The Symptoms and Manifestations of Coronary Heart Disease

By James M. Rippe

Because every person is an individual, physical responses to progressive coronary artery disease vary. Not every individual with heart disease has every manifestation and symptom of the condition. Individuals likewise experience specific symptoms in different ways. But these manifestations are typical:

  • Nothing: Many people can have significant coronary atherosclerosis but experience no discomfort or other sign of the disease. That’s why this condition is known in medicine as silent ischemia. Ischemia means lack of blood flow. People with diabetes are particularly susceptible to silent ischemia, but others can have it, too.

  • Angina: More formally known as angina pectoris, angina is typified by temporary chest pain, usually during exertion. This pain usually is felt as a tightness or uncomfortable feeling across the chest or up to the neck and jaw, not as a sharp stab. Angina also may have other manifestations.

  • Unstable angina: Chest pain that is new, occurs when you’re at rest, or suddenly grows more severe is called unstable angina. It’s a medical emergency.

  • Heart attack: Completely cutting off blood flow to a coronary artery causes an acute heart attack, or myocardial infarction (MI), the most severe result of coronary heart disease. The closure can be gradual or the result of a blood clot. A spasm in a coronary artery, particularly in the area of a narrowing, may also result in heart attack.

  • Sudden death: The cause of sudden death from coronary heart disease often is a rhythm problem such as ventricular tachycardia or ventricular fibrillation. These rhythm problems sometimes occur in the setting of an acute heart attack. The first indication or symptom for some people that they have CHD is a fatal cardiac arrest or heart attack. Many of these deaths happen to people in their 50s, 40s, or younger.

Recognizing angina, or chest pain

Angina typically is a discomfort felt in the chest, often beneath the breastbone (or sternum) or in nearby areas such as the neck, jaw, back, or arms.

  • Individuals often describe the chest discomfort as a “squeezing sensation,” “vicelike,” “constricting,” or “ a heavy pressure on the chest.” (In fact, the term angina comes from a Greek word that means “strangling” — a strangling pain.)

  • Angina often is brought on by physical exertion or strong emotions and typically is relieved within several minutes by resting or using nitroglycerin.

  • Some individuals, particularly women, may experience angina as a symptom different from chest discomfort or in addition to it. Shortness of breath, nausea, faintness, abdominal pain, indigestion, or extreme fatigue may also be manifestations of angina.

  • When chest pain occurs at rest, it usually is classified as unstable angina.

And just how do you pronounce the word? Some people say “an--nuh” and others say “an-juh-nuh.” Either is correct. Some cardiologists may be a little snobby about their preference, but pay them no mind.

Understanding the causes of angina

You know how your muscles begin to scream when you run faster than your blood can carry adequate oxygen to them. The same thing may happen when the coronary arteries become so narrowed by atherosclerotic plaques that blood flow to the heart is inadequate to supply the heart muscle with the oxygen it needs.

The temporary chest discomfort known as angina is your heart’s way of getting your attention. It occurs when you ask your heart to work harder, and it therefore demands more blood — for instance, when you’re walking briskly or running, climbing a hill or stairs, having sex, or doing housework or yardwork. Strong emotions such as fear or anger also can trigger an episode.

Considering angina’s effect on the heart

Angina usually does not damage the heart. It is a temporary condition — the usual episode lasts only 5 to 10 minutes. (In MVD, the episodes can last longer, about 10 minutes up to 30 minutes.) Chest discomfort makes you stop and rest, slowing the heart and lessening its demand for blood.

Alternatively, most people with angina know to take a nitroglycerin tablet under the tongue when they have an angina attack. The nitroglycerin dilates the coronary arteries, enabling blood flow to the heart to increase.

Any discomfort that doesn’t stop with rest or that lasts more than 5 to 10 minutes may be a heart attack and needs to be treated as an emergency.

Diagnosing angina

An individual’s own description of the discomfort he or she experiences provides the most important information leading to the diagnosis of angina. However, your physician will typically order appropriate tests based on your symptoms and signs.

These may range from an electrocardiogram, exercise stress test, or stress echocardiogram to nuclear stress testing and cardiac catheterization. Some of these tests can be conducted in your physician’s office, but others require the resources of a hospital.

Distinguishing other causes of chest pain

All chest pain is not angina and does not involve the heart. Various conditions involving other structures in the chest can occasionally cause chest discomfort; these include spasm of the esophagus, acid reflux, hiatal hernia, and muscular pain.

Treating angina

People who have angina typically can live comfortably for many years with this condition by finding out how to manage the symptoms and lower their risk factors for complications.

Developing angina can be a big blow emotionally. So big that patients often adopt an unrealistically gloomy perception of their prognosis. Actually, there’s much you can do to adapt. Start with an open, frank discussion with your physician about the following lifestyle modifications:

  • Adjusting your approach to physical activity, leisure-time pursuits, eating habits, and other practices to reduce risk factors and control and even reduce the symptoms of angina.

  • Modifying strenuous activities that consistently and repeatedly produce angina, by taking simple measures such as slowing your walking pace, strolling (not sprinting) to the car through the rain, vacuuming or raking more slowly, and so on.

  • Avoiding strenuous activities that require heavy lifting, such as snow shoveling (unless you discuss it with your physician).

  • Adding slowly progressive exercise training, under your physician’s supervision, which can dramatically increase your ability to perform enjoyable activities of daily living.

  • Considering with your physician other interventions such as medication or surgery if your angina causes unacceptably severe modifications of your lifestyle because quality of life is important!