Chest Pain – Part 1 – angina

By Julian Booker, MD

Chest pain is one of the most frightening symptoms that a person can experience. The problem is that not all chest pain is dangerous and not all chest pains are created equal. Some chest pain such as that associated with a heart attack, can be very dangerous. What makes things worse is that each person experiences symptoms differently, so all the possible combinations make discerning the causes very difficult. Sorting these things is difficult enough for an experienced physician, so how are you expected to figure these things out? For those of you that already know what angina feels like, this post may not provide you with much new information.

Angina is a specific type of chest pain usually related to inadequate blood flow to the heart muscle (myocardium).  Angina usually occurs when there is blockage in the heart arteries (coronary arteries) although not always. Angina is usually somewhat vague and nondescript. It is so vague that some people, they do not even consider it a pain. Many describe the discomfort as a pressure-like sensation, heaviness, tightness, dullness or fullness. The discomfort is located in the mid-chest or under the left breast. Some women may say it feels like their bra is too tight. Other people feel like they have indigestion. Angina is also active; it likes to move. Some patients report arm tingling or numbness in their shoulder and/or arm. If this happens, the left arm is most common. Some people have throat tightness or jaw pain. Back pain is less common but still occurs.

Angina usually does not work alone. There will frequently be other symptoms that to keep any eye out for. Some of the more common symptoms are shortness of breath or difficulty breathing, nausea and/or vomiting, weakness and cold-sweats. Angina not associated with a heart attack, is often brought on by stressors like exercise, anger and sometimes after eating. Typically it lasts for 5-10 minutes and is relieved by rest. If you take some nitroglycerin, then that usually helps too.

There are some risk factors that make angina more likely like older age, a strong family history of coronary artery disease, a prior history of coronary artery disease,  and risk factors such as diabetes that predispose one to coronary artery disease. Unfortunately there are some groups, like diabetics, that may have symptoms that are very atypical or even absent. If you have diabetes, it is important to be vigilant and maintain a high level of suspicion for any unusual symptoms.

If you are having symptoms that may be angina, I strongly advise you to consider:

  1. Take an aspirin
  2. Seek medical attention from a trusted health professional.
  3. If you are having severe pain or pain that lasts longer than 20 minutes, you may want to go to your local emergency department.

If your chest pain is not related to heart blockages then what is if from? I will be following this post shortly with some common causes of noncardiac or non-heart related chest pain.


I wanted to take a few minutes to list some common risk factors for coronary artery disease

  1. Older age
  2. Strong family history of coronary artery disease
  3. High blood pressure (hypertension)
  4. Abnormal cholesterol
    1. High total cholesterol (hyperlipidemia)
    2. High bad cholesterol or LDL
    3. Low good cholesterol or HDL
  5. Diabetes
  6. Male gender
  7. A history of smoking
  8. Obesity
  9. Sedentary lifestyle
  10. Certain autoimmune disorders like lupus

About Julian Booker, MD

I am a noninvasive cardiologist at the University of Alabama at Birmingham specializing in multi-modality cardiovascular imaging and preventative medicine. My training was primarily at Baylor College of Medicine in Houston TX and the National Institutes of Health in Bethesda MD.
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