The chest pain of angina comes in four flavours

woman angina

by Carolyn Thomas    @HeartSisters

There are four main types of angina pectoris women should know about, no matter how you pronounce it: ‘anj-EYE-nuh’ in Canada or Australia, or AN-gin-uh’ in the U.S.   This term is translated as “strangling in the chest”.

The chest pain called angina is not the same as a heart attack – but it can feel like one and can in fact lead to one. Here are the four types of angina you need to know:

  • Stable angina: Mayo Clinic cardiologists define this as any pain/discomfort between neck and navel that comes on with exertion and is relieved by rest. When you climb stairs, exercise or walk, your heart muscle demands more blood, but it’s harder for the muscle to get enough blood when your coronary arteries have become narrowed. Stable angina can also be triggered by emotional stress, cold temperatures, heavy meals, smoking or other activities that can narrow arteries.
  • Unstable angina can strike without any link to physical exertion and is not relieved by rest or your usual angina medications like nitroglycerin. If a fatty plaque deposit in a coronary artery ruptures or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, severely decreasing blood flow to your heart muscle. If the blood flow doesn’t improve, heart muscle deprived of oxygen dies – and that’s a heart attack, or myocardial infarction. Unstable angina is a serious medical emergency and requires urgent treatment.
    * Stable angina (persistent, recurring chest pain that usually occurs with exertion)
    * Unstable angina (sudden, new chest pain — or a change in the pattern of previously stable angina — that may signal an impending heart attack)
    A third, a rare type of angina called variant angina (also called Prinzmetal’s angina) is caused by a coronary artery spasm.
  • Variant angina (also called Prinzmetal’s angina) is considered relatively rare (only 2% of all angina cases).  It’s usually caused by a coronary artery spasm, and is more likely to affect younger women than in older women or men. The artery can momentarily narrow during this spasm, suddenly reducing blood flow to your heart and causing severe pain. It nearly always happens while you are at rest. It doesn’t follow physical exertion or emotional stress. Attacks may be very painful and usually happen between midnight and 8 a.m. You may also have a blockage in at least one major coronary artery, and the spasm usually happens very close to the blockage. According to the Canadian Society of Internal Medicine, patients with Prinzmetal’s typically have good exercise tolerance, often with no abnormal EKG changes during conventional cardiac treadmill stress testing. Tragically, even an invasive diagnostic angiogram can sometimes fail to identify heart disease in patients with Prinzmetal’s. Drugs such as cocaine can also cause such a life-threatening spasm, which is why paramedics and medical staff may ask if you’ve ingested cocaine when you present with cardiac symptoms.
  • Microvascular angina causes chest pain, but without any apparent blockage in a coronary artery. This pain is caused by an improper functioning of the tiny microvascular blood vessels that feed your heart. This condition is sometimes also called Syndrome X.  Coronary microvascular angina is also called non-obstructive coronary artery disease or small vessel disease. Doctors don’t know yet whether coronary microvascular angina is the same as microvascular disease linked to other conditions such as diabetes.  Standard cardiac diagnostic tests look for coronary artery blockages that affect blood flow in your large coronary arteries, but these tests can’t detect plaque deposits that form, scatter, or build up in the smallest coronary arteries. And standard tests can’t detect when the arteries spasm or when the walls of the arteries are damaged or diseased.  See also: My Love-Hate Relationship With My Little Black Box

When angina symptoms fail to respond to the standard toolbox of medications or invasive cardiac procedures like bypass surgery or stenting, it’s known as refractory angina

The European Society of Cardiology Joint Study group on the Treatment of Refractory Angina (European Heart Journal 2002; 23: 355–370) describes refractory angina as a clinical diagnosis based on a combinations of history, examination and investigations) and states:

“Refractory angina pectoris is a chronic condition characterized by the presence of angina caused by coronary insufficiency in the presence of coronary artery disease which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery. Chronic is defined as a duration of more than three months.”

For many women, angina symptoms can feel very different from the classic angina symptoms of men.

For example, a woman may have chest pain that feels like a stabbing, pulsating, burning, heavy or dull form of chest discomfort rather than the more typical vise-like pressure and tightness of men. Women are also more likely to experience nausea, shortness of breath or abdominal symptoms. These differences may lead to delays in seeking treatment for many women.

Remember, too, that during a heart attack, at least 10% of women experience no chest symptoms at all.(1)

Chest pain can also continue following treatment for heart attack – a distressing and frightening development just when you’re expecting that things should be back to normal. About 20% of heart attack patients still experience angina one year after the major cardiac event, according to a study in the journal, Archives of Internal Medicine.(2) Denver researchers noted that those most likely to experience angina symptoms one year after heart attack included those who:

  • were younger
  • were people of colour
  • were male
  • had a previous history of coronary artery bypass graft surgery (CABG)
  • had experienced chest pain while resting in hospital after a heart attack
  • were still smoking
  • had undergone revascularization procedures (CABG, angioplasty, stents) after hospitalization
  • had experienced significant new, persistent or fleeting symptoms of depression

“Stretching pain” (or stretch pain) is commonly reported by about 30-40% of those who have recently had a coronary stent implanted. See also: Post-stent chest pain

Chest pain after angioplasty/stenting occurs frequently and is considered to be due to vasospasm or coronary artery stretch during the procedure, described in a study reported in the Journal of the American College of Cardiology.(3)  A significant increase in restenosis (or stent failure) of the newly-stented artery was noted at 6- to 9-month follow-up among those patients who reported post-procedure chest pain (29.5%) compared to patients who had not reported post-procedure chest pain (16.6%).  Researchers observed that these higher restenosis rates may have been associated with local vessel stretch and deep vessel wall injury during cardiac catheterization/balloon angioplasty.

Dressler’s syndrome has also been identified as something that happens to a small number of people three to four weeks after a heart attack. The heart muscle that died during the attack sets the immune system in motion, calling on lymphocytes, one of the white blood cells, to infiltrate the coverings of the heart (pericardium) and the lungs (pleura). It also starts generating antibodies, which attack those two coverings. Chest pain is the predominant symptom. It can feel painful to take a deep breath or to twist the chest. The patient is often terrified that it’s another heart attack. Management of Dressler’s starts with the use of anti-inflammatory drugs.

Angina can also occur in the absence of any coronary artery disease. Up to 30% of people with angina have a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart.

People with severe anemia may also have angina because their blood doesn’t carry enough oxygen. And those with thickened heart muscles need more oxygen and can have angina when they don’t get enough.

Costochondritis causes chest pain that can be confused with heart attack (and vice versa). This is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can often reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is not associated with swelling, unlike Tietze’s syndrome, where swelling is characteristic.  In North America, treatment of both is typically limited to heat or ice, and medications to reduce inflammation.  Recent 2017 research published in the International Journal of Sports Physical Therapy confirms costo treatment as practiced in New Zealand by physiotherapists who treat the back, using manual therapy focused on jammed (or “frozen”) rib joint(s) around the back where they hinge onto the spine.  See more here.

Anecdotally, yoga aficionados also report may experience chest pain after doing yoga. The poses used in Bikram yoga, for example, can manipulate muscles, including those in the chest region. Overextending them or straining one of them while getting into and out of poses could cause chest pain after a session. Inflammation in the lungs, an embolism, and high blood pressure may be exacerbated by the practice.

Injured ribs will likely produce chest pain, particularly after exercise, including yoga. Heartburn often mimics the chest pain associated with a heart attack, and may be aggravated by the changes in posture and position required during Bikram yoga. And if you suffer from asthma, the heat and humidity of hot yoga may make it difficult to breathe. Trying to get enough air in your lungs could make your chest hurt as well.

In a U.K. study of almost 100,000 people aged 45-89, epidemiologist Dr. Harry Hemingway of the University of London pointed out the difficulty in diagnosing angina in women, which is often missed by tests such as treadmill exercise electrocardiograms, compared to men. The U.K. researchers also found that angina in women over age 45 is linked with higher mortality rates.

Dr. Hemingway says:

“For women, angina is a more significant public health problem than many doctors, or indeed the general public, realise.  We need to ensure fair access to cardiac investigation and treatment services.” 

Dr. Peter Weissberg, medical director at the British Heart Foundation which funded the study published in the Journal of the American Medical Association, adds:

“Angina has traditionally been thought of as a male affliction. This study confirms that after age 45, women fare worse than men when they develop angina. Women with angina should receive prompt and appropriate treatment to reduce their risk of suffering a heart attack.”

