Typically, patients of angina experience the following symptoms: 

1. Discomfort in the middle of the chest, with certain characteristic qualities and of a certain duration. 
2. This discomfort is provoked by exertion or emotional stress. 
3. The discomfort is relieved by rest or a short-acting nitrate tablet placed under the tongue. 

However, not all patients who experience angina will experience all the above symptoms atypical cases of angina will meet at least two, but not all of the criteria. Hence, one must lookout for any of the above symptoms.  

What factors trigger the onset of angina? 

This list is long and includes: ^{1 2} 

• Exercise
• Hurrying
• Sexual activity
• Unfamiliar tasks 
• A heavy meal
• Exposure to cold
• Stress
• Anger
• Fright
• Frustration

What does angina feel like? 

Angina is commonly referred to as a pain in the chest, but this may not necessarily be the case; chest discomfort is enough to be called angina.¹ Patients who have experienced it have described it in diverse ways as: ¹ 

• Heaviness in the chest
• A sensation of one’s chest being squeezed
• Pressure on the chest
• Chest heaviness 
• Tightness in the chest  
• A dull ache in the chest
• Burning or aching feeling in the chest 
• Crushing but not stabbing chest pain. 
• Feeling as though one’s chest is going to explode
• Like there is an elastic band around one’s chest. 

As one can see, each patient may experience the same symptom differently. It is important to note, however, that sharp pain in the chest is rarely ever angina. ¹

The symptoms of angina typically last for a few minutes; chest pain that is limited to a few seconds, or which is prolonged for hours, is less likely to be angina. ¹

Where exactly is angina felt? 

The pain/discomfort of angina is most frequently felt in the center of the chest, behind the breastbone which, is at the front and center of the chest.¹ However, this is not always the case, nor is the pain restricted to a single small area of the chest.¹ 

This pain may extend to the shoulders, arms, neck, jaw and teeth, most often – but not always – on the left side.¹ The back of the forearm and hand are usually more involved than the front.² Some patients feel it extending into the upper back, between shoulders, or from shoulder to shoulder.¹ Occasionally, it may be felt in the upper part of the abdomen as well.¹

A few patients experiencing angina may feel no discomfort in the chest at all; their only symptoms may be a pain in one or more of the areas mentioned above.¹

How are the details of angina relevant to its treatment? 

While some studies have found that the middle-of-the-chest location of anginal pain helps distinguish it from other causes of chest pain, other studies have found little or no correlation between the exact location of the pain and the likelihood of the patient developing a heart attack. The severity of angina pain does not necessarily indicate the extent of the heart disease which causes it, but the burden of symptoms felt by a patient does influence the nature and extent of the anti-anginal treatments prescribed to him or her. 

Patients must remember that not all patients of heart disease caused by a block in the blood vessels of the heart will experience angina. Patients who have never experienced angina may also be found to have suffered ‘silent’ cardiac damage.² 

Other symptoms of angina

Apart from chest pain/discomfort, patients experiencing angina may also notice the following symptoms: ¹ 

• Difficulty in breathing
• Shortness of breath
• Nausea
• Light-headedness
• Profuse sweating
• Weakness
• Confusion
• Panic
• Anxiety
• Dry mouth
• Fatigue
• Tightness in the throat

What is stable angina? 

Angina which develops gradually with exertion, emotional excitement or after heavy meals, lasts for 2-10 minutes and is relieved by slowing down one’s activity, rest or short-acting nitrate drugs is called stable angina. ² 

The level of physical activity which provokes angina is predictable; for example, after climbing a certain number of stairs at a certain pace. However, this threshold varies according to one’s emotional state, and may differ from day to day, or at different times of the same day. ²

In women and diabetic patients, the chest discomfort is more likely to be atypical in location, and may not strictly be related to provoking factors. During each episode, the pain gradually increases, followed by a gradual decrease.² Patients must pay attention to whether angina occurs after less exertion than in the past, or at rest (after previously never having occurred at rest). 

What is unstable angina?  

Angina which shows progressively increased frequency, prolonged nature and/or severity compared to the usual symptoms of stable angina, is called unstable angina. It may occur even while lying down and can wake one up from sleep at night. Each episode usually lasts for more than 10 minutes, may occur at rest, or with only minimal exertion. The discomfort is usually severe enough to be felt as pain. Short-acting nitrates too may provide only temporary relief. It may be a symptom of an acute heart condition and needs to be carefully monitored and promptly investigated. ³

Reference key: 

1. Harrison’s Principles of Internal Medicine, Volume 1, Chapter 12: Chest Discomfort 
2. Harrison’s Principles of Internal Medicine, Volume 2, Chapter 243: Ischemic Heart Disease 
3. Harrison’s Principles of Internal Medicine, Volume 2, Chapter 244: Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction