Symptoms of Coronary Artery Disease

CAD speaks in two voices: the warning voice of angina - chest discomfort on effort that eases with rest - and the emergency voice of heart attack. Learning both, and their atypical disguises, saves lives. Emergencies first.

HEART ATTACK - call 102/108 now

• Chest pressure, heaviness, squeezing or pain in the center or left of the chest, lasting more than 15-20 minutes
• Spreading to the left arm, both arms, jaw, back or upper abdomen
• With sweating, nausea, breathlessness, extreme weakness, or a sense of doom
• Women, diabetics and the elderly often have atypical attacks: breathlessness, extreme fatigue, nausea or upper-abdominal discomfort WITHOUT classic chest pain
• What to do: call 102/108, sit down and stay calm, loosen tight clothing, do not drive yourself. If a doctor has ever advised it or one is available to ask, chew one plain aspirin (unless allergic) while waiting
• Minutes matter: "time is muscle" - the artery must be reopened fast, ideally by angioplasty within the golden hours

Angina - the warning voice

• Pressure, heaviness or burning behind the breastbone triggered by effort: climbing stairs, walking uphill, carrying loads, after heavy meals, in cold air, with emotional stress
• Eases within minutes of rest or a sorbitrate (nitroglycerin) tablet under the tongue
• May radiate to the left shoulder, arm, jaw or back
• Stable angina keeps a predictable pattern for months; new, worsening, or rest angina is "unstable" - treat as an emergency

The disguises people miss

• "Gas" that appears on walking and settles with rest - the commonest misread in India
• Jaw or tooth pain on exertion with no dental cause
• Breathlessness on effort in someone who never had it
• Sweating with chest discomfort, however mild
• In diabetics with nerve damage: silent ischemia - reduced blood flow with NO pain at all; found only on testing

One-line summary

Effort-triggered chest pressure that eases with rest is angina; chest pain with sweating or breathlessness lasting over 15-20 minutes is a heart attack - call 102/108, sit down, and chew aspirin only if advised.