Understanding the Signs and Symptoms of Angina

Angina is one of the most common warning signs of an underlying heart condition, manifesting as chest pain or discomfort when the heart isn't receiving enough blood. Often described as pressure, tightness, or a squeezing sensation in the chest, angina typically arises with physical exertion or emotional stress. However, while angina is not a disease, it serves as a critical symptom that demands attention.

At MemorialCare Heart & Vascular Institute at Long Beach Medical Center, we’re dedicated to educating the community on recognizing the signs of angina, how to tell it apart from other conditions and knowing when it’s time to seek medical help. If you're unsure whether you're experiencing heartburn or angina, the differences will be explained in more detail below.

What is Angina?

Angina is the body’s way of letting you know the heart isn’t getting enough oxygen-rich blood. When blood flow to the heart is restricted, it can cause uncomfortable chest pain that may feel like pressure or tightness. The severity and duration of angina varies, depending on the heart condition and the individual. The pain may also spread to the shoulders, arms, neck, jaw or back.

The severity, duration and triggers of angina can vary depending on the condition and the individual. Some people experience stable angina, which occurs during physical activity or stress and goes away with rest and medication. Others experience unstable angina, which happens unexpectedly, lasts longer and may indicate a more serious heart issue like a heart attack.

What Are the Signs and Symptoms of Angina?

Angina can feel different for each person, but most people feel similar symptoms in different cases. Some main symptoms of angina include:

• Chest pain or discomfort (pressure, squeezing or burning)
• Pain spreading through the arms, neck, jaw, shoulder or back
• Shortness of breath
• Dizziness or lightheadedness
• Nausea
• Fatigue
• Sweating

Symptoms Mistaken for Angina

Angina shares some symptoms with other conditions, so it’s important to bring any of these symptoms up with your physician so together you can determine next steps. Don’t minimize your conditions or how you feel; if it’s angina, you’ll want to take the necessary steps to start the treatment journey. Here are some symptoms that are typically mistaken for angina, and how to self-identify between the two conditions:

Heartburn/acid reflux:

• What it is: Acid reflux occurs when stomach acid flows back into the esophagus, often causing heartburn, which is the burning sensation in the chest or throat. This condition can happen occasionally and is usually triggered after eating, especially with certain foods or large meals.
• How it differs from angina: While both conditions involve chest discomfort, heartburn tends to be a localized, burning sensation in the chest that can rise into the throat, often after eating. Angina, however, is described as a pressure or tightness in the center of the chest, and it may radiate to the arms, neck or jaw. Angina is typically triggered by physical exertion or emotional stress, whereas heartburn usually occurs after meals and is often relieved by antacids.

Costochondritis:

• What it is: Inflammation of cartilage connecting the ribs to the breastbone.
• How it differs from angina: Costochondritis pain is sharp, localized, and reproducible by pressing on the chest. Angina pain is more spread out and feels like pressure or tightness.

Anxiety/panic attacks:

• What it is: Psychological stress that can cause physical symptoms like chest pain, shortness of breath, and palpitations.
• How it differs from angina: Anxiety-related chest pain is often accompanied by a sense of dread, dizziness, or a “fight or flight” sensation. Angina pain is more likely to be steady and related to physical exertion.

Pulmonary conditions:

• What it is: Lung-related issues such as pneumonia, pleurisy, or pulmonary embolism.
• How it differs from angina: Pulmonary pain is often sharp and worsens with breathing or coughing. Angina pain is more constant and related to heart strain.

Muscle strains/injuries:

• What it is: Overuse or injury to chest muscles.
• How it differs from angina: Muscle pain is usually localized and worsens with movement or pressure. Angina is not affected by pressing on the chest and is more likely to occur during exertion.

Pericarditis:

• What it is: Inflammation of the sac surrounding the heart.
• How it differs from angina: Pericarditis pain is sharp and worsens when lying down or taking deep breaths. Angina pain is more of a pressure or squeezing sensation and is typically relieved by rest.

Due to the overlap of many of these conditions, it’s important to get a professional medical opinion for any unexplained chest pain.

What Causes Angina?

Common causes of angina include high blood pressure, anemia, heart valve disease and thyroid disorders. These often lead to reduced oxygen supply, causing the heart to work harder.

Angina can occur due to underlying heart diseases such as:

• Coronary Artery Disease: Coronary Artery Disease (also known as CAD) is the most common cause of angina and the most common type of heart disease in the United States. CAD occurs when plaque builds up in the walls of the arteries, narrowing them and restricting blood flow. CAD can also be the first sign of a heart attack.
• Blood Vessel Spasms: Angina can sometimes be caused by a temporary tightening of the coronary arteries (rather than plaque build-up). This can happen because of stress, cold weather conditions, smoking or drug use.

Whether your condition is common or complex, it's important to seek medical advice for proper testing, especially if you're at a higher risk for angina or have a family history.

Who Is at a Higher Risk for Angina?

It is important to be aware of risk factors so you can bring this up with your medical provider. Common risk factors for angina are:

• Age: Men over 45 and women over 55 are at a higher risk since aging leads to increased plaque build-up.
• Smoking: Smoking damages the blood vessels and reduces oxygen flow within the blood, leading to increased blood pressure.
• High cholesterol: High levels of LDL cholesterol can lead to plaque build-up.
• Diabetes: Diabetes increases the risk of CAD and nerve damage.
• Genetics: CAD can have a history of running within family genes.
• Lack of physical activity: A lifestyle with low to no physical activity can lead to conditions like obesity, high blood pressure and overall poor heart health.
• Obesity: Excess weight puts additional strain on the heart and can lead to diabetes and high cholesterol.
• Race/ethnicity: African Americans who have already had a heart attack are at a greater risk for developing angina than Caucasians.

