How can I tell if my mother's having an angina episode or a heart attack?

A fellow caregiver asked...

My mom was recently diagnosed with angina and is taking nitroglycerin. How can I tell the difference between an angina episode and a full-blown heart attack?

Expert Answer

Barry M. Massie is chief of cardiology at the San Francisco V.A. Medical Center.

Angina (chest pain) and heart attacks stem from the same cause -- a lack of blood flow and oxygen to the heart due to narrowed or blocked blood vessels. The difference lies in severity and duration.

Angina episodes usually occur with exertion or stress, and the symptoms typically go away with rest, usually within five to ten minutes. Nitroglycerin improves blood flow and reduces the need for oxygen, making symptoms disappear even more quickly.

In contrast, heart attacks last longer and don't respond to nitroglycerin. A heart attack happens when an important blood vessel becomes totally blocked, usually because a blood clot has formed at the site of a previous partial blockage.

If your mother's pain or discomfort lasts more than 15 minutes or isn't relieved by two nitroglycerin pills (assuming it was before), she may be having a heart attack. If so, she needs immediate medical intervention to prevent or limit permanent damage.

Call 911 and have your mother taken to a nearby hospital -- preferably one that is set up to deal with heart attacks. To prepare yourself in advance, ask her physician which hospital would be the best choice.

You should also be aware that not all heart attacks feel like chest pain. A person having a heart attack may complain of pressure, tightness, "heartburn," or pain in the neck, jaw, shoulder, or left arm. Although the symptoms may differ from the typical angina episode, it's the duration and lack of response to rest and nitroglycerin that will help you determine which one is happening.