Angina is diagnosed when a patient presents to the emergency room with a set of symptoms that alert the physician towards a possible case. These patients need several investigations to confirm the diagnosis. Therefore, anginal symptoms are the cornerstone of the diagnosis and the public should understand them as they require urgent medical consultation.
The most important symptoms include:
1. Chest pain or discomfort
It is by far the most common presentation of angina and one of the most common causes of admission into the ER. Causes of chest pain vary from a mild inflammation of the muscles to a rib fracture and severe life-threatening causes, which include heart attacks, pulmonary embolism (obstruction of lung arteries by blood clots), and aortic dissection (blood moving through the wall of the aorta that may rupture).
Anginal pain has a set of characteristics that make it stand out from other causes of chest pain. They are as follows:
- Anginal pain is precipitated or aggravated by effort, emotional stress, or heavy meals and relieved by rest or nitroglycerin.
- It feels as if pressure is exerted on the chest, or a burning sensation in the middle of the chest, or even a squeezing or a choking sensation.
- Pain is usually localized just beneath the breast bone. It may also be felt in the jaw or left shoulder or down along the left arm. Anginal pain is not “Stabbing” in character, and if a stabbing pain is felt, it points towards a heart attack rather than angina, and immediate medical care is a must.
- Anginal pain starts acutely and is usually relieved within 10 minutes. Therefore, chronic pain that is never relieved often excludes angina. Also, chest pain that lasts for less than 1 minute is not usually due to angina. Another type of angina is called “Angina decubitus” which occurs at night while lying down.
If anginal pain occurs at rest, it means that it progressed to unstable angina, and needs urgent medical care. Anginal pain may also be precipitated by heavy meals or cold weather. Chest pain that increases during respiration points towards causes in the chest wall itself, whether related to muscles as myositis (inflammation of muscle tissue) that may occur in influenza or bone fractures.