Angina or Heart Attack Pain – Difference in Signs, Symptoms

Cardiovascular diseases that result in chest pain may be due to angina, myocardial infarction (heart attack), pericarditis or an aortic dissection. There are other possible causes, however, the presentation is usually not sudden and severe pain as it is with these conditions. Of these, angina is the most common and may occur as episodes over years before a heart attack ensues.

Differentiating between angina or a heart attack is crucial as the latter requires immediate medical attention. Some cases of angina that are not responding to medication or rest is also considered as a medical emergency since it is likely to leas to an infarct. However, many angina sufferers are sometimes confused as to when they should seek medical attention.

As a rule of thumb, any chest pain, whether mild or severe, that is persistent needs medical attention, especially if you have a history of heart disease. This is further supported by the presence of any, even one, of the signs and symptoms of a myocardial infarction (heart attack). These features are listed below.

Angina pectoris is the cardiac pain that is caused by a low oxygen supply (hypoxia) to the muscle tissue of the heart (myocardium). This reduced oxygen supply results in ischemia (cell injury). The pain is mild and lasts for anywhere from 2 minutes up to 10 minutes.

Myocardial infarction (heart attack) causes cardiac pain as a result of the death of heart muscle tissue.  The pain is usually severe and typically lasts for more than 10 minutes.

In both angina and a heart attack, the sensation ranges from discomfort to pain in the center of the chest. Many other non-cardiac causes may also cause central chest pain and it is important to differentiate between cardiac and non-cardiac chest pain.

Angina vs Heart Attack Signs and Symptoms

Chest Pain

  • Location
    • Angina – behind breastbone (retrosternal)
    • Heart attack – behind breastbone (retrosternal)
  • Radiates
    • Angina – arm, jaw, neck, middle of upper abdomen
    • Heart attack – arm, jaw, neck, middle of upper abdomen
  • Trigger
    • Angina – exercise, strenuous physical activity, emotional stress
    • Heart attack – spontaneous or exercise, strenuous physical activity, emotional stress
  • Relief
    • Angina – rest, nitrates (nitroglycerin)
    • Heart attack – unresponsive to rest or nitrates


  • Angina – usually absent or may very rarely occur
  • Heart attack – present in majority of the cases

Pale Skin (Pallor)

  • Angina – not present or mild if so
  • Heart attack – usually present

Dizziness and/or Fainting

  • Angina – absent; mild dizziness may occur but not fainting
  • Heart attack – common; severe dizziness and occasional fainting


  • Angina – absent or sometimes mild
  • Heart attack – severe (feeling of impending doom)

Nausea and/or Vomiting

  • Angina – absent or may very rarely occur
  • Heart attack – common

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