There are several treatment options for these types of angina, ranging from medications alone to coronary bypass surgery in order to reduce the frequency or severity of your symptoms and to lower your risk of heart attack and death. Angina symptoms in women can be both physical and emotional.

Remember, all chest pain should be considered heart-related until proven otherwise.

Learn more about angina from the experts at Mayo Clinic.

(1) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026.
(2) Maddox, T.M. et al: “Angina at 1 Year After Myocardial Infarction: Prevalence and Associated Findings”.  Archives of Internal Medicine (2008). 168[12]: pp. 1310 – 1316.
(3) Kini, A.S. et al:  “Postprocedure chest pain after coronary stenting: implications on clinical restenosis” J Am Coll Cardiol. (2003)  41(1):33-38. doi:10.1016/S0735-1097(02)02617-7
NOTE FROM CAROLYN:  My book A Woman’s Guide to Living with Heart Disease“. reads like the“Best Of” Heart Sisters blog archives.  You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon –  or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

See also:

85% of Hospital Admissions for Chest Pain are NOT Heart Attack

How Does It Really Feel To Have A Heart Attack?  Women Survivors Tell Their Stories

The Myth of the “Hollywood Heart Attack” for Women

What Is Causing My Chest Pain?

When Chest Pain is “Just” Costochondritis

The Freakish Nature of Cardiac Pain (first of a three-part series on pain)

Brain Freeze, Heart Disease and Pain Self-Management (second of a three-part series on pain)

Chest Pain While Running Uphill (third of a three-part series on pain)

Please note: information on this website is not intended to replace medical advice.  Consult your physician for questions about your own personal health.

45 thoughts on “The chest pain of angina comes in four flavours

  1. Had a stent last year but still have chest pains, have read a lot about the unstable angina as I think that’s what I’m experiencing as I’m at rest but have pain when I move. I don’t know why, as have mentioned it to my doctor …waiting for tests as a long waiting list, Just hope it doesn’t take too long as it’s painfully and scary. Information on here has been very helpful, the bits I can relate to and understand.

    Thank you ..

    Liked by 1 person

    1. Hi Diana – I’m not a physician so cannot comment specifically on your case, but I can say generally that chest pain on exertion as you have been experiencing is what we call “stable” angina, while chest pain at rest is “unstable” angina – a more serious condition. As a heart patient with a stent, you should have been prescribed nitroglycerin for occasional chest pain. If not, please ask your physician about this – many heart patients use nitro to manage occasional episodes of stable angina following a cardiac event. Meanwhile, if your symptoms increase in frequency or severity, or if you experience symptoms while at rest, seek immediate help. Good luck to you…


  2. I get little sharp pains and chest pressure after my stents, 4 of them put in. Is is from being extremely nervous or is that symptom due to the heart?


    1. Hello Susan – I’m not a physician so cannot answer your question. Depends on how long ago your stents were implanted (“stretching pain” is common in the very early days/weeks post-stent). Talk to your physician about these symptoms just to be sure.


  3. I’m so glad to have found this site as I would love to get some insider knowledge. I’m a 56 year old female and have for about the past week been having sharp pain on the left side of my chest that goes up and to the back of my shoulder. This happens every morning after I have been up for about 20 minutes and lasts one to two hours. I hesitate to go to a doctor about it because two months ago I had cervical spinal surgery and I am still dealing with that (collar, limited activities etc.) and wonder if it could be connected there. Seems so odd that it is only in the morning. Would angina strike like that? On a “regular” schedule? I really don’t want to go through any more medical procedures if it is not absolutely necessary so that is why I am asking. I also have RA. Any insight would be greatly appreciated.


    1. Hello Ann – I’m not a physician so cannot comment on your specific case, but I can tell you generally that we can be suspicious of chest pain when it is unusual and can’t be linked to any other day-to-day causes. For example, every time I’d spend a full day gardening, I’d have bad back pain the following morning from all that bending and hauling. In your case, you have had surgery that just may be the culprit, and also RA. Given that the pain goes away on its own suggests it may be associated with getting up and moving first thing in the morning, and as you move around for a couple of hours it eases up.

