Angina - when you have chest pain
Signs and symptoms of angina
You may feel pressure, squeezing, burning, or tightness in your chest. You may also have pressure, squeezing, burning, or tightness in your arms, shoulders, neck, jaw, throat, or back.
Some patients may have different symptoms, including shortness of breath, fatigue, weakness, and back, arm, or neck pain. This applies especially to women, older people, and people with diabetes.
You may also have indigestion or be sick to your stomach. You may feel tired. You may be short of breath, sweaty, lightheaded, or weak.
Most times, people have angina when they are exposed to cold weather. People also feel it during physical activity. Examples are climbing stairs, walking uphill, lifting something heavy, or having sex.
How to treat your chest pain
Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity.
If you are lying down, sit up in bed. Try deep breathing to help with the stress or anxiety.
If you do not have nitroglycerin and your symptoms are not gone after resting for 5 minutes, call 9-1-1 right away.
Your doctor may have prescribed nitroglycerin tablets or spray for severe attacks. Sit or lie down when you use your tablets or spray.
When using your tablet, place the pill between your cheek and gum. You can also put it under your tongue. Allow it to dissolve. Do not swallow it.
When using your spray, do not shake the container. Hold the container close to your open mouth. Spray the medicine onto or under your tongue. Do not inhale or swallow the medicine.
Wait 5 minutes after the first dose of nitroglycerin. If your symptoms are not better, are worse, or return after going away, call 9-1-1 right away. The operator who answers will give you further advice about what to do.
(Note: your doctor may have given you different advice about taking nitroglycerin when you have chest pain or pressure.)
Do not smoke, eat, or drink for 5 to 10 minutes after taking nitroglycerin. If you do smoke, you should try to quit. Your doctor can help.
Know your risk factors
After your symptoms have gone away, write down a few details about the event. Write down:
- What time of day the event took place
- What you were doing at the time
- How long the pain lasted
- What the pain felt like
- What you did to relieve your pain
Ask yourself some questions:
- Did you take all of your regular heart medicines the right way before you had symptoms?
- Were you more active than normal?
- Did you just have a large meal?
Share this information with your doctor at your regular visits.
Try not to do activities that strain your heart. Your doctor may prescribe medicine for you to take before an activity. This can prevent symptoms.
When to call the doctor
Call 9-1-1 if your angina pain:
- Is not better 5 minutes after taking nitroglycerin
- Does not go away after 3 doses of the medicine
- Is getting worse
- Returns after the medicine helped at first
Also call your doctor if:
- You are having symptoms more often.
- You are having angina when you are sitting quietly or are not active. This is called rest angina.
- You are feeling tired more often.
- You are feeling faint or lightheaded.
- Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady.
- You are having trouble taking your heart medicines.
- You have any other unusual symptoms.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008 Jan 15;117(2):296-329. Epub 2007 Dec 10.
Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1;120(22):2271-2306.
Sabatine M, Cannon CP. Approach to the patient with chest pain. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Saunders Elsevier; 2014:chap 50.
Fihn SD, Gardin JM, Abrams Jet al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-e471.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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