The classic symptom of CAD is a type of pain known as angina, a word that has Greek and Latin roots meaning "to strangle" or "to choke or throttle someone in a fit of rage." As the name implies, angina is painful and dangerous.  

Angina indicates that the heart isn't getting enough blood to supply it with oxygen and glucose. This condition is called ischemia. The pain may come on suddenly and appear as if you are having a heart attack. But it's just as likely to arrive without all the drama and can often be chronic in people with documented CAD.

Stable vs. Unstable

In fact, angina doesn't always herald the onset of a heart attack. It can occur intermittently over a period of weeks or months. If it happens at predictable times, such as during periods of stress or exertion, it's called stable angina. Episodes of stable angina usually last two to 15 minutes.

Unstable angina, or "rest angina," occurs when no particular demand is being placed on the heart, and the pain does not get better simply with rest. It can even wake you up from a sound sleep. Unstable angina typically occurs when a coronary artery is narrowed by at least 70 percent.

Sometimes angina causes only a vague pressure, heaviness, or discomfort; or it masquerades as indigestion or shortness of breath. Women and elderly people are more likely than men and younger people to have this atypical kind of angina. When angina does occur, the pain may settle in the arm, shoulder, chest, back, abdomen, or even in the jaw. Angina can cause other symptoms, too, such as sweating or a general sense that something is amiss. Ischemia from CAD doesn't always produce symptoms. People with diabetes, for instance, are more likely than people without diabetes to have CAD without angina. This condition is called silent ischemia.

Angina or Heart Attack?

Where is the line between angina and a heart attack? If the pain changes in quality, lasts more than 15 minutes, or doesn't respond to the nitroglycerin tablets your doctor has prescribed, you should seek immediate medical attention. It is possible you are having a heart attack and need to be evaluated by physicians.

The following list summarizes the symptoms that may indicate angina or the onset of a heart attack caused by underlying CAD:

  • pain or aching in the upper body, back, abdomen, or jaw
  • numbness, a feeling of discomfort, tightness, or pressure, or a burning sensation in any of the above-mentioned areas
  • dizziness
  • nausea or vomiting
  • indigestion or heartburn
  • weakness or fatigue
  • sweating or clammy skin
  • a fast heart rate or an irregular rhythm
  • anxiety or a general feeling of being unwell

It’s important that you do not ignore these symptoms. People often delay seeking medical attention because they're not sure whether something is wrong and don't want to set off any false alarms. But doctors respond to more false alarms than real ones, and it's their job to sort out which is which. If you even suspect that you might be having a heart attack, see a doctor right away. The quicker you get to treatment, the more likely heart function will be preserved.