Q: I have always had a great fear of heart disease because my father died of a heart attack in his early 50s. In the year before his death he often complained of anginal chest pain. Although I am only 39, in recent weeks I have noted occasional episodes of chest pain and worry that they may be angina. How can I tell if my chest pain is due to heart disease?
A: Coronary artery disease is the cause of angina pectoris -- a discomfort, usually in the chest, that is most often precipitated by physical activity and promptly relieved by rest. The characteristic features of angina are the nature of the discomfort, its location and the precipitating factors.
While pressure is the most common attribute of angina, anginal discomfort may be a tightness, squeezing, burning, aching, heaviness or choking sensation. On rare occasions pain may be sharp, but not sticking like a needle. The most common site of angina pectoris is beneath the sternum (breastbone), but angina may begin or radiate to any site above the waist, especially the left upper arm and forearm and the jaw. The discomfort of angina usually increases gradually in intensity, reaches a plateau and gradually diminishes, all over a period of several minutes.
Angina is typically triggered by exertion, most commonly walking. The distance that can be walked without pain tends to vary from day to day. Exercise tolerance is often reduced early in the morning, after a meal, and when walking up an incline or into the wind. Physical activity involving use of the arms, such as shoveling, sweeping, scrubbing, raking or chopping wood, may precipitate angina. Emotions like anger, fear, anxiety and excitement can themselves cause anginal distress or reduce the amount of exertion required to produce angina.
If your chest pain has these features of angina, you should consult your physician to determine whether the pain is due to coronary artery disease. A clinical diagnosis of angina makes coronary artery disease very likely, but a definitive diagnosis requires special tests, such as an electrocardiogram during an exercise stress test.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.