What’s the Difference Between a Heart Attack and Angina?

When it comes to heart disease, you may hear the terms “angina” and “heart attack” often. They might seem similar, because they are often used in similar situations. You probably hear or read about them together, so it’s easy to get them confused. 

Both angina and heart attacks are associated with chest pain. Most of the time they are a result of coronary artery disease (CAD). This is a condition that affects the blood vessels (the coronary arteries) that bring blood to the heart. Buildup of plaque inside the vessels makes them narrow, which means that not as much blood can get through them to bring oxygen to the heart muscle. 

So, while they are similar in these ways, heart attack and angina are not the same thing. Here, we’ll help you understand the difference between the two.

Physical differences between angina and heart attack

Angina is a term for chest pain that happens when the heart doesn’t get enough blood and oxygen. It’s like your body is sending warning signals that the heart is at risk of damage. There are different types of angina: 

• Stable angina is most common and follows predictable patterns. 

• Unstable angina is unpredictable and more dangerous (more on this below).

A heart attack, on the other hand, occurs when the lack of blood flow is so severe that it causes damage to the heart muscle. This is a medical emergency. When the heart muscle is damaged, it can be life-threatening.

Here’s another way to look at it: 

• Angina is what you feel (a symptom) when your heart is not getting enough blood. It doesn’t cause permanent damage.

• A heart attack is what happens (the outcome) when the lack of blood flow starts to damage the heart.

Angina vs. heart attack symptoms

So what does angina feel like? Here are some common examples of “typical” angina symptoms:

• Chest pain or pressure that improves with rest or on its own after a few minutes

• Pain in your neck, jaw, shoulders, arms, or back

• Shortness of breath

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Common symptoms of a heart attack include:

• Chest pain or pressure that doesn’t let up

• Pain in your neck, jaw, shoulders, arms, or back

• Shortness of breath

• Cold sweats

You might have additional symptoms with angina or a heart attack, which you might not realize are a result of heart disease. These are called atypical symptoms, and they are more common in women and in people with diabetes. Symptoms include:

• Fatigue

• Weakness

• Nausea

• Indigestion

• Dizziness 

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So what’s the difference?

You might notice that symptoms are the same for both angina and heart attack. The only difference? Sometimes chest pain from angina is less severe, or it goes away with rest. On the other hand, chest pain due to heart attack can last longer, worsen, or persist with rest. 

It can be hard to tell the difference, so get medical attention right away if there’s any question. Having angina doesn’t always mean you’re having a heart attack, but it could be a sign that you are at risk of one, especially if the pain is new, worsening, or changing.

What causes angina and heart attacks?

Both angina and heart attacks are usually due to coronary artery disease, or CAD. The underlying process is called atherosclerosis, or plaque buildup in the arteries. Atherosclerosis can happen in any artery, but when it happens within the walls of the arteries that supply the heart, it’s called CAD. This process can start early in life and progress over time.

Another cause is constriction or spasm of the small arteries that supply the heart, rather than narrowing due to plaque. This is called microvascular dysfunction, and it’s a common cause of angina in women.

Angina triggers

It’s common for angina to worsen with certain triggers and improve when the trigger goes away. Angina happens when the heart muscle doesn’t get enough blood, so anything that increases the demand on the heart can trigger an angina attack.

Common triggers include:

• Physical activity

• Cold or hot temperatures

• Emotional stress

• Sexual activity

• Heavy meals

• Smoking

Risk factors

Risk factors are things that make someone more likely to develop a condition. The risk factors for CAD fall into two categories: those you can change or improve and those you can’t change. 

The risk factors you can change include:

• Smoking

• High blood pressure

• High cholesterol

• Excess weight

• Diabetes  

• A diet high in saturated or trans fats

• Lack of exercise 

• Heavy alcohol use

• Illegal substances, such as cocaine and amphetamines

The risk factors you can’t change include:

• Family history

• Aging

• Race and ethnicity

When should you go to the ER for chest pain?

If your angina is new, changing, or worsening, don’t ignore it. This is called unstable angina. It’s much more serious, because it could mean your CAD is worsening or you’re having a heart attack.

