You’re sprinting to keep up with your dog when the pain suddenly strikes. It feels like something heavy is sitting on your chest or squeezing it. As the discomfort joins with shortness of breath, nausea or pain in your arm or jaw, you start to wonder: Am I having a heart attack?
It’s possible, and when in doubt you should call 911 or have someone drive you to the ER. But if you sit down, relax and the symptoms subside within a few minutes, you might simply be experiencing angina, says Alon Gitig, M.D., assistant professor of medicine at Icahn School of Medicine at Mount Sinai and director of cardiology for Mount Sinai Doctors-Westchester.
As Gitig explains, unlike a heart attack, angina isn’t an imminent medical crisis, but it can most certainly set you up for one. Angina, by definition, refers to chest pain or discomfort that stems from reduced blood flow to the heart. While no one likes to be uncomfortable, what you really ought to be concerned about is the root cause — and that tends to be heart disease, or more specifically, coronary artery disease.
Coronary artery disease means the vessels leading to your heart have too much plaque, fatty deposits made of cholesterol and other substances. This buildup causes the vessels to narrow so that only a limited amount of blood can pass through. That might not be noticeable most of the time, but when you exert yourself physically or get mentally stressed, your heart tries to quickly pump more blood. When the demand exceeds what your narrowed arteries can handle, your heart fails to get the oxygen it requires and you feel angina.
While the pain or discomfort should quickly subside once you relax, the underlying problem remains. A piece of plaque could break off, form a clot and cause a heart attack by completely blocking blood flow to the organ.
Surprising signs of angina
Most people with angina only get chest pain when doing something active or stressful, but some have “atypical” angina that doesn’t fit the classic pattern. Women, people with diabetes and adults over 65 are more apt to fall into the atypical group, Gitig says.
To some people with atypical angina, an attack feels more like heartburn, he says. “Or it could be atypical in that the pain happens at rest, not just when walking up a flight of stairs or shoveling snow,” he explains. In other people fatigue, not angina, is the most pressing symptom of underlying coronary artery disease — yet it can also be a confusing one because fatigue is a sign of so many different problems.