Chest Pain: Understanding Angina and Heart Attack Symptoms & Care

Chest pain is a critical symptom that can indicate various underlying conditions, ranging from benign to life-threatening. Two of the most serious causes are angina pectoris and myocardial infarction (heart attack). Understanding the differences and recognizing their symptoms is crucial for timely intervention.

Angina Pectoris

Angina pectoris is a clinical syndrome characterized by a sensation of precordial discomfort, pressure, or shortness of breath. It is typically precipitated by physical exertion and relieved by rest or sublingual nitroglycerin.

Angina occurs when the heart's workload and myocardial oxygen demand exceed the coronary arterial system's capacity to supply oxygen, leading to myocardial ischemia (a transient or permanent reduction of blood supply). Any increase in these factors, especially within a limited coronary blood flow, can induce angina.

Angina is typically triggered by physical activity and usually lasts no more than a few minutes once the patient ceases the precipitating activity.

Symptoms of Angina

• Pain below the breastbone or elsewhere in the heart region. It may radiate to the left shoulder and down the inside of the left arm to the fingers. It can also radiate directly to the back (interscapular area), jaws, teeth, and even down the right arm.
• Profuse sweating, often accompanied by cold and clammy skin.
• Nausea, vomiting.
• Intense paleness.
• Nocturnal angina is often preceded by a dream and can be accompanied by marked changes in respiration, pulse rate, and blood pressure.

Myocardial Infarction (Heart Attack)

Myocardial infarction is ischemic myocardial necrosis (death of heart tissue) caused by a sudden lack of coronary blood flow to a segment of the myocardium.

Unlike angina pectoris, myocardial infarction involves an "injury current" that is reflected in the electrocardiogram (ECG). There is necrosis of the affected tissue, represented by specific signs, symptoms, and ECG abnormalities.

Symptoms of Myocardial Infarction

The pain is similar to angina but is usually more severe and is only slightly or very temporarily relieved by nitroglycerin. It can be very mild, and a significant percentage of acute myocardial infarctions are silent or not recognized as a serious condition by the patient. However, in acute episodes, the patient is often distressed and may have feelings of impending doom.

Unlike angina, in most cases of myocardial infarction, the patient may experience symptoms while at rest, without having performed intense exercise.

• Deep visceral pain, described as substernal pressure. Often radiates to the back, jaw, or left arm.
• On examination, the patient is usually restless, anxious, pale, and in pain.
• Skin may be cold and clammy.
• Nausea and vomiting.
• Intense paleness.

Emergency Treatment for Chest Pain

In both angina and suspected myocardial infarction, immediate action is critical:

• Emergency transportation to a health center, ideally in a semi-sitting position.
• Ensure the patient is kept as quiet and calm as possible.
• Apply oxygen if available and indicated.
• In cases of myocardial infarction with cardiac arrest (PCR), cardiopulmonary resuscitation (CPR) should be performed once established.