AnginaAngina pectoris, Cardiac chest painAngina is chest discomfort that appears when the heart muscle is not receiving enough blood, typically brought on by exertion or emotion and eased within minutes by rest. It is a warning that a coronary artery has narrowed, rather than a heart attack in itself.
Chest pain: telling an emergency from a scare
Most chest pain is not a heart attack, but the pattern that is one is recognisable. This quiz covers the features that make cardiac pain likely, the symptoms women and people with diabetes get instead, and what to do in the first few minutes.
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Question 1/8
1. Which description is most typical of heart attack pain?
Every question, with the answer explained
The full set, for revision or for reading straight through. The correct answer is marked, and the explanation says why.
1. Which description is most typical of heart attack pain?
- A sharp stab that lasts two seconds
- A heavy, tight, crushing pressure lasting more than a few minutes
- Pain that is worse when you press on the chest wall
- Burning that comes only after spicy food
A heavy, tight, crushing pressure lasting more than a few minutes. Cardiac pain is usually heavy, tight or crushing rather than sharp, lasts more than a few minutes, and is not reproduced by pressing the chest. Pain you can pinpoint with one finger is rarely cardiac.
2. Where can heart attack pain spread to?
- Only the left arm
- Jaw, neck, back, shoulders or either arm
- Only the chest itself
- Only the legs
Jaw, neck, back, shoulders or either arm. It commonly radiates to the jaw, neck, back, shoulder or either arm — not just the left. Jaw pain with sweating and no dental cause deserves an ECG.
3. Which group most often has a heart attack without classic chest pain?
- Young men
- People with diabetes, and older women
- Athletes
- Children
People with diabetes, and older women. Diabetic nerve damage can blunt the pain, and women more often present with breathlessness, nausea, fatigue or jaw discomfort. A 'silent' heart attack is not painless disease — it is disease without the expected signal.
4. Someone has crushing chest pain and is sweating. What is the first thing to do?
- Drive them yourself to a clinic across town
- Call emergency services and have them sit and rest
- Give them a glass of milk
- Wait 30 minutes to see if it settles
Call emergency services and have them sit and rest. Call for an ambulance and keep them still. Ambulance crews can start treatment and take an ECG on the way; a private car cannot, and driving yourself while having a heart attack is dangerous.
5. Aspirin during a suspected heart attack — what is the usual advice?
- Never give it
- Chew a 300 mg aspirin unless allergic or told otherwise
- Take four tablets at once
- Only give it after reaching hospital
Chew a 300 mg aspirin unless allergic or told otherwise. Chewing a single 300 mg aspirin thins the blood at the clot and improves survival. Chewed, not swallowed whole, so it is absorbed faster. Skip it if the person is allergic or has been told to avoid it.
6. Which chest pain feature points away from the heart?
- It is brought on by walking uphill
- It is worse on taking a deep breath or pressing the chest
- It comes with sweating and nausea
- It eases with rest after exertion
It is worse on taking a deep breath or pressing the chest. Pain that changes with breathing or with pressure on the chest wall is more typical of muscle, rib or lung causes. Pain reliably brought on by exertion and eased by rest is the classic pattern of angina.
7. What is angina?
- A heart attack
- Chest pain from a heart muscle not getting enough blood, usually on exertion
- Inflammation of the lungs
- A type of arrhythmia
Chest pain from a heart muscle not getting enough blood, usually on exertion. Angina is a warning, not an infarct: narrowed arteries supply enough blood at rest but not under load. New angina, or angina that suddenly comes on at rest, needs assessment quickly.
8. Indigestion-type burning with sweating and breathlessness in a 55-year-old — what is the safe assumption?
- It is certainly acid reflux
- Treat it as possible cardiac pain until an ECG says otherwise
- It is muscular
- It is anxiety
Treat it as possible cardiac pain until an ECG says otherwise. Heart attacks are mistaken for indigestion often enough to be a recognised cause of delayed treatment. Burning pain with sweating or breathlessness in an adult with risk factors earns an ECG, not an antacid.
Words used in this quiz
- AtherosclerosisHardening of the arteries, Arterial plaqueAtherosclerosis is the build-up of fatty, fibrous plaque inside artery walls, which stiffens them and narrows the channel blood flows through. It develops silently over decades and is the process behind most heart attacks and strokes.
- ECGEKG, ElectrocardiogramAn ECG records the heart's electrical activity through stickers placed on the chest and limbs, printing it as a tracing. It takes a few minutes, is painless and involves no radiation, and it is the first test in chest pain, palpitations and blackouts.
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