MANY PEOPLE ARE unaware they have coronary heart disease or are susceptible to it, particularly if they haven’t seen a doctor regularly to undergo routine screening tests such as a lipid profile, which measures amounts of triglycerides and “good” and “bad” cholesterol in the blood. In fact, as many as 3 to 4 million people have no symptoms despite insufficient blood flow to the heart—a condition called silent coronary artery disease. Eventually, however, symptoms occur in most individuals with coronary heart disease. The most common initial symptom is chest pain. The chest pain can be a sign of stable angina or an indication of something more serious like unstable angina or a heart attack. Unstable angina and heart attacks are also known as acute coronary syndromes.

Stable Angina
Angina is a warning sign that your heart needs more oxygen. In technical terms, the symptoms are the result of myocardial ischemia— a shortage of blood and oxygen to the heart muscle due to partial blockage of a coronary artery by plaque buildup.

Stable angina occurs most often during physical activity, when the heart requires more oxygen than at rest but cannot get a sufficient blood supply because of narrowing of one or more coronary arteries. Symptoms occur when an artery is narrowed by about 70 percent.

Types of symptoms
The most common symptom of stable angina is pressure beneath the breastbone. Some people experience sensations of tightness, squeezing, burning, aching, heaviness, or choking in the chest area. Angina can also produce pain in the left shoulder that radiates up to the neck and jaw, or pain in the inner part of the left arm that may travel down to the fingers. The intensity of the discomfort usually increases steadily, reaches a plateau, and gradually diminishes with rest—all within a few minutes.

Some women tend to experience stable angina differently than men. They are more likely to have symptoms when they are at rest or under emotional stress. Women may also feel stable angina as pain in the jaw or as heartburn. Other vague symptoms common in women include breathlessness, nausea, and fatigue.

Because angina is often triggered by physical activity, you may experience symptoms while walking or during activities that involve scrubbing or raking. Sexual activity and bowel movements are other possible triggers. Anger, fear, anxiety, and excitement also can cause angina or reduce the amount of physical activity needed to produce it. However, if you’re like most people with stable angina, you’ll be able to predict what level of exertion will produce symptoms.

To relieve angina, your doctor may recommend rest until the symptoms subside or the use of a nitrate medication. In some cases, your doctor may ask you to take a nitrate pill before participating in an activity that has caused chest pain in the past.

Unstable Angina
Unstable angina is midway in severity between stable angina and a heart attack. If you have unstable angina, it is a sign that not enough blood and oxygen are reaching the heart, most likely because a blood clot or spasm has narrowed—but not completely blocked—a coronary artery.

Like a heart attack, unstable angina is a medical emergency. In fact, it is a sign that a heart attack could occur soon.

Three features distinguish unstable angina from stable angina:

• Chest pain that is unexpected and can occur at rest

• Chest pain that is more severe and lasts longer than 20 minutes

• Chest pain that is not relieved by rest or medication

Call 911 immediately if you think your chest pains are more than just stable angina. You’ll be taken to the hospital, where doctors can evaluate the chest pain. If unstable angina is diagnosed, you’ll likely need to stay in the hospital for two to five days to receive treatment to prevent a heart attack.

Heart Attack
Unlike stable and unstable angina, in which the coronary arteries are partially blocked, a heart attack occurs when a coronary artery becomes completely obstructed. The cause of this blockage is often a blood clot that forms where a plaque tears or ruptures. Together, the plaque and blood clot can completely block the artery.

Many people who have a heart attack have a history of angina, and some individuals experience more frequent or severe angina in the days leading up to a heart attack. Others may have less distinct warning symptoms such as increasing fatigue and shortness of breath. In many cases, however, a heart attack strikes suddenly and without any warning.

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