Some symptoms can indicate that you’re having a heart attack or are at higher risk for a heart attack:

• New and/or worsening chest pain

• Pain that starts with less physical activity than normal

• Pain at rest

• Pain that feels different than it felt before

• Pain that travels to the arms, neck, back, or jaw

• Chest pain with cold sweats, nausea, or vomiting

If you’re having any of these symptoms, go to an emergency room right away.

Diagnosing angina and heart attack

Once in the emergency department, things might move pretty quickly. It’s common to be rushed to a room, and to have a lot of people standing around you. This can be alarming, but your healthcare team has to move quickly to figure out if you’re having a heart attack and how serious your CAD is. 

Testing is often helpful in this process, so you might have one or more of the following tests:

• An electrocardiogram, or ECG, is a tracing of the electrical activity of the heart. It can give your healthcare team a lot of information, including signs of a serious heart attack.

• A troponin level is a blood test that looks for heart damage. If elevated, there’s a good chance you’re having a heart attack. Even if it’s normal, you might still be at high risk of a heart attack and need more testing.

• Other studies, like a chest X-ray and more blood work, may be done to look for other causes of chest pain, like infections or blood clots in the lungs.

• A stress test is another way to assess CAD. For this test, you will either get medicine through a vein in your arm or walk on a treadmill to speed up your heart rate. Cardiologists will look at special images of the heart when it’s working harder, to see if parts of the heart aren’t getting enough blood.

• A cardiac catheterization is a procedure where a wire is threaded from an artery in your groin or wrist up to your heart. A cardiologist can use special dye and X-rays to look for blockages in the heart that may be causing your angina or heart attack. They can then place a stent, which is a tube-like device, to widen narrowed blood vessels and increase the blood flow to the heart.

If you’re being evaluated for chest pain in a clinic (not hospital) setting, you will probably get some of these tests. Your cardiologist might also recommend additional imaging tests, like a CT or an echocardiogram.

How to treat angina

After all the testing is complete, your cardiology team will discuss treatment options with you. Recommendations will depend on your symptoms and how severe your CAD is. Treatment can involve medications, procedures, and lifestyle changes (see prevention below).

There are some medications that you can take on a daily basis to help prevent angina attacks:

• Beta blockers, such as metoprolol, labetalol, carvedilol, or nebivolol, can prevent angina. These medications decrease the amount of work your heart is doing, which decreases the amount of blood it needs. 

• Calcium channel blockers, such as nifedipine, diltiazem, and verapamil, work like beta blockers to reduce how hard the heart has to work.

• Ranolazine is another medication that can help if the others aren’t working well enough. It also decreases the work of the heart.

• Long-acting nitrates, such as isosorbide, dilate blood vessels in your body, which lowers the amount of blood your heart pumps and lowers your blood pressure. This makes it easier for the heart to work, which in turn helps improve angina.

In some situations, you might be able to manage symptoms of an angina attack at home. Some people have angina that’s very predictable and doesn’t change over time (stable angina). In this case, treating an episode of angina involves these simple steps:

• First, stop activity and rest. This should improve your symptoms. 

• Take nitroglycerin as directed. This medication comes in many forms, such as a pill under your tongue or a spray. It’s a short-acting nitrate, which improves symptoms by reducing the work for your heart.

• If rest and nitroglycerin aren’t improving your symptoms in the way you would expect, get medical attention right away.

Ways to reduce your risk of angina and a heart attack

Since angina and heart attacks both come from coronary artery disease (CAD), taking steps to lower your risk of CAD can also lower your risk of angina and heart attack. 

It’s important to address the risk factors you can change. This involves:

• Adopting heart-healthy eating habits

• Getting plenty of exercise

• Quitting smoking, if you smoke

• Prioritizing sleep

• Avoiding excessive alcohol

It also helps to see your primary care physician regularly, so they can keep an eye on your blood pressure, blood sugar, and cholesterol. If needed, they help with treatment options for these. Managing everything on your own can be really challenging, so consider talking with your healthcare team to see how they can help.

Last, it helps to find out if heart disease runs in your family, if possible. Having a family history of CAD, especially at an early age, increases your risk. Managing other risk factors is even more important if heart disease runs in your family.

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Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology and the American College of Physicians, among others.

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