Angina vs. Heart Attack: Key Differences and How to Tell the Difference

Angina and heart attack (myocardial infarction) are both related to coronary artery disease, but they differ significantly in terms of symptoms, severity, and medical implications. Understanding how to distinguish between the two is crucial for timely and appropriate medical care.

1. Trigger of Chest Pain

Angina typically occurs due to specific triggers such as physical exertion, emotional stress, heavy meals, or exposure to cold weather. In contrast, a heart attack can occur suddenly and without any obvious cause, often striking even at rest.

2. Nature of the Pain

The discomfort associated with angina is usually described as pressure, tightness, or a squeezing sensation in the chest. It is generally less intense than a heart attack. On the other hand, a heart attack causes severe chest pain that is often accompanied by cold sweats, shortness of breath, nausea, and a sense of impending doom.

3. Duration of Symptoms

Angina episodes typically last for a few minutes and subside with rest or medication like nitroglycerin. They rarely last more than 20 minutes. In contrast, heart attack symptoms persist for more than 30 minutes and do not improve with rest or standard angina treatments. If chest discomfort lasts this long, especially after physical activity, it's essential to seek emergency medical attention immediately.

4. Response to Medication

One of the most telling signs is how the body responds to treatment. Angina often improves quickly with nitroglycerin or by stopping the activity that triggered it. However, a heart attack does not respond well to such interventions and requires urgent hospitalization and advanced treatment.

5. Electrocardiogram (ECG) Findings

Angina and ECG Changes

During an angina episode, an ECG may show ST-segment depression or T-wave inversion. These changes are usually temporary and return to normal once the episode subsides.

Heart Attack and ECG Changes

In the case of a heart attack, the ECG reveals more significant and dynamic changes, including ST-segment elevation, deep T-wave inversion, and the appearance of pathological Q waves. Even after recovery, some of these ECG abnormalities, particularly the Q waves, may remain permanent.

6. Blood Test Results

Blood tests can also help differentiate between angina and heart attack. During an angina attack, cardiac enzyme levels—such as troponin—are usually within the normal range. However, during a heart attack, these enzymes are significantly elevated, indicating damage to the heart muscle.

Why Accurate Diagnosis Matters

Misdiagnosing a heart attack as angina can have life-threatening consequences. Prompt recognition and treatment are essential to minimize heart damage and improve outcomes. If you or someone you know experiences chest discomfort that doesn't go away, don't wait—seek emergency medical help right away.