Angina vs. Heart Attack

Angina pectoris, or angina, refers to chest pain that has specific triggers. Heart attack, also known as myocardial infarction, is a more severe chest pain and can be fatal if left unchecked. Due to certain similarities between the two conditions, people could mistake angina for a heart attack. Therefore, it is vital to be able to recognize fundamental signs that differentiate two conditions and know when it is necessary to visit a hospital. 1

What is Angina?

Angina is the medical term for persistent pain in the chest, which results from an insufficient blood supply to the heart, specifically the myocardium (muscles of the heart). In angina, inadequate blood flow to the heart causes strangling or pressure-like pain called cardiac ischemia.1

It is not unusual to experience a tugging or painful sensation in the heart as a result of overexertion (exercise or other forms of stressful physical activity) or extreme emotions (overexcitement or fright). There are different forms of angina depending on how and when the chest pain resolves. Angina-induced pain has a characteristic distribution in the chest (below the sternum or chest bones), arm, and neck, and is brought on by exertion, cold, or excitement. There are three forms of clinically recognized forms of angina pectoris:

  1. Stable angina: This is the form of angina brought about by any strenuous activity or emotional stress. In most cases, stable angina is caused by a coronary artery disease that hinders free blood flow to the heart. People with stable angina experience chest pain because they have an increased demand for oxygenated blood in the heart, which cannot be met. This could be either due to partial blockage or obstacles in the coronary artery. The pain usually alleviates upon resting or angina treatment. 3
  1. Unstable Angina: Unlike stable angina, unstable angina is characterized by chest pain even with reduced physical exertion. Most times, the pain builds up and becomes intense when at rest. The pain is typically considered severe and long-lasting (more than 20 minutes) and can’t be alleviated with rest or angina treatment. In most cases, unstable angina occurs before or close to myocardial infarction. So whenever it happens, it is treated as a medical emergency.6
  1. Variant Angina: This type of chest pain is caused by a sudden spasm and narrowing of the coronary arteries that supply oxygenated blood to the heart. Unlike stable angina, variant angina is not typically associated with coronary artery disease. It is marked by an increased occurrence of painful episodes at rest, without any preceding physical exertion. It usually happens in cycles, such as early mornings or late nights, and can be treated with medication. Not properly handled variant angina can lead to serious heart conditions, including sudden cardiac arrest.2

Signs and Symptoms

The main identifying sign of angina pectoris is persistent and severe pain in the chest and surrounding regions. Other related angina symptoms are breathlessness, nausea/vomiting and fatigue. The pain episodes usually last for a few minutes (can last longer depending on the severity of the heart disease). As angina pectoris is caused by inadequate blood supply to the heart, any activity that puts increased demand on the heart could lead to an episode. The symptoms can be generally relieved with rest and medication. Radiating pain in the heart/chest can sometimes be mistaken for indigestion or heartburn.2

Causes and Risk Factors 

The primary cause of angina pectoris is inadequate blood supply to the heart. Certain risk factors that could increase the chances of angina include: 1,4

  • Failing heart health (as a result of ageing)
  • Emotional stress
  • Physical exertion 
  • Smoking 
  • Excessive eating
  • Heavy drinking 
  • Family history/genes

Diagnosis 

The diagnosis of angina usually invovles a physical exam with medical history check. Addittionally, your healthcare provider could order the following tests to confirm the diagnosis of angina: 2

Management and Treatment 

Angina pectoris is treated or managed using a two-pronged approach:

  1. The amount of oxygen or blood being delivered to the heart is increased. 
  2. The blood requirement by the heart muscles is reduced. Medications such as nitrates, calcium blockers, and beta-blockers are the go-to treatment.

There are also other surgical approaches centred around the idea of myocardial revascularization. Your doctor will suggest treatment options depending on the type of angina and symptoms.

Prevention 

You can prevent angina by maintaining decent heart health and consuming a healthy diet, reducing stress, exercising regularly, and quitting or limiting smoking and alcohol consumption.

What is a Heart Attack?

Myocardial infarction occurs when a blood supply in the coronary artery is wholly or partially blocked, usually by a thrombus. This leads to decreased blood flow to the myocardium, depriving it of oxygen. Prolonged oxygen deprivation can lead to cell and tissue death. A heart attack is the final stage or devolution of any pre-existing heart condition or disease. According to the American Heart Association, angina pectoris (chest pain) is a warning sign of heart disease, and recognizing it and getting treated early may prevent a heart attack.1,4

Signs and Symptoms

The signs and symptoms of myocardial infarction can present differently depending on gender, age, and ethnicity. According to the National Health Service (NHS), the most common symptom of myocardial infarction applicable to both men and women is chest pain. However, women are more likely to have other symptoms such as shortness of breath, nausea, and back or jaw pain.