      Angina happens when blood flow to the heart muscle is reduced for some reason (which is why it so often happens with exertion when we place increased demand on the heart muscle). Also, angina is not typically described as “sharp” pain (it COULD, but it’s not typical). But again, I’m not a doctor – call your GP and have a discussion about this. If it’s related to your recovery from surgery, there may be something he/she can advise. Good luck to you…


  4. I didn’t know I had angina until I had an attack a few months ago, but since then I’ve been really tired. Is this a symptom or just a coincidence?


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  8. Hi,
    I have a history of chemotherapy/radiation and IST (inappropriate sinus tachycardia). I’ve had lots of tests done, and the Cardiologist tells me everything is ok. I have mild radiation-induced sclerosis. Currently I’m getting chest pain that they thought might be acid reflux (I had it a bit before and had been on PPI’s). They gave me a GTN (nitro) spray but I’m too scared to try it as it dilates the blood vessels and I know that will give me a migraine and then I’d need my nasal spray of Sumatriptan to stop that; Sumatriptan causes constriction of the blood vessels.

    The dilation and constriction I can’t imagine would be good for me… or my heart. The pain feels a bit like something getting stuck in my chest, like a muscular dull ache. Anyway, I wonder what others experience of GTN sprays were and your thoughts. Or if the tablets might be better as I’ve heard you can spit them out when you feel better or your headache is bad. I feel quite scared to be honest. I have an extensive medical history and do not like hospitals or many medics.

    Liked by 1 person

    1. Hi Katherine – you’ve had such an overwhelming variety of serious medical issues already. I’m not a physician so can’t advise you specifically, but I can however tell you some general facts. I’m guessing you have a history of migraine, hence your reluctance to bring one on, as we know that nitro can indeed trigger a migraine for those who are susceptible. But before you decide, read Dr. Bernard Lown’s take on using nitroglycerin to address cardiac pain.

      Using nitro tablets vs spray may not make much of a difference – the drug works as soon as the (unchewed, uncrushed) tablet is absorbed through the lining of the mouth, usually giving relief within a few minutes if the chest pain is cardiac in nature. By the time you “feel better”, the drug’s already in your system. Spitting out the tablet right away could reduce the overall quantity, but it may not be sufficient to actually help address your symptoms.

      Right now, however, you don’t really know if your chest pain is due to acid reflux or heart issues.

      You may be putting the cart before the horse: the first dilemma is to figure out if acid reflux is actually what’s causing your symptoms. Go back to your physician to discuss your treatment options.


    2. Hello, I’ve been having chest pains in the center of my chest mostly when I’m at rest but sometimes when I walk that seem to feel similar to when I had my heart attack but yesterday had a stress echo and didn’t feel any pain in my chest when exerting myself.

      I was told by my cardiologist that I would develop stable angina (feeling chest pain with exertion) before I would develop unstable angina (feeling chest pain at rest) but are there exceptions to this???

      Can you have unstable angina (feeling pains in your chest at rest before you develop stable angina????


      1. Hi Jim – I’m not a physician so cannot comment specifically on your symptoms, but I can tell you generally that there are exceptions to every rule in cardiology. Several of my readers have reported, for example, that their first heart attack symptoms struck out of the blue while they were at rest. Try keeping a symptom journal so you can track your symptoms/how severe they were/when they occurred/what you were doing in the 1-2 hours just before they happened. This might help your doctor solve the mystery if symptoms continue. Like my friend cardiac psychologist Len Gould likes to say: “Before a heart attack, all symptoms feel like indigestion. After a heart attack, all symptoms feel like another heart attack.” Best of luck to you…


  9. Bikram is NOT yoga. Its a formula of a group of “yoga” postures created by a very corporate minded individual. The real traditional physical practice of yoga, is not a forceful practice. Its important to have education in regards to what yoga is! The physical practice stemming from Raja Yoga is just a very small aspect of yoga!

    To make a genaral statement in regards to Yoga regarding a practice which is truly not a form of yoga but a corporate bastardisation of the physical practice of yoga can actually be robbing people of an opportunity to actually be able to heal their angina via the many other approaches to Yoga, for example meditation, pranayama, hatha and etc… The real practice of yoga is an individual practice, not a formula of group set of exercises that will suit everyone. This is ignorance, and western bastardisation for means of capital gain.

    Get educated about the real practice of yoga and the sister science, Ayurveda…



  10. Hi Carolyn, I just came across your website and find it very informative and interesting. I am a 33 year female. I think I may have varient angina, but have not been diagnosed with anything yet.

