Angina vs. Heart Attack: How to Spot the Difference and What to Do

A heart attack is one of the leading causes of sudden death after age 50 — and recognizing it quickly, distinguishing it from angina, and acting correctly in the first minutes can save lives.

What Is Angina and Why It Happens

Blockages in the coronary arteries often narrow them and cause angina. Reduced coronary blood flow makes the heart work poorly under stress or exertion and can trigger rhythm disturbances. A squeezing chest pain and a racing pulse signal that the heart isn’t getting enough blood and oxygen.
The most common form of coronary artery disease is stable angina, which tends to stay the same for weeks. Doctors see it most often in men in their 50s and 60s (about 70% of patients) and in women in their mid-60s to mid-70s. With the right treatment people with stable angina can live and work with few limitations, but acute episodes still require urgent care because they can turn into a heart attack.

Heart Attacks in Women: Symptoms That Are Easy to Miss

Women over 50 often don’t recognize a heart attack right away — not because they ignore their health, but because their symptoms can differ from the classic pattern. Instead of crushing chest pain, a woman may feel unexplained fatigue, nausea, shortness of breath, or upper-abdominal pain. Sometimes she only feels anxiety and a general sense of being unwell without a clear location of pain. If these symptoms come on suddenly without an obvious cause, don’t wait — call emergency services.

Recognizing an Angina Attack

Chest pain appears after physical exertion or emotional stress. The pain is not sharp or stabbing; it feels like a squeezing pressure. That pressure behind the breastbone can radiate to the left shoulder blade, left arm, and left shoulder and usually builds gradually, worsening with breathing. The person often becomes pale and experiences fear of dying. Pain usually lasts two to four minutes and generally does not exceed 15 minutes. Then the pain eases (in stable angina it subsides with rest), and the patient often feels very tired and weak.

First Aid for Angina

Stop any physical activity immediately. Lie down with a high pillow or raise the head of the bed, or sit in a chair with armrests. Make breathing easier by opening a window, loosening a tight collar, and unbuckling belts.
Chew and swallow one aspirin tablet (0.25 g) right away, and place a nitroglycerin tablet under the tongue if the blood pressure is at least 90/60 mm Hg and there are no contraindications. If you have known angina, always carry nitroglycerin. Put one tablet under the tongue and repeat if pain persists for more than five minutes. If the attack does not stop after taking nitroglycerin, suspect a heart attack and call emergency services immediately.

Cardiologist Comment: Will Validol Help?

Hanna Soloshchenko, cardiologist (highest category), 24 years’ experience. Founder of the “Your Cardiologist” clinic

Validol and Corvalol are not drugs that treat a heart attack. They are mild sedatives and can be used together with cardiac medications when an attack is accompanied by severe anxiety or panic. For people prone to anxiety, a hypertensive crisis can cause strong fear that further raises blood pressure. In those cases, a sedative may be used alongside antihypertensive medicines.
Never use these sedatives alone to treat a cardiac attack.
Why do people still believe these drugs help? Word of mouth spreads stories: a neighbor’s chest ached after stress, she took Corvalol and felt better — but she didn’t have a heart attack, only a stress reaction. She told others that she had “treated” a heart attack, and that recommendation spread. Self-treatment like this can cost precious time during a real heart attack.
Read more practical advice from cardiologist Hanna Soloshchenko on her Facebook page.

If the Person Faints

Do not leave the person alone while waiting for emergency services. Lay the person on their back and raise their legs. Check breathing and pulse. Do not use ammonia inhalants — they can trigger a reflex spasm of breathing. If there is no pulse and no breathing, start cardiopulmonary resuscitation (CPR) immediately. Put the person on a firm, flat surface, kneel at the chest, place your hands one on top of the other in the center of the chest, and push down 30 times in a row at a rate of 100–120 compressions per minute. After 30 compressions, give two rescue breaths mouth-to-mouth or mouth-to-nose. If you are not confident in rescue-breath technique, perform chest compressions only — that is better than stopping. Continue until the ambulance arrives or until signs of life return.

