The pain of angina comes from the heart, but it's not generally felt exactly over the heart. The most common focus of pain is under the sternum (breastbone), midway between the breasts or pectoral muscles.
Often the pain is not localized to just the sternum and it spreads, commonly down the left arm but also to the back, sides, upper abdomen, right arm, neck, jaw, or even the teeth. Sometimes the pain can occur in these places without occurring in the chest. Any pain in these areas that occurs during exercise and improves with rest should be evaluated by a doctor.
Not everyone with ischemia will experience angina. If there is no angina, it is referred to as "silent ischemia." More commonly, however, people will experience chest pain.
The pain isn't a sudden, shooting, or stabbing type. It's often described as either a dull ache, pressure, heaviness, or a crushing sensation. Pain that comes and goes over a few seconds is also unlikely to be angina, which is steady and often predictable.
Women may experience different symptoms. Women often experience pain in the neck, jaw, throat, abdomen, or back.
Angina is often predictable in the sense that a pattern may emerge after a few attacks. Some people will come to learn that a certain level of exertion is likely to trigger pain. In most cases, the pain will start when expected and slowly ease when exertion is stopped. It is often worse when exertion follows a meal, in cold weather, and in times of emotional stress. Not all angina is predictable.
Unstable angina is the name given to chest pain that:
- unexpectedly becomes worse than usual at a given level of exertion
- starts with lower levels of exertion
- starts while resting
- continues after stopping exercise or taking nitroglycerin medication
Unstable angina can be a warning of an imminent heart attack. In fact, until being assessed by a doctor at a hospital, there's no way to be sure it isn't a heart attack. If you usually experience steady or predictable symptoms and notice an unexpected change in this pattern, you should seek immediate medical attention.