    I saw my GP a few months ago because I had developed some sharp chest pain at rest that lasted a couple minutes and then went away. She sent me for an electrocardiogram, which came back showing I had a slightly enlarged heart on the right side. She told me not to worry and that I shouldn’t be concerned with it. However, now I constantly worry about it.

    I am not the healthiest person when it comes to exercise, but I do eat fairly healthy. My boyfriend and friends tell me not to worry about it, but I don’t sleep very well and feel tired a lot.

    Things have been fine, but then tonight it happened again, sharp chest pains at rest only lasting a couple minutes. So now comes the worry and anxiety again. If you were me what would you do? Should I call my doctor on Monday and see if there is anything to be done? I’m lost and scared. Your thoughts would be greatly appreciated or anyone on here. Thanks,


    1. Hello Summer,
      I’m not a physician so can’t comment on your specific symptoms. I can however tell you generally that worrying about your heart is not good for your heart! Chronic low-grade stress has been shown to increase your cardiac risks. Right now, you just don’t know if this symptom is heart-related or not (it’s entirely possible that it isn’t, which means all this worry and anxiety is for nothing). You might consider keeping a symptom journal to show to your GP (date, description of symptom, what you were doing/eating/drinking/experiencing in the 2-3 hours leading up to the onset of symptoms).

      In the meantime, you could also do what every heart patient is instructed to do by physicians: regular DAILY exercise, a heart-healthy diet (e.g. the Mediterranean Diet) stress reduction techniques, and healthy sleep habits. Do some homework to focus your energies on improving, not worrying. Best of luck to you…


  11. I read this article by chance and about four weeks later was awakened in the middle of the night with what I first thought was truly terrible heartburn. Having read your article and knowing I had high blood pressure, I decided to err on the side of caution and went to the Emergency Dept. It turned out I had had an awful attack of angina and the ECG, which I would not have had had I not gone, showed up cardiac problems.

    This article probably saved my life! Had I not read it, I would not have gone to Emergency, just put it down to one of those odd things, so I am truly indebted to you.

    Thank you so much. 😊

    Liked by 1 person

    1. Elena, thank YOU for taking the time to come back and leave your comment here. You made my day! I’m so glad you paid attention to that little voice inside that told you that something was very wrong. Best of luck to you in your recovery… 🙂


  12. Hey Carolyn!

    Missed this one and glad I found it!

    As the years of Coronary Microvascular Disease and variant angina have progressed, I have found myself having that burning feeling – like a brush burn on the skin – but inside my chest. Seems to follow spasm or the sharpest of my incidents and feels like an after effect. It indeed is insanity to have so many feelings that are then connected back to angina. Sometimes referred pain and nerve related and at times hard to distinguish.

    Thank you for your ongoing care and advocacy. Love your articles and words that help us keep ourselves moving forward.


    Liked by 1 person

    1. Nice to hear from you, Annette. That ‘insanity’ you describe sums up why the symptoms of angina are so unlike how people experience so-called normal pain (headache, sore muscle, etc). Hang in there…


  13. When I had angioplasty a couple of years ago, I was in the worst agony I have ever had. I am again having angina after my first heart attack and will see an interventional cardiologist. I am very concerned that he will want to do another angioplasty and I don’t think I will live through this again. Do you know why I am not given pain meds to have this done? Thank you.

    Liked by 1 person

    1. Hello Pat – I’m not a physician so of course can’t comment on your specific situation. You don’t mention whether the pain you experienced happened during your angioplasty, or afterwards. I can tell you that in general, patients are almost always given some form of medication called conscious sedation during the procedure. Cardiac pain experienced during angioplasty is typically caused in part by stretching of the coronary artery wall when the balloon is inflated, briefly blocking blood supply to the heart. Typically, you won’t feel the catheter moving through your blood vessels because the arteries have no nerve endings. But whether the “agony” you describe happened during or after your procedure, pain medications are widely available and should be administered. Talk to your cardiologist about this concern when you see him. Best of luck to you…


  14. I appreciate the descriptions of various types of chest pain. I have a question. Is it possible to experience a muscle spasm in the chest for the same reasons that one experiences muscle spasms in the neck, back, etc? I’ve always suffered migraines due to muscle spasm, but I experienced my first “spasm” (or that’s what I think it was) in the center of my chest last night. It scared me quite a bit!