How to Tell Angina From a Heart Attack

How Heart Attack Symptoms Differ From Angina

A likely sign of a heart attack is very intense squeezing chest pain that lasts from 20 minutes up to several hours. Chest pain during a heart attack is usually stronger than pain during an angina episode and does not go away with rest.
Pain that does not respond to nitroglycerin may radiate to the left side of the chest, the left arm or shoulder blade, the neck, and the jaw. Other signs include agitation, sudden paleness, nausea or vomiting, cold sweat, rapid and irregular pulse, shortness of breath, and a fear of imminent death.
Severe weakness, low blood pressure, dizziness, sweating, a severe headache, or sudden problems with coordination, speech, or vision are reasons not to give nitroglycerin. Do not give nitroglycerin without measuring blood pressure first.

What to Do During a Heart Attack

Call an ambulance immediately and keep the patient calm with access to fresh air. To reduce the risk of clotting, have the person chew one aspirin tablet (0.25 g) and drink water. Do not combine aspirin with ibuprofen. For pain relief, the article recommends two tablets of analgin. If the blood pressure has not dropped, give one nitroglycerin tablet (0.5 mg) under the tongue. After that tablet dissolves, give another after five minutes if needed, up to a maximum of three doses. If clinical death occurs, start CPR immediately until the resuscitation team arrives.
Medical teams call the first 90 minutes after a heart attack the “golden window” — restoring blood flow in that time gives the best results and limits heart muscle damage. The faster a patient reaches the hospital, the better the chances for full recovery. Do not try to drive to the hospital yourself; waiting for an ambulance is the right choice because the ambulance crew can start treatment en route.

Life Goes On

With coronary artery disease, angina, or after a heart attack, keep heart rhythm under regular medical supervision. The target resting heart rate is 55–60 beats per minute. If angina persists after a heart attack — a common situation — patients often need lifelong medications such as nitrosorbit, Isoket, or isosorbide-5-mononitrate. Patients with glaucoma should consult an ophthalmologist about these drugs.
Monitor regularly. A threshold value to watch is 5.2 millimoles per liter for total cholesterol. Do a blood test every three months if your doctor recommends it. If cholesterol is high, cut out fatty and spicy foods. Replace animal fats with plant oils, eat more vegetables, fruits, whole grains, low-fat dairy, fish, and white (chicken) meat. Use olive oil, fermented dairy, and seafood at least three to four times a week. Limit poultry, eggs, and sweets to about once a week. Stop smoking and avoid alcohol. Stress raises cholesterol too, so try to reduce stress where possible.

Rehabilitation After a Heart Attack

A heart attack is not a sentence — modern cardiology has clear recovery protocols that allow most patients to return to their normal lives within a few months.
For the first two weeks allow maximum rest and follow prescribed medications under a doctor’s supervision. Then add short walks — start with 10–15 minutes per day and gradually increase to 30–40 minutes. Exercise is an ally: it strengthens the heart muscle and improves circulation, but raise activity slowly and only with your cardiologist’s approval.
Psychological rehabilitation matters too. Anxiety and depression often follow a heart attack. Do not ignore these symptoms — see a psychologist or psychiatrist if needed.

Cardiologist on Rehabilitation After a Heart Attack: What’s Allowed and What’s Forbidden

“In most cases, medications after a heart attack must be taken lifelong. Some of these drugs are available through the ‘Affordable Medicines’ program — free or at a minimal cost with an electronic prescription from a family doctor,” explains cardiologist Hanna Soloshchenko. “Rehabilitation begins in the hospital. First the patient may sit up in bed, then take a few steps in the ward and do breathing exercises. Next comes a self-care stage when the patient can walk to the bathroom and wash independently. If there are no complications, the doctor schedules the first walking test — a few hundred meters with ECG monitoring before and after exertion. The patient repeats these tests before discharge; later the tests include climbing stairs with very gradual increases in distance and number of steps. Ideally, continue rehabilitation in a cardiology-focused sanatorium.
A common mistake is that patients increase activity too quickly after discharge, perform exercises that cause shortness of breath, palpitations, or chest pressure, or simply return to their previous life as if nothing happened.
Remember! After a heart attack avoid heavy exertion and lifting heavy objects, and avoid intense garden work or other strenuous tasks. A heart scar forms over about a month, even after an uncomplicated heart attack.”

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