I find that a lot of folks I counsel often confuse the cardiology term angina with heart attack or myocardial infarction (MI). Maybe that's because we refer to an episode of angina as an “angina attack.” To help you understand these terms, let’s look at their similarities and the differences.
Some refer to angina as a heart cramp, which is actually a very apt term. Angina is a symptom of ischemia, which is a lack of adequate blood flow to the heart muscle cells. If you think of the heart as a muscle, which it is, then a cramp there is similar to a cramp in your leg muscle. Muscles “cramp” because of an imbalance of electrolytes in their cells—or from dehydration, fatigue, or overuse.
The bottom line is that a lack of funds in your electrolyte or hydration accounts is a common source of muscle cramps. And your heart is no different. The heart muscle also “cramps” when the supply of oxygen does not meet the energy demands in the cells of the constantly beating heart muscle.
We refer to angina as “stable” when it occurs in response to an increase in energy demand, such as physical exercise. It also indicates that it is fairly predictable. Stable angina is usually reproducible during exercise stress testing. When angina is suspected and/or diagnosed during a stress test, an angiogram or cardiac catheterization is needed to assess the circulatory system of the heart.
If an invasive procedure like a stent or coronary bypass is not recommended (or is deferred for some reason), then medication is usually prescribed to keep the heart below the “anginal threshold” —the pulse range and blood pressure level at which symptoms of ischemia appear. (The higher heart rates and blood pressures needed to respond to exertion place an extra oxygen and energy demand on your heart.)
Stable angina is relieved with rest. Some people may take nitroglycerin under the tongue to assist the heart.
Unstable angina happens unpredictably. The unstable angina symptoms are the same as those for stable angina, but unstable angina can happen when you are resting, or when you are emotionally upset.
Angina symptoms typically include chest pain/pressure/discomfort, shortness of breath, and fatigue. Less typical are a pain, pressure, or discomfort in the jaw (and/or teeth), the arm (including the elbow and wrist), or indigestion. Some folks describe a feeling that if they could just burp they would feel better. Because angina symptoms tend to focus in the chest, the condition is sometimes called "angina pectoris."
Angina Versus Heart Attack
The BIG difference between an angina attack and a heart attack is that angina is a warning, but is TEMPORARY and there is no permanent muscle damage to the heart. Rest and/or nitroglycerin will relieve the ischemia, and so the angina symptoms.
Sadly, even a person with no prior history of angina can have a heart attack. Myocardial infarction is the Latin-based medical term for heart attack, which also was referred to as a coronary thrombosis back when I was a kid. “Myo” is Latin for muscle, “cardio” for heart, and “infarct” is a term for tissue death.
So, the good news is that someone with angina has not damaged their heart. The “bad” news is that folks with angina do have heart disease, and need to see a cardiologist regularly to evaluate and track their heart disease, as well as learn their treatment options.