Some people continue to experience chest pain or discomfort after their heart attack, heart surgery, or balloon angioplasty. It is important to notify your doctor immediately if you experience recurrent chest pain and/or symptoms you had with your initial event. Testing may need to be done to determine if it is due to new blockages, another medical condition, or is related to the blockage that caused the initial event. 

Your symptoms may be due to a temporary lack of oxygen to the heart muscle. This condition is termed angina. Smoking, elevated blood pressure, overexertion, eating a large meal, exposure to very cold weather, and severe emotional upset, can bring on angina. The person is usually able to predict when the discomfort or symptoms will occur and the discomfort is usually relieved quickly with rest or with use of a medication called nitroglycerin. When angina is predictable and relieved with rest and medication it is referred to as stable angina. 

It is important to understand the difference between a temporary lack of blood flow to the heart (stable angina) and a complete lack of blood flow to the heart that causes a heart attack. Unstable angina is the type of angina that is usually caused by a partial blockage, that can become a complete blockage (heart attack) unless it is treated quickly. As referred to in the section 'Types of Acute Coronary Syndrome,' this type of angina is not predictable, may come on at rest, and is not relieved by rest or nitroglycerin. This is a medical emergency that requires care in an emergency department as soon as possible. 

Stable angina can usually be treated successfully with medications and risk factor management. It will be important to identify the 'triggers' or activities and situations that cause angina for you. You will want to discuss these triggers with your doctor and determine how to avoid them or reduce the effect of the triggers on your heart. 

Many people describe angina as a squeezing, vise-like, or heavy sensation behind the breastbone or sternum. It is rarely a sharp pain. Some people also feel symptoms in the jaw, teeth, shoulder, or back. Symptoms may radiate or travel down the arm, often described as a heaviness or numbness. Some others feel that they are having indigestion or are unusually short of breath. If you do not have chest pain, your symptoms are termed by health care providers as an 'angina equivalent.' It is still angina, caused by a temporary lack of oxygen to part of the heart muscle and should be treated that way. 

Nitroglycerin is very fast acting when used as a tablet or spray under the tongue and should relieve your symptoms almost immediately. Please click on the word nitroglycerin to learn more about how it works, how to take it, and special considerations when carrying it. Other medications may be prescribed to treat angina. The goal of the treatment is to increase the amount of activity you are able to do before angina comes on. Treatment may also reduce the likelihood that angina will come on with other triggers like emotional upset and exposure to cold weather. Medications may include the following drug classes: 

• Long-acting forms of nitroglycerin 
• Beta-blockers 
• Calcium Channel Blockers 

Risk factor management is extremely important because the primary cause of angina is coronary artery disease or a blockage in one or more places in the arteries that supply oxygen to the heart. Uncontrolled and/or untreated risk factors can lead to heart attack, stroke, and peripheral vascular disease (blockages in arteries found in the abdomen and legs). 

Notify your doctor immediately if your angina is coming on more frequently, with less activity, or is stronger or more intense. Consider it a medical emergency if your angina is not relieved with rest and nitroglycerin and call 911!