Other symptoms include:

  • Tachycardia (increase in or high blood pressure)
  • Bradycardia (decrease in blood pressure)
  • Severe pain
  • Laboured breathing
  • Fatigue
  • Sweating 

Causes and Risk Factors 

The causes and risk factors are similar to those of angina pectoris. It is because severe angina is a precursor to heart attack (the plaque breaks and blocks the coronary artery).

Diagnosis 

The diagnosis of a heart attack will be made by a health professional who will order an electrocardiogram (ECG) within 10 minutes of hospital admission to confirm the diagnosis, determine the type of heart attack and suggest the most suitable treatment. Once the condition has been stabilised, a doctor may order further tests to assess the functioning of the heart and potential complications. Such tests include blood test, chest X-ray and coronary angiography.4

Management and Treatment 

Treatment and management is determined by the type of a heart attack experienced. The typical approach to the treatment of myocardial infarction involves combinations of thrombolytic (dissolve blood clots), antiplatelet (decrease plaque aggregation), and antithrombotic (combination of thrombolytic and antiplatelet) medications to open blocked arteries and prevent further blockage. 

Other drug options include:

  • Opioids (given with an antiemetic) to prevent pain and reduce excessive sympathetic activity
  • Organic nitrate5
  • β-adrenoceptor antagonists
  • Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin AT1 receptor antagonists (ARBs)

Prevention 

People with a history of a heart attack need to make preventing another heart attack their priority. The prevention strategies include:

  • Adopting a healthy lifestyle
  • Quitting smoking
  • Eating a healthy diet
  • Getting physical exercise
  • Taking medications as prescribed

How to Differentiate between Angina and a Heart Attack

A heart attack is more severe than angina; the resulting pain is abrupt and does not alleviate with rest or angina medications. On the other hand, angina pectoris alleviates with rest and/or medications. 1

Can Angina Lead To A Heart Attack

Yes, angina can lead to a heart attack. This is why keeping a check on your heart health condition is essential. This way, you will notice any signs of angina in its early stages, and with proper management, you can prevent angina from resulting in myocardial infarction.1

When to See a Doctor

When dealing with cardiac health, the best way to go by is “when in doubt, visit the physician”. It is advised to consult the doctor immediately once you notice any uncomfortable or painful irregularities or persistent changes that match the signs and symptoms of heart attacks or angina.

Summary

If you regularly experience chest discomfort, be sure to visit your doctor as soon as possible for testing and evaluation. There are various signs and symptoms that the physician will check with a series of diagnostic tests to provide effective treatment. For example, you might be diagnosed with angina and prescribed the necessary medicine. Ensure you understand your condition and the importance of keeping your heart health in check. Angina pectoris and a heart attack can often be confused, leading to fatal consequences. Knowing the differences between the two is essential. If you are unsure about the signs and symptoms you are experiencing, contact your healthcare provider as soon as possible. 

References

  1. Bulkley BH, Klacsmann PG, Hutchins GM. Angina pectoris, myocardial infarction and sudden cardiac death with normal coronary arteries: A clinicopathologic study of 9 patients with progressive systemic sclerosis. American Heart Journal. 1978 May;95(5):563–9.
  2. Ginghina C, Ungureanu C, Vladaia A, Popescu BA, Jurcut R. The electrocardiographic profile of patients with angina pectoris. J Med Life. 2009 Mar;2(1):80–91.
  3. Rousan TA, Mathew ST, Thadani U. Drug Therapy for Stable Angina Pectoris. Drugs. 2017 Mar;77(3):265–84.
  4. Stern S, Behar S, Gottlieb S. Aging and Diseases of the Heart. Circulation [Internet]. 2003 Oct 7 [cited 2022 Nov 1];108(14). Available from: https://www.ahajournals.org/doi/10.1161/01.CIR.0000086898.96021.B9
  5. Tsujimoto T, Kajio H. Use of Nitrates and Risk of Cardiovascular Events in Patients With Heart Failure With Preserved Ejection Fraction. Mayo Clinic Proceedings. 2019 Jul;94(7):1210–20.
  6. Yeghiazarians Y, Braunstein JB, Askari A, Stone PH. Unstable Angina Pectoris. N Engl J Med. 2000 Jan 13;342(2):101–14.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Christian Nonso Mba

Bachelor's degree, Pharmacy, Igbinedion University, Okada

I enjoy creative writing a lot. I have written books and articles on various platforms via numerous channels. I find articles medical and drug industry particularly interesting. But with my wealth of experience I can incorporate any desired “tone” into any topic when writing.

Substantial research on the use and legalization of Cannabis species in treatment of pain is a long term project.

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