    I’m a 27 year old woman who exercises regularly, eats a healthy diet, and is usually well-rested. I’ve not been experiencing any stress that I can think of. Last night, I couldn’t get comfortable when I went to bed; something deep in my chest was sore no matter my position. This would be normal if it had been soreness in my back, but the location of the pain was different. Most of the time, I fall asleep immediately, but I was awake for over an hour due to the discomfort, which ranged from mild to quite painful.

    As I laid awake last night due to the pain/stretching/tightness, I found it difficult to pinpoint the exact locations of the pain; the worst of it was deep in the center of my chest, but I felt pain in my jaw and neck a couple of times. My first thought was, “maybe I’m having a heart attack,” and I was alarmed by the strange pain, but when I half-woke my husband (who was a paramedic for a few years), he asked if the pain changed when I breathed – which it didn’t. He was content to assume it was not heart-related, because my breathing didn’t effect the discomfort.

    This has only ever happened to me once–last night. The descriptions of angina that I’ve found imply that it is shows ongoing symptoms/multiple episodes. Maybe I should just see if this happens again. My muscle spasms have never been cause for alarm, though they are a real pain. The chest pain seemed different, but I am back to normal today, and I don’t want to make a huge deal over nothing, if it was simply another muscle spasm.

    What are your thoughts?

    Liked by 1 person

    1. Sorry for the delay in responding to your comment Bekah – for some reason, it got lost in the shuffle! I hope that since you wrote this, you are indeed feeling “back to normal” now. In answer to your question: yes, there are several possible non-cardiac reasons for chest pain.

      I was confused by what your husband told you about breathing (“not heart-related, because my breathing didn’t effect the discomfort”). In fact, unlike the chest pain caused by other conditions like acid reflux (temporary, severe chest pain when taking a deep breath or coughing), the intensity level of cardiac pain typically remains unchanged when you breathe deeply.


    2. If by any chance you are still concerned about this, or have had another “episode”, I would not ignore it. I had also always had migraines. Then I experienced discomfort in my chest one day, and it ended up being a coronary spasm that ended in a full blown heart attack. It took a lot of convincing every one in the emergency room to believe me, because I was a young, thin, fit and healthy woman. I now manage the “Prinzmetal’s angina” with Ranexa. I do not ignore the spasms anymore either, and I have a wonderful cardiologist that I see regularly.


      1. I am glad you received the help you needed. 🙂

        First time I have replied or written (after months of reading). When I see comments like yours I am left to wonder… how did you get through to the doctors? What test was performed that shed light on the real issue at hand?

        The reason I ask, is cause I have been feeling very unwell (chest/back pains, cold hands feet, and feeling very tired – after I experience an episode) for the last couple of months. I have ended up in Emergency 3 times, and they keep saying that everything looks normal (blood test, EKG, stress test).

        However to this day I present with the same symptoms and cannot help but feel that I’m not being taken seriously due to my age (39) and level of fitness.

        Can you provide any guidance?

        Thank you!


  15. I have been experiencing symptoms of prinzmetal angina which a private consultant who I couldn’t afford further treatment with said I had, but sent a very vague letter to my GP not confirming the same.

    He prescribed medication to treat the same, but I still had episodes even tho there was more time in between bad episodes.

    I am symptomatic every single day especially after 6 pm. On admission to hospital 25 times since November the cardiologist I saw refuses to diagnose me and says I’m a worrier. I’m 27 and a cage fighter on the side; worry is not in my vocabulary. I cannot train anymore and am struggling to keep my job in the defence forces. I tried coming off medication as advised (due to all tests coming back normal apart from atopic beats which I never had before either) but episodes came back instantly. I have an extremely good diet and do not know where to go next. I have 10 counselling sessions done since these episodes started and am aware what anxiety is and I don’t have it bad. My heart pauses a couple seconds every nite also; at this stage I nearly hope it doesn’t come back.


    1. Hello Clinton. First, I’m so sorry you have to be going through all this, especially at such a young age. Docs tend to be dismissive because statistically, it’s so unusual to see a person of your age with cardiac issues like this. That’s why it’s awful to be a statistic!

