Coronary artery disease (CAD) reduces the flow of blood to your heart. It happens when the arteries that supply blood to your heart muscle become narrowed and hardened due to fat and other substances accumulating into a plaque where the coronary artery is injured (atherosclerosis).

This can cause your heart to become weak and beat abnormally. Over time, it can lead to heart failure.

Chest pain, shortness of breath, and other symptoms are associated with CAD.

One common symptom of CAD is a type of chest pain called angina. Angina may feel like tightness, heaviness, or pressure in your chest. It may involve an aching, burning, or numb sensation. It can also feel like fullness or squeezing.

You may also feel angina radiating to your back, jaw, neck, shoulders, or arms. The discomfort may also extend from your shoulder down to your fingers or into your upper abdomen. You typically won’t feel angina pain above your ears or below your belly button.

Sometimes angina causes only a vague feeling of pressure, heaviness, or discomfort. It can masquerade as indigestion or shortness of breath. Women and older adults are more likely than men and younger people to have this kind of angina.

Angina can cause other symptoms too, such as sweating or a general sense that something is wrong.

Cause of angina

Angina results from ischemia. Ischemia happens when your heart isn’t getting enough blood with oxygen. This can make your heart muscle cramp and function abnormally.

It usually happens when you’re involved in an activity that requires extra oxygen, such as exercising or eating. When you experience stress or cold temperatures and your body is trying to cope, your heart can also become deprived of oxygen.

Ischemia from CAD doesn’t always produce symptoms. Sometimes anginal symptoms don’t occur until a person is to the point of having a devastating cardiac problem, such as a heart attack, heart failure, or heart rhythm abnormality. This condition is called “silent ischemia.”

Stable and unstable angina

Angina may be classified as stable or unstable.

Stable angina:

  • Happens at predictable times. For example, it commonly happens during periods of stress or exertion when your heart is working harder and needs more oxygen.
  • Usually lasts for a few minutes and disappears with rest.
  • Sometimes also called “chronic stable angina” in that, when it does occur, each episode is similar, brought on by making the heart work harder, and predictable within a long timeframe.

Unstable angina:

  • Also called “rest angina,” it occurs when no particular demand is being placed on your heart.
  • The pain usually doesn’t get better with rest and can worsen with each episode or be excruciatingly severe out of nowhere. It can even wake you up from a sound sleep.
  • Thought to be due to an acute rupture of an atherosclerotic plaque and subsequent associated blood-clot formation inside a coronary artery, causing a sudden and severe blockage of blood flow to the heart muscle.

In addition to angina, CAD may cause the following symptoms:

  • shortness of breath
  • sweating
  • weakness
  • dizziness
  • nausea
  • rapid heartbeat
  • palpitations — the feeling that your heart is pounding hard and rapidly and is fluttering or skipping beats

How do you know if you’re experiencing angina or a heart attack?

Both of those conditions can involve chest pain and other similar symptoms. However, if the pain changes in quality, lasts more than 15 minutes, or doesn’t respond to the nitroglycerin tablets that your doctor has prescribed, get immediate medical attention. It’s possible that you’re having a heart attack, and you need to be evaluated by a doctor.

The following symptoms can be signs of either angina or the onset of a heart attack caused by underlying CAD:

  • pain, discomfort, pressure, tightness, numbness, or burning sensation in your chest, arms, shoulders, back, upper abdomen, or jaw
  • dizziness
  • weakness or fatigue
  • nausea or vomiting
  • indigestion or heartburn
  • sweating or clammy skin
  • fast heart rate or irregular heart rhythm
  • anxiety or a general feeling of being unwell

Don’t ignore these symptoms. People often delay seeking medical attention because they’re not sure if anything is seriously wrong. This can lead to delayed treatment when you need it most. It’s much better to be safe than sorry.

If you suspect you might be having a heart attack, get medical help right away. The quicker you get treatment for a heart attack, the better your chances of survival.