Coronary Artery Disease: Symptoms

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Symptoms

Typically, the earliest symptoms of coronary artery disease (CAD) are chest pain, also called angina, and shortness of breath with exertion. Other symptoms of coronary artery disease include a fast heartbeat, weakness, dizziness, nausea, and increased perspiration.

Heart attack symptoms in men and women often differ. Men usually 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 warning symptoms 1 month before having a heart attack. These symptoms included unusual fatigue, sleep disturbances, and shortness of breath. Only 30% 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, over 50% of men and 63% of 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.

Angina

Chest pain is the most common symptom of coronary artery disease. Many people have chest pain, although it may be caused by conditions other than coronary artery disease. Angina, the chest pain related to coronary artery disease, may have a distinct pattern.

The chest pain of angina can be described as:

• A feeling of pressure, heaviness, weight, tightness, squeezing, discomfort, burning, or a dull ache in the chest (people often put their fist to their chest when describing the pain).
• Difficult to pinpoint (you cannot 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 gradually 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 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 experience tingling or numbness in the arm, hand, or jaw when angina is present.

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

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 supplying it. 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 and diminishes after they rest and take nitroglycerin, a medication 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 takes longer or fails to respond to nitroglycerin. Because unstable angina can progress to a heart attack, it requires immediate medical attention.

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.

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.

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Last updated:	May 29, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Ruth Schneider, MPH, RD - Diet and Nutrition
Editors:	Kathleen M. Ariss, MS, Pat Truman