Difference Between Angina and Heart Attack

Angina and heart attack are two terms we hear very often. They both are heart conditions. Simply because the world is under the ever increasing threat of non-communicable diseases it is vital that we know the difference between these two conditions.


Angina is a chest pain, which is of constricting type, felt behind the sternum, starts suddenly, seems to travel along the medial side of the upper arm, and lasts less than 20 minutes. It may be associated with sweating, difficulty in breathing, and may worsen with effort and lessen with rest. The reason for this pain is reduced blood supply to the heart muscle.

The heart receives blood from superior and inferior vena cava and pumps it out via the aorta and pulmonary arteries. The heart muscle itself is supplied by two coronary arteries. They are the right coronary artery and the left coronary artery. The right divides into anterior descending and circumflex arteries. These arteries can get blocked due to atherosclerotic plaque formation or arteriosclerosis. This reduces the blood supplied to the heart muscle, and the work it can do declines. When the actual effort overwhelms the blood supply angina starts.

It is very important to understand that heart muscle does not die in angina. Antiplatelet drugs and plaque stabilizing drugs should be administered immediately after admission. ECG is an immediate and an essential investigation. Prophylactic treatment maintains wide open arteries and dietary alterations, and reduces angina symptoms.

There are other types of angina. Vincent angina is due to inflammation of gums. Even medical professionals get these two mixed up sometimes. ECG will not show any lasting damages. Troponin T will be negative. Regular follow-up is necessary because the presence of angina is a risk factor for future development of heart attacks.

Heart Attack

Heart attack is actual death of cardiac muscle due to poor coronary blood supply. Heart attack presents similar to angina. The chest pain lasts longer than 20 minutes. The onset, character, radiation, aggravating and alleviating factors are similar to those in angina. There are two types of heart attacks. They are medically known as myocardial infarctions. The first one is “non ST elevating myocardial infarction” (NSTEMI). There are no ST segment elevations in ECG, and there may be ST segment depression. Depression of ST segment by more than two small squares in limb leads or by more than one small square in chest lead is considered significant.

The initial treatment is similar in both angina and in myocardial infarction. For NSTEMI, low molecular weight heparin is the best drug. For ST elevating myocardial infarction, thrombolysis is best after excluding contraindications. Complications of myocardial infarctions include arrhythmia, heart failure, cardiogenic shock, hypotension, syncope, pericardial tamponade, valve lesions, and Dressler’s syndrome.

What is the difference between Angina and Heart Attack?

• Angina is the chest pain caused by poor blood supply.

• There is no structural damage to the heart while there is death of heart muscles in myocardial infarction.

• Angina is rarely complicated while myocardial infarction may be complicated.