When Should I Seek Treatment for Angina?

While some causes of chest discomfort may result from other less dangerous conditions, it could also be a symptom of a serious condition, such as angina or a heart attack. If you have experienced any of the symptoms below, seek treatment immediately:

• Abrupt and severe chest pain: If you experience sudden and intense chest pain, especially if it feels like pressure, squeezing, or tightness, seek emergency care immediately.
• Accompanying symptoms: Chest pain accompanied by the following symptoms requires medical attention:
• Shortness of breath
• Sweating
• Nausea/vomiting
• Dizziness/lightheadedness
• Radiating pain
• Prolonged and persistent: Chest pain lasting more than a few minutes should not be ignored.
• Existing health issues: Individuals with a history of heart disease, high blood pressure, diabetes, or high cholesterol should talk with their primary care doctor to monitor their heart health.

How is Angina Diagnosed:

There are a few ways our team at MemorialCare Heart & Vascular Institute at Long Beach Medical Center can determine whether or not you are truly experiencing angina:

• Electrocardiogram: A quick, non-invasive test that uses electrodes to track your heart’s electrical activity, both at rest and during activity. It can help diagnose various heart conditions, including abnormal rhythms and changes in heart size.
• Stress Test: A stress test helps determine how your heart responds to exercise, helping diagnose CAD and other conditions. Your heart rate, blood pressure, and EKG are monitored while you walk on a treadmill to assess heart function and treatment effectiveness.
• Echocardiogram: Also known as an echo test, this is a painless ultrasound test that creates detailed images of your heart’s size, structure, and movement. It provides key insights into heart health and can detect various heart diseases.
• Chest X-Ray: A simple, painless imaging test that captures a black and white image of your chest, showing your heart, lungs, and rib cage. While it doesn’t reveal the inside of your heart, it helps assess its size, shape, and position.
• Nuclear Stress Test: Similar to a standard stress test but with added imaging, this test uses a small amount of radioactive material to highlight blood flow to the heart. It helps detect coronary artery disease and evaluate heart function under stress.
• Coronary Angiogram: This is a specialized X-ray that uses contrast dye to visualize the coronary arteries, the vessels supplying blood to the heart. A catheter is inserted through a blood vessel in your groin or arm to release the dye, allowing doctors to detect blockages or plaque buildup linked to coronary artery disease.
• Cardiac Computed Tomography (CT) Scan: A CT scan uses X-rays to take detailed cross-sectional images of your heart and blood vessels. It helps detect early signs of CAD and other heart issues. During the test, you’ll lie on a table while the scanner moves around you to capture images.
• Magnetic Resonance Imaging (MRI) Scan: An MRI uses a magnetic field and radio waves to create clear, detailed images of your heart and other organs. It’s especially useful for detecting issues that X-rays, or CT scans might miss. The scan is quick, comfortable, and provides high-quality results to help diagnose a range of conditions.

Advanced Cardiac Care at MemorialCare Heart & Vascular Institute at Long Beach Medical Center

At MemorialCare Heart & Vascular Institute (MHVI) at Long Beach Medical Center, patients have access to one of the region’s most comprehensive cardiovascular programs. Our board-certified cardiologists, cardiac surgeons, and vascular specialists work together using the latest diagnostic tools and treatments to deliver personalized care for every patient.

Whether you're being evaluated for angina, recovering from a heart event, or managing a chronic condition, our multidisciplinary team provides advanced, evidence-based care in a supportive environment. With state-of-the-art imaging technology, minimally invasive procedures, and a full spectrum of diagnostic services—including stress tests, echocardiograms, cardiac CTs, and more—MHVI ensures accurate diagnosis and effective treatment plans tailored to your needs.

Our Institute is nationally recognized for excellence in cardiac care and is committed to helping patients live healthier, longer lives through prevention, early detection, and innovative treatment options.

Angina is a serious condition that signals underlying heart problems. Understanding its factors, symptoms, and diagnosis can help individuals know what to look out for. If you experience unexplained chest pain, don’t wait. Schedule an appointment with a specialist at MemorialCare’s Heart & Vascular Institute or call (844) 662-6484 for expert guidance and support.

About Dr. Ron Sklash

Dr. Sklash is a board-certified cardiologist at Memorial Cardiology Medical Group and a member of the MemorialCare Heart & Vascular Institute at Long Beach Medical Center. His expertise spans cardiology, echocardiography, cardiac computed tomography (CT), nuclear cardiology, and internal medicine, with a clinical focus on noninvasive cardiology. He has been serving the Long Beach community since 2013.

Dr. Sklash earned his medical degree from the American Medical Program at Tel Aviv University in Israel. He completed his residency at Mount Sinai Beth Israel in New York, followed by a research fellowship in cardiology at St. Luke's-Roosevelt Hospital Center. He then pursued a general cardiology fellowship at Winthrop University Hospital of Stony Brook University in Mineola, New York, and an additional one-year fellowship in preventive cardiology.

Outside of medicine, Dr. Sklash enjoys spending quality time with his wife—an internist in the local community—and their two daughters. A passionate sports enthusiast, he can often be found playing basketball, golf, or tennis under the Southern California sun.