Heart attack vs angina: how the chest pain differs and when to call 999

Angina is a warning that the heart muscle is not getting enough blood for what you are asking of it; a heart attack is when the blood supply to part of the heart muscle is suddenly blocked. In angina the pain is temporary and the muscle recovers once you rest or take medicine. In a heart attack the blockage persists, so the pain continues and heart muscle is damaged unless treatment restores flow.

That gives the most useful practical rule, which the NHS applies in its advice: pain that does not stop after resting for a few minutes or after taking your angina medicine, pain that starts suddenly and does not go away, or pain with sweating, sickness, light-headedness or breathlessness should be treated as a possible heart attack, and you should call 999.

The NHS describes angina as a feeling of pain or tightness, usually in the chest, that can be a sign of a heart problem. The pain can feel like tightness, squeezing or pressure or a dull ache and may also be felt in the neck, shoulders, jaw or arms. It can make you feel sick, breathless, dizzy or sweaty. Attacks are often brought on by exercise, stress, emotion or cold temperatures.

The BHF explains the types. Stable angina is the most common, tends to happen when the heart works harder, goes away when you rest and feels similar to what you have had before. Unstable angina can happen at rest, feels more severe and lasts longer and may not improve with rest or medicines. Vasospastic and microvascular angina are less common types caused by spasm in the coronary arteries. A big meal can also trigger angina, and the BHF notes people sometimes confuse it with indigestion.

For someone with a diagnosis of angina, the NHS instructions are to stop what you are doing and rest, use prescribed medicine, usually glyceryl trinitrate (GTN), and take another dose after 5 minutes if the first does not help. If you still have symptoms 5 minutes after the second dose, call 999.

The NHS says a heart attack happens when blood flow to your heart is blocked and that it needs emergency treatment in hospital. Symptoms can include chest pain that feels crushing or squeezing and may spread to the arm, neck and jaw, shortness of breath, feeling or being sick, an indigestion-like burning and fullness, sweating, and pale, blue or grey skin. The BHF adds that symptoms are different for different people, and less common symptoms include sudden anxiety, severe tummy pain and coughing or wheezing.

Heart attacks are usually caused by a blood clot stopping enough blood getting to the heart. Risk factors named by the NHS include smoking, high blood pressure, high cholesterol, a close relative who has had a heart attack, diabetes and overweight or obesity. Treatment in hospital may include medicines to treat the blockage, angioplasty with a stent or bypass surgery.

It can be impossible to tell from the pain alone. The NHS angina page states that new sudden pain or discomfort in the chest that does not go away, pain spreading to the arm, neck, jaw, shoulder, stomach or back, and chest pain with sweating, sickness, light-headedness or breathlessness should prompt a 999 call, because you could be having a heart attack. The BHF heart attack page says not to worry about wasting anyone's time.

If you have been told you have angina and your symptoms are more frequent, worse than before, last longer or happen at rest, the NHS advises getting help from NHS 111. If you have never had chest pain like this before, it should be assessed promptly and not self-diagnosed as angina. Do not drive yourself to A&E.