Angina vs. Heart Attack: Understanding Chest Pain Differences

Learn the differences between angina and a heart attack, covering symptoms, causes, treatment, and urgent warning signs.

By Medha deb

Created on Sep 25, 2025

Learn the differences between angina and a heart attack, covering symptoms, causes, treatment, and urgent warning signs.

Angina vs. Heart Attack: Understanding the Differences in Chest Pain

Chest pain can be alarming, but not all chest pain is the same. Two of the most common causes—angina and heart attack—are closely related, yet differ in cause, severity, and treatment. Understanding these differences is essential for recognizing symptoms, seeking timely care, and managing your heart health effectively.

What Is Angina?

Angina is a type of chest pain or discomfort that happens when your heart muscle doesn’t get enough oxygen-rich blood. It’s a warning sign that your heart is under stress—typically during physical exertion or emotional stress, when your heart works harder than usual. Angina itself does not permanently damage the heart, but it indicates an increased risk for heart conditions like heart attack or coronary artery disease.

Angina is usually triggered by physical activity or stress.
Typically, it improves with rest or medication.
It does not cause permanent damage to the heart muscle.

What Is a Heart Attack?

A heart attack (also called myocardial infarction) happens when the blood flow to a part of the heart is blocked long enough to cause part of the heart muscle to be damaged or die. Unlike angina, a heart attack usually does not resolve with rest or medication, and it is a medical emergency requiring immediate treatment.

Caused by a sudden, complete blockage of blood flow to heart muscle.
Symptoms are often more severe and longer lasting than angina.
Leads to permanent damage to heart tissue if not treated promptly.

Similarities and Key Differences

Feature	Angina	Heart Attack
Cause	Temporary reduced blood flow (often from narrowed arteries or spasm)	Sudden complete blockage of a heart artery
Severity	Mild to moderate, usually resolves with rest	Severe, persistent, does not improve with rest
Duration	Lasts minutes, improves after trigger is removed	Lasts more than a few minutes, ongoing
Damage	No lasting heart damage	Permanent heart muscle damage
Relief	Rest or nitroglycerin usually alleviates pain	Rest or nitroglycerin does not alleviate pain
Treatment	Lifestyle changes, medication	Immediate emergency care (medication, angioplasty, surgery)

Causes: Why They Happen

Angina Causes

Angina most often results from reduced blood flow through the coronary arteries supplying the heart. This is usually due to:

Coronary artery disease (CAD): most common cause, due to plaque buildup narrowing the arteries
Coronary artery spasm: temporary narrowing caused by muscle spasm
Increased oxygen demand (e.g., during exercise, emotional stress)

Heart Attack Causes

A heart attack occurs when a coronary artery is completely blocked, most often by:

Rupture of a plaque (fatty deposit in the artery wall), leading to a blood clot
Severe narrowing from long-term plaque buildup
Less commonly, a spasm or sudden narrowing of the artery

Symptoms: How to Spot the Difference

Both conditions can cause chest pain, but there are important differences to recognize:

Angina Symptoms

Chest pain or discomfort: Often described as pressure, squeezing, fullness, burning, or tightness.
Pain may radiate to the arms, neck, jaw, shoulder, or back.
Triggered by activity or emotional stress.
Relieved by rest or nitroglycerin.
Usually lasts a few minutes.
Shortness of breath, dizziness, nausea, or sweating can also occur.

Heart Attack Symptoms

Severe chest pain or pressure: Sudden, intense, and often described as crushing or heavy.
Pain may radiate to arms, neck, jaw, back, or stomach area.
May occur even at rest or during sleep; not always triggered by exertion.
Not relieved by rest or usual angina mediation.
Symptoms lasting longer than a few minutes (or come and go in waves).
Associated symptoms: shortness of breath, cold sweats, nausea, vomiting, dizziness, profound weakness, or anxiety.

Differences in Women and People With Diabetes

Women and those with diabetes may experience atypical symptoms for both angina and heart attack:

Stomach pain or indigestion
Unexplained fatigue or weakness
Discomfort in neck, jaw, shoulder, back, or even teeth
Shooting or stabbing pain rather than pressure
Shortness of breath without chest pain

Types of Angina

Stable angina: Most common, occurs predictably with activity or stress, improves with rest.
Unstable angina: Unpredictable, may occur at rest, lasts longer, may signal impending heart attack—medical emergency.
Variant (Prinzmetal’s) angina: Rare, usually at rest, caused by artery spasm.

When to Seek Emergency Help

It can be difficult to tell angina from a heart attack based on symptoms alone, so when in doubt, seek emergency care.

If chest pain is severe, lasts more than a few minutes, or does not improve with rest or medication, call 911 or your local emergency number immediately.
Also seek immediate help if you have chest discomfort along with shortness of breath, cold sweat, nausea, or pain radiating to other parts of your body.

Diagnosis

Healthcare providers use several approaches to distinguish angina from heart attack:

Medical history: Description, onset, duration, and triggers of pain.
Physical exam
Electrocardiogram (ECG): To check for evidence of heart muscle injury.
Blood tests: For markers of heart muscle damage (like troponin).
Stress tests: To assess for angina during exertion.
Imaging: Echocardiogram, coronary angiography, or CT scan to evaluate arteries.

Treatment Options

Angina Treatment

Lifestyle modifications: Quitting smoking, eating a heart-healthy diet, regular exercise, managing stress, and weight control.
Medications such as nitrates (e.g., nitroglycerin), beta blockers, calcium channel blockers, and statins.
Occasionally, procedures like angioplasty or surgery if arteries are very narrow.

Heart Attack Treatment

Emergency medical care is critical.
Medications: Thrombolytics (to dissolve clots), antiplatelet agents, blood thinners, pain relievers, and oxygen.
Procedures: Angioplasty and stenting, or coronary artery bypass surgery.
Ongoing medications to reduce risk of another heart attack.
Cardiac rehabilitation program after hospital care to improve recovery.

Prevention Tips

Whether you have angina, are recovering from a heart attack, or just want to lower your risk, these steps help protect your heart:

Stop smoking and avoid tobacco exposure.
Eat a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
Stay physically active; aim for at least 150 minutes of moderate activity a week.
Maintain a healthy weight and manage blood pressure, cholesterol, and diabetes.
Limit alcohol and manage stress levels.

Frequently Asked Questions (FAQs)

What does angina feel like compared to a heart attack?

Angina usually feels like pressure or tightness in the chest triggered by activity or stress, improving with rest. Heart attack pain is more intense, persists with rest, and may come with nausea, sweating, or breathlessness.

Are the risk factors for angina and heart attack the same?

Yes, major risk factors for both include high blood pressure, high cholesterol, smoking, diabetes, obesity, and a family history of heart disease.

How is unstable angina different from a heart attack?

Unstable angina is unpredictable, can occur at rest, and may not resolve with rest or medication. It means a heart attack risk is increased, but heart muscle damage has not yet occurred. It is a medical emergency, just like a suspected heart attack.

Can you have a heart attack without any chest pain?

Yes, especially women, elderly, and people with diabetes might experience atypical symptoms such as shortness of breath, nausea, jaw pain, or unusual fatigue.

What should I do if I am not sure whether my chest pain is angina or a heart attack?

Always treat new, severe, or prolonged chest pain as a possible heart attack. Call emergency services right away. It is better to be safe and get checked by a medical professional.

References

Information for this article was synthesized from trusted medical sources including the Mayo Clinic, GoodRx, Heartscope, and Florida Medical Clinic. If you have specific medical concerns, always consult your healthcare provider.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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