Some people have painful symptoms of cardiac ischemia, and others have no symptoms at all (silent ischemia). People who feel pain, pressure or discomfort from cardiac ischemia have an angina attack. Angina is the primary symptom of coronary artery disease (CAD). According to the American Heart Association, rouhgly 20 percent of patients who have a heart attack experience angina before the attack. Angina may feel like a squeezing vise or crushing pressure deep in the chest behind the breastbone (sternum) and may also be felt in the shoulders, arms, back, neck or jaw. In women, angina may be experienced as abdominal pain or inconsistent chest pain that does not fit the classic model of heart-related chest pain.

Translated literally, the term “angina pectoris” means “a choking sensation of the chest.” The pain of an angina attack can be a warning sign of a more dangerous underlying cause and should be taken seriously by patients, especially if it worsens or starts to happen more often. Angina that occurs at irregular times, without provocation (e.g., physical exertion) is known as unstable angina. This is considered a major warning sign of a heart attack, and any person experiencing unstable angina should consult a physician at the earliest possible opportunity.

It is important to also note that most chest pain reported to physicians is not cardiac ischemia, but due to some other cause (e.g., muscle pain, gastrointestinal issues). However, when chest pain is reported, physicians first will attempt to exclude cardiac problems.

Conversely, not all people with cardiac ischemia suffer from angina. According to the American Heart Association, as many as 4 million people in the United States suffer from cardiac ischemia without symptoms (silent ischemia). In fact, studies have shown that silent ischemia is the most common manifestation of coronary heart disease, accounting for about 80 percent of ischemic episodes.

Ischemia, whether silent or symptomatic, is associated with increased risk for heart attack and other serious cardiac events. In people with silent ischemia, the first indication of heart trouble is frequently a major heart attack. Thus, it is the goal of physicians to identify as many cases of silent ischemia as possible, through screening and careful attention to known risk factors for heart disease. Studies have demonstrated that silent ischemia can be more common among certain ethnic or racial groups. For example, recent reports find that Asian Americans, in comparison to white Americans, experience significantly fewer episodes of ischemic chest pain. Other symptoms, however, occur more frequently, such as shortness of breath, fatigue and palpitations.