Heart pain, also called angina, can vary greatly from person to person. While some people experience intense pain and discomfort, others may have only minor symptoms or none at all. There are a few key factors that determine whether heart pain will be noticeable or not.
What causes heart pain?
Heart pain is caused when part of the heart does not receive enough blood and oxygen. This usually happens because of coronary artery disease – a narrowing of the arteries that supply blood to the heart. When the heart works harder, it needs more oxygen. If the coronary arteries are narrowed, they cannot deliver enough oxygen-rich blood. This lack of blood and oxygen causes pain and discomfort called angina.
Stable and unstable angina
There are two main types of angina:
- Stable angina – Predictable pattern of heart pain that is usually triggered by activity or stress and goes away with rest. Not immediately dangerous.
- Unstable angina – Unexpected pain occurring even at rest. Indicates arteries are severely narrowed. Dangerous sign that heart attack may happen soon.
Unstable angina is considered a medical emergency. Stable angina may not always be noticeable, but unstable angina usually causes significant, noticeable pain and discomfort in the chest.
What factors determine if heart pain is noticeable?
Severity of artery narrowing
The severity of artery narrowing is a key factor in determining if angina will be noticeable or not. If the arteries are severely narrowed, blood flow is greatly reduced. This typically causes intense angina pain, even during rest. Mild narrowing may only cause minor or no pain.
Location of narrowed arteries
Which arteries are narrowed also impacts the intensity of angina pain. Blockages in the major arteries that supply a large part of the heart often cause the most intense pain. Narrowing of smaller branches may go unnoticed.
Individual pain threshold
People have varying sensitivity to pain. A blockage that causes severe discomfort in one person may only cause mild symptoms in someone else with a higher pain tolerance.
Use of medication
Medications like nitrates and calcium channel blockers are commonly used to treat angina. When taken as prescribed, they can reduce the severity and frequency of angina pain. Some people may have no pain at all when on medication.
Heart rate and blood pressure
Faster heart rate and higher blood pressure increase the heart’s demand for oxygen. This can make angina pain more noticeable. Slow heart rate and low blood pressure decreases oxygen demand and may prevent or reduce angina.
Other medical conditions
Some conditions like diabetes can cause neuropathy, which decreases pain sensation. This may mask angina pain. Other factors like psychological disorders can also affect perception of pain.
Angina patterns and their symptoms
There are three main patterns of stable angina. The severity and noticeability of symptoms can vary between patterns.
| Angina Pattern | Characteristics | Noticeability of Symptoms |
|---|---|---|
| New-onset (First presentation of angina symptoms) | Occurs unexpectedly, even at rest | Often highly noticeable and concerning |
| Increasing angina (Previously stable angina getting worse) | More frequent attacks, triggered by lighter activity | Noticeable increase in symptoms |
| Stable angina (Predictable pattern of angina) | Occurs with activity or stress; resolves with rest | May have mild or no symptoms if routine is maintained |
As shown in the table, new-onset and increasing angina patterns often cause noticeable symptoms, while stable angina may only cause mild or minimal symptoms for some people.
What does heart pain feel like?
The most common heart pain symptoms include:
- Tightness or squeezing sensation in the chest
- Heaviness or pressure in the chest
- Burning feeling in the chest
- Fullness in the chest, neck or arms
- Pain that radiates out to the shoulders, arms, neck, jaws or back
- Shortness of breath
- Nausea
- Sweating
- Dizziness
- Fatigue
These symptoms often last just a few minutes and are relieved by rest. However, the more severe the artery narrowing, the longer and more intense the pain may be.
Angina symptoms in women
Women are somewhat more likely to have atypical angina symptoms like the following:
- Stomach pain or discomfort
- Shortness of breath
- Nausea or vomiting
- Pain that radiates to the arm or back rather than the chest
This can make heart pain less noticeable in some women.
Angina symptoms in diabetics
Diabetics are prone to nerve damage called diabetic neuropathy. This can mask heart pain and make it less noticeable. Diabetics may only experience vague symptoms like:
- Mild chest discomfort
- Fatigue
- Shortness of breath
- Nausea
- Dizziness
When to seek emergency care
It’s important to seek emergency medical care if you experience:
- Sudden, severe chest pain or pressure
- Pain or discomfort in areas like the jaw, neck or back
- Dizziness, lightheadedness or fainting
- Shortness of breath
- Nausea, sweating or palpitations
- Pain that does not resolve with nitroglycerin or rest
These could be signs of a heart attack, which requires immediate emergency care.
Diagnosing the cause of chest pain
If heart pain is suspected, doctors can use tests like:
- Electrocardiogram (ECG) – Records electrical signals of the heart to detect abnormal rhythms, inadequate blood flow, or heart damage.
- Exercise stress test – Monitors ECG while walking on a treadmill to reveal coronary artery blockages.
- Echocardiogram – Uses ultrasound to produce images of the heart’s structure and function.
- Cardiac catheterization – Dyes are injected into the arteries to highlight blockages on an X-ray.
- CT angiogram – CT scan using injected dye to visualize heart arteries.
These tests can help pinpoint the cause of chest pain and guide appropriate treatment.
Reducing the risk of heart pain
Making heart-healthy lifestyle changes and following your doctor’s recommendations can help prevent angina. Important steps include:
- Quitting smoking
- Following a balanced, low-fat diet
- Exercising regularly
- Losing excess weight
- Managing conditions like high blood pressure and diabetes
- Taking medications as prescribed
- Learning to manage stress
Treatment options for angina
Depending on the cause of angina, treatment options may include:
- Medications – Nitroglycerin, beta blockers, calcium channel blockers and other drugs can prevent or relieve angina episodes.
- Surgery – Procedures like angioplasty to open blocked arteries or bypass surgery to route blood around blockages.
- Stents – Expandable tubes placed in arteries to keep them open and improve blood flow.
- Lifestyle changes – Diet, exercise, quitting smoking and stress reduction techniques.
Treatment aims to restore blood flow to the heart, prevent progression of artery disease, and reduce the frequency and severity of angina.
Conclusion
The noticeability of heart pain varies dramatically based on the severity of coronary artery blockages, pain perception, use of medication, and other factors. While some people have mild or no angina symptoms, others experience frequent, debilitating chest pain and discomfort. Understanding the typical patterns and sensations of angina can lead to quicker diagnosis and life-saving treatment. Taking preventive steps and following your doctor’s recommendations provides the best protection against future heart damage and angina episodes.