Read more about Alan and how he learned to cope after a heart attack.

Angina (chest pain)

Chest pain, also called angina, is the most common symptom of coronary artery disease. The pain may have a distinct pattern. Angina can be described as:

• A feeling of pressure, heaviness, weight, tightness, squeezing, discomfort, burning, or dull aching in the chest. People often put their fist to their chest when describing the pain.
• Hard to pinpoint (you can't point to the exact location of the pain). Pressing on the chest wall does not cause the pain.

The chest pain of angina usually begins at a low level, then increases over several minutes to a peak. Angina that starts with an activity usually will decrease when the activity is stopped. Chest pain that begins suddenly or lasts only a few seconds is less likely to be angina.

Angina usually begins in the chest, but it can also start in or spread to different areas of the body, such as:

• Down the left arm (most common site).
• To the left shoulder.
• To the neck or lower jaw.
• To the mid-back.
• Down the right arm.

Some people may feel tingling or numbness in their arm, hand, or jaw when they have angina.

See a picture of areas that may be affected by angina.

How does angina happen?

Angina is often brought on by activities that make the heart work harder, because the heart needs more oxygen than can be delivered through the narrowed arteries. Some of these activities include:

• Strenuous exercise (especially if you ordinarily do not exercise).
• Use of cocaine or amphetamines.
• Exposure to cold temperatures.
• Sudden, intense emotions such as anger or fear.
• Smoking.
• Eating a heavy meal.

Many people have stable angina, which is predictable. It eases after they rest and take nitroglycerin, a medicine that opens blood vessels to improve blood flow. But if there is a change in the usual pattern of your angina, you may have unstable angina. In unstable angina, chest pain occurs at rest or with less and less exertion, may be more severe and last longer, or doesn't respond to nitroglycerin. Because unstable angina can progress to a heart attack, it requires medical attention right away.

For information about their differences, see stable versus unstable angina. For information about variant, or Prinzmetal's, angina and other kinds of angina, see types of angina. For more information, see the topic Heart Attack and Unstable Angina.

How do you know if chest pain is heart-related?

Chest pain can be a symptom of many other conditions. For example, anxiety, inflammation in or injury to the chest wall, or a blood clot in the lung can cause pain in the chest.

Chest pain and shortness of breath are more likely to be serious and related to your heart if:

• They are like symptoms you have had before because of coronary artery disease.
• You have risk factors for coronary artery disease.

Your chest pain is less likely to be caused by a heart problem if:

• You can point to the exact spot that hurts.
• The pain gets worse when you take a deep breath, or holding your breath for a few seconds reduces the pain significantly.
• The pain gets better or worse when you move or press on a specific part of the chest wall, neck, or shoulder.
• Antacids dramatically relieve the pain.
• The pain lasts only a few seconds.

It's important to treat symptoms early to prevent permanent damage to your heart. If any type of chest pain continues, it needs to be checked by a doctor.

Because many vital organs are found in the chest, even chest pain that is not caused by coronary artery disease may be a sign of a serious problem in the aorta (the large blood vessel that leads out of the heart), lungs, or digestive organs.