Coronary artery disease (CAD) does not usually cause symptoms until it becomes advanced. Subtle symptoms can include dizziness, indigestion-like sensations, fatigue, and lack of energy. More noticeable symptoms of CAD include shortness of breath and chest pain. These are all warning signs of a heart attack and you should seek medical attention if you have any of the signs or symptoms of CAD.
In general, symptoms of CAD are related to narrowing of the blood vessels of the heart, which can intermittently prevent the heart muscle from receiving optimal blood supply. It’s important not to remember that, though symptoms are not common with CAD, they can occur.
The most common symptoms of CAD are:
- Shortness of breath: If you have insufficient blood flow in the coronary vessels, you may feel that you can’t catch your breath, can’t get enough air, or cannot breathe. This sensation is often described as dyspnea. It is more likely to occur or worsen with physical exertion or emotional stress. Sometimes, shortness of breath may not be so obvious, and it can make you feel as if you do not have energy or endurance.
- Chest discomfort: Often, insufficient blood flow to your coronary arteries can manifest as indigestion-like chest discomfort. In general, true indigestion should occur shortly after eating and may worsen when you are in a lying down position. Chest discomfort caused by coronary artery disease is more likely to occur with demanding physical activity and to improve when you reduce your physical activity.
- Dizziness/lightheadedness: You may experience intermittent lightheadedness or dizziness if you have CAD. This is more likely to accompany physical exertion, but it can happen at any time.
- Lack of energy: A sense of diminished energy and frequent or unexpected fatigue may occur with CAD. This is a particularly concerning warning sign if you have other symptoms of CAD as well, but it can be the only symptom.
Chest pain (angina): Typical angina is described as severe chest pain, tightness, and pressure, which is most intense on the left side of the chest and may involve the jaw and left shoulder. With CAD, angina may occur for a few seconds and resolve on its own or may worsen over the course of minutes, which is the sign of a myocardial infarction (heart attack). Many people who have a heart attack as a complication of CAD recall having had brief episodes of chest pain over the prior months.
- Advanced CAD can produce angina if your heart muscle temporarily does not get enough blood flow through the coronary arteries. Stable angina occurs in a nearly predictable fashion, for instance, with physical exertion or during times of severe stress, and generally means that a plaque has become large enough to produce a partial obstruction of a coronary artery.
Atypical symptoms of CAD are not as widely recognizable. People who experience these symptoms might not even mention them to the doctor, even at a regularly scheduled check-up. This can lead to missed diagnoses, inadequate therapy, and worse outcomes.
Atypical symptoms of CAD include:
- Unstable angina: Unlike stable angina, unstable angina can happen at any time and without a particular pattern or trigger. It is not triggered by stress or physical exertion, and notably, tends to occur at rest. If you have unstable angina, you are at high risk of developing a total occlusion of the coronary artery, leading to a heart attack.
- Atypical chest pain: The pain of angina is characteristically described as pressure, or a tight, squeezing sensation. But it may also manifest as a hot or burning sensation or even tenderness to touch, and it can be located in the back, shoulders, arms, or jaw. Women, in particular, are more likely to experience atypical chest pain as a result of CAD, and, some women may not have chest discomfort at all. Instead, they may experience tingling or numbness of the left side of the chest or arm.
- Palpitations: A rapid or irregular heartbeat may feel like a thumping or quivering sensation and is often accompanied by dizziness or lightheadedness.
- Silent heart attacks: Usually, heart attacks are characterized by distressing chest pain and shortness of breath. However, CAD can cause silent heart attacks that occur without any noