Angina - when you have chest pain

You may feel pressure, squeezing, burning, or tightness in your chest. You may also have pressure, squeezing, burning, or tightness in your arms, shoulders, neck, jaw, throat, or back.

Some people may have different symptoms, including shortness of breath, fatigue, weakness, and back, arm, or neck pain. This applies particularly to women, older people, and people with diabetes.

You may also have indigestion or be sick to your stomach. You may feel tired. You may be short of breath, sweaty, lightheaded, or weak.

Some people have angina when they are exposed to cold weather. People also may feel it during physical activity. Examples are climbing stairs, walking uphill, lifting something heavy, or having sex.

Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity.

If you are lying down, sit up in bed. Try deep breathing to help with stress or anxiety.

If you do not have nitroglycerin and your symptoms are not gone after resting, call 911 or the local emergency number right away.

Your health care provider may have prescribed nitroglycerin tablets or spray for severe attacks. Sit or lie down when you use your tablets or spray.

When using your tablet, place the pill between your cheek and gum. You can also put it under your tongue. Allow it to dissolve. Do not swallow it.

When using your spray, do not shake the container. Hold the container close to your open mouth. Spray the medicine onto or under your tongue. Do not inhale or swallow the medicine.

Wait for 5 minutes after the first dose of nitroglycerin. If your symptoms are not better, are worse, or return after going away, call 911 or the local emergency number right away. The operator who answers will give you further advice about what to do.

(Note: your provider may have given you different advice about taking nitroglycerin when you have chest pain or pressure. Some people will be told to try 3 nitroglycerin doses 5 minutes apart before calling 911 or the local emergency number. In this case, follow your provider's instructions).

Do not smoke, eat, or drink for 5 to 10 minutes after taking nitroglycerin. If you do smoke, you should try to quit. Your provider can help.

After your symptoms have gone away, write down a few details about the event. Write down:

• What time of day the event took place
• What you were doing at the time
• How long the pain lasted
• What the pain felt like
• What you did to relieve your pain

Ask yourself some questions:

• Did you take all of your regular heart medicines the right way before you had symptoms?
• Were you more active than normal?
• Did you just have a large meal?

Share this information with your provider at your regular visits.

Try not to do activities that strain your heart. Your provider may prescribe medicine for you to take before an activity. This can prevent symptoms.

Call 911 or the local emergency number if your angina pain:

• Is not better 5 minutes after taking nitroglycerin
• Does not go away after 3 doses of the medicine (or as directed by your provider)
• Is getting worse
• Returns after the medicine had helped

Also contact your provider if:

• You are having symptoms more often.
• You are having angina when you are sitting quietly or are not active. This is called rest angina.
• You are feeling tired more often.
• You are feeling faint or lightheaded.
• Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady.
• You are having trouble taking your heart medicines.
• You have any other unusual symptoms.

Acute coronary syndrome - chest pain; Coronary artery disease - chest pain; CAD - chest pain; Coronary heart disease - chest pain; ACS - chest pain; Heart attack - chest pain; Myocardial infarction - chest pain; MI - chest pain

Boden WE. Angina pectoris and chronic ischemic heart disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 56.

Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 35.

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. PMID: 34709928 pubmed.ncbi.nlm.nih.gov/34709928/.

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. PMID: 37471501 pubmed.ncbi.nlm.nih.gov/37471501/.

Updated by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.