What Are the Symptoms of Coronary Artery Blockage?

The heart’s own arteries (coronary arteries) are the vessels that feed the heart’s own muscle tissue, working almost like pipes carrying fuel to the heart’s own engines. As these channels narrow or become blocked, the heart muscle can no longer receive as much oxygen and nutrients as it needs, and it lets us know through symptoms. You can find the articles in which I explain the causes and risk factors of coronary artery disease and treatment methods such as closed bypass under the relevant heading. In this article, I focus directly on the symptoms through which coronary artery blockage shows itself and on when we need to take them seriously.

What Happens When the Coronary Arteries Become Blocked?

Narrowing in the coronary arteries usually progresses slowly and insidiously; when the vessel has narrowed to a certain degree, the heart muscle receives enough blood at rest but falls short when demand rises during exertion. We call this situation stable angina (exertional angina). If a plaque in the vessel suddenly ruptures and a clot forms on it, the vessel can become completely blocked; this is an emergency called a heart attack (myocardial infarction), which can cause irreversible heart muscle damage within hours.

What Are the Most Common Symptoms?

Chest Pain or a Feeling of Pressure (Angina): This is the most classical symptom; it is described as a feeling of pressure, tightness or heaviness in the middle of the chest, mostly begins with exertion and passes within a few minutes with rest. Pain Radiating to the Arm, Jaw or Back: The discomfort in the chest can sometimes radiate to the left arm, the jaw, the neck or the upper part of the back. Shortness of Breath: A feeling of breathlessness that appears especially on exertion and is different from before. Palpitations and Fatigue: When the heart cannot receive enough blood, it may also show itself as unexpected fatigue during daily activities or as an awareness of the heartbeats. Nausea, Sweating and Dizziness: Especially in an acute blockage, cold sweating, nausea and a feeling of weakness accompanying chest pain are frequently seen.

It Does Not Cause the Same Symptoms in Everyone: Atypical Findings

There is one point I particularly want to underline here: in female patients and in people with diabetes, the picture often appears not as classical chest pain but with more vague findings. A large-scale registry study showed that about 42% of women having a heart attack described no chest pain at all, presenting instead with only symptoms such as extreme fatigue, a feeling of indigestion, back or jaw pain and shortness of breath. In patients with nerve damage due to diabetes, pain perception can also be blunted, so the blockage may progress without causing any pain at all (silent ischaemia). For this reason, the absence of classical chest pain never rules out coronary artery blockage.

Symptoms of a Heart Attack: Act Without Losing Time

Severe chest pain or a feeling of pressure that starts suddenly, lasts longer than 20 minutes and does not pass with rest, accompanied by cold sweating, shortness of breath, nausea and an intense feeling of restlessness or fear of death, are the classical symptoms of a heart attack. When faced with this picture, calling an ambulance directly instead of trying to get to hospital by your own means saves lives; because opening the blocked artery as soon as possible directly determines how much of the heart muscle will be permanently damaged.

How Do We Make the Diagnosis?

After listening to the complaints we usually start with an electrocardiogram (ECG); this gives us a quick idea of whether there is an acute event. In stable complaints we assess the condition of the arteries with methods such as an exercise stress test or coronary computed tomography angiography; if suspicion is high or in an acute presentation, we move directly to catheter angiography.

Frequently Asked Questions

I have chest pain but it lasts a few seconds; could this be coronary artery blockage? Chest pain of cardiac origin usually lasts at least a few minutes; sharp, stabbing pains that pass within seconds are mostly related to non-cardiac causes. Even so, if you have any doubt it is worth having it assessed.

I feel pressure in my chest during exercise but it passes when I rest; is this important? Yes, this description points to classical exertional angina and must definitely be assessed; making the diagnosis before the blockage progresses widens the treatment options.

Why can the symptoms be different in women? The rate of presenting during a heart attack without chest pain, with more vague symptoms such as fatigue, indigestion or back pain, is markedly higher in women than in men.

I have diabetes; am I at risk even if I feel no pain at all? Yes. Nerve damage due to diabetes can mask chest pain; for this reason we place importance on regular cardiological assessment in diabetic patients.

In Summary

Although coronary artery blockage most classically shows itself as chest pressure that increases with exertion, it can progress with much more silent and vague findings, especially in women and in diabetic patients. What matters to us as the real warning sign is not whether the symptom is typical, but whether it is a newly appeared, unexplained change that affects daily life.

If you have experienced chest pressure that increases with exertion, unexplained shortness of breath or any of the symptoms I have described above, you can book an appointment for a detailed cardiological assessment.

References

1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021;144(22):e368-e454.
2. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes. Eur Heart J. 2020;41(3):407-477.
3. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality. JAMA. 2012;307(8):813-822.
4. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation. Eur Heart J. 2018;39(2):119-177.