      I’m not a physician so cannot advise you on your specific case, but I can say generally that you seem to be doing the right things so far: eating healthy, being fit, seeing a counsellor. All good. I’m also hoping you are not smoking – if so, please stop. I’m guessing you mean ectopic beats (like a ‘flip’ or a missed heartbeat) which can often be made worse by stress, chocolate, alcohol and even some strong cheeses. Right now, you don’t know whether your symptoms are heart-related or not – but SOMETHING is causing them; you just don’t know yet precisely what that is.

      If I were in your shoes, I’d start keeping a symptom journal of all episodes (time of day, what you’re doing at the time, what you’ve eaten in the two hours leading up to the episode, any extenuating circumstances). Often when we do this, we are able to observe a pattern developing to show to our GPs. Best of luck to you – and do NOT give up hope!


  16. I read this with interest, thinking one of these would explain the kind of chest discomfort/pain I have had in the months since my 3 SCAD-caused heart attacks in August 2011.

    But none of these four seem to cover some of my experience – and the experiences I’ve heard about from other SCAD survivors. First of all, none of them mention that in the early weeks and months after a heart attack, an angiogram, and/or the placement of stents and/or having bypass surgery, you will have discomfort and pains in the heart area that are due to the healing process – the heart recovering from/reacting to the trauma it’s been through.

    I no longer have those kinds of sensations to the degree I did in the first 3-6 months. And I can distinguish between chest discomfort brought on by stress (I’ve rarely experienced it brought on by exertion). I do still go through periods when I have discomfort which may last for a few seconds, or recur off and on over a few hours, or off and on over a couple of days. None of this rises to a level where I call 911 or go to the doctor, even though it does, of course, give one pause. Any little twinge in the upper torso, when one is a heart attack survivor, gives one pause!

    The sensations also are quite variable: everything from “sensation I can’t describe” to a momentary kind of or periodically recurring sharp pain, to a dull ache, to a sense of tightness, etc, etc.

    So I guess my point is that your article and these four types of angina don’t, for me, adequately address the fact that most heart attack survivors will have sensations in their heart area/chest/upper torso, etc. that won’t be stable angina or due to prinzmetals or microvascular disease, yet won’t be unstable angina either, i.e., not a medical emergency – and, not really definitively explainable.


    1. Excellent points, Lynda. This post focuses on identifying chest pain in the non-heart patient; but once you’ve survived a cardiac event, as you point out, EVERY “little twinge” in the heart area can cause immediate concern! The “stretching pain” following stent implantation, for example, is very commonly reported by patients and can last for weeks (although nobody in the CCU warned me of this very distressing post-op symptom before I was discharged following my heart attack!) Think I’ll edit the post to include this info. Many thanks for your input.


    2. Thank you for addressing symptoms following procedures. When angiogram was being pushed for me (which I did not have), no mention was made of, especially in my case, as a princess-and-pea type, of lasting pain, which, if I’d been rational enough to think about, would be obvious, even, of course, in varying degrees dependent on the individual.


  17. ( My reply to a private comment from a woman diagnosed with Prinzmetal’s variant angina )

    You are, unfortunately, describing an all-too-common scenario for many women with Prinzmetal’s (or many other types of cardiac diagnoses, for that matter!)

    Your cardiologist can answer your specific medical questions, of course, but according to the Cleveland Clinic, Prinzmetal’s variant angina “does not damage heart muscle, but if a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.”

    The American Heart Association says: “(Prinzmetal’s angina) doesn’t follow physical exertion or emotional stress. Attacks can be very painful and usually occur between midnight and 8 a.m.”

    But every cardiac event and every heart patient is unique. That’s why you must get more info from your doctors to ensure that your diagnosis is correct, and your treatment appropriate for YOU. Meanwhile, your stress level at work needs to be addressed immediately. Chronic stress releases cortisol, adrenaline and other stress hormones that can further damage coronary arteries, and is a serious risk factor for future cardiac events. Read more at “Women’s Heart Disease & Chronic Stress”

    Only you can decide if a leave of absence from your “extremely stressful” job is the right step – please tell your doctor immediately that you need help managing this ongoing stress.

    Also, if you haven’t done so already, please visit the WomenHeart online community, log in, and do a search for Prinzmetal’s, where you’ll meet many, many women in the same boat who’ll be able to share their experiences with you. It’s a very helpful resource for all women with heart disease.

    Good luck to you,


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