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.
2. Indigestion
The chest pain in angina may be felt as a burning sensation, and it may be mistaken by many physicians as GERD, which is a condition where the acid in the stomach is “refluxed” back into the esophagus, damaging the epithelium and causing a characteristic burning sensation. Both conditions are differentiated based on medical history. While pain of angina is preceded by effort, heartburn or GERD is related to meals, and while angina is relieved by nitroglycerine, GERD is relieved by antacids. Also, investigations tests include stress ECG, and echocardiography may be needed to confirm the diagnosis. Any burning sensation in the chest, particularly if you are above 40, necessitates a visit to the doctor as soon as possible.
3. Shortness of Breath
The subjective feeling of shortness of breath is better known as “dyspnea.” In these cases, the individual does not necessarily have a lack of oxygen. It is the most common symptom related to the chest along with chest pain. The causes of dyspnea range from psychological causes as panic attacks to severe causes as aspiration of foreign bodies or heart failure.
In short, if there is anything wrong in the heart, the lungs, the throat, or the nervous system, our brains may translate it into dyspnea. In the case of angina, it may result from the associated distress and feeling of impending doom, which occurs with heart attacks, or from the irregular heart rhythm that results from the heart’s deprivation of oxygen.
4. Sensing your own heartbeats (palpitations)
Angina patients sometimes feel their own heartbeats, which may be distressing. We usually don’t feel our own heartbeats, and if we do, it means that there is something wrong with the rhythm of our hearts, a clinical condition known as “arrhythmia.” Arrhythmia may be triggered by a multitude of causes, and one of them is ischemia (decreased blood flow to the heart). When the heart can’t get enough oxygen, its electrical network of fibers starts to malfunction, which eventually causes beats to be irregular.
5. Sweating
As bizarre as it sounds, sweating is an important symptom of angina and heart attacks. According to recent studies, it is suggested that profuse sweating that isn’t accompanied by fever should prompt medical care for the possibility of a heart attack. The explanation for that phenomenon is that, when the body faces mortal danger -like that of a heart attack-, it triggers the sympathetic nervous system response, also known as fight or flight response, and one of its manifestations is sweating, as well as the impending sense of doom that the patient experiences along with the chest pain.
6. Fatigue and feeling of unwellness
Fatigue is a common complaint in patients suffering from heart conditions. The heart pumps blood carrying oxygen and nutrients to the body, and when this physiological process is impaired, the muscles fail to function properly because they need high and constant supply of oxygen and glucose. In the case of angina, the resulting arrhythmia and the inability of the heart to deliver the required blood to the muscles will lead to easy fatiguability and general feeling of weakness.
7. Angina in females
Although stable angina is more common in males, owing to their hormonal susceptibility to having high levels of cholesterol, and therefore a higher risk of deposition of this cholesterol and narrowing of the coronary arteries, females have a higher chance to develop other types of angina most commonly microvascular angina. Microvascular angina affects the small blood vessels that branch off the primary coronary arteries supplying the heart. This different pathology of angina causes symptoms that may be different than the classical ones discussed above, where:
- Symptoms may be subtler in women, with nausea, fatigue, and a general feeling of weakness and unwellness.
- Pain may be sharp rather than squeezing and may last for more than a few minutes.
- Pain may occur at night or at rest and is not relieved rapidly by rest or nitrates, in contrast to the typical anginal pain.
- It may be associated with other symptoms related to other diseases that commonly occur with it as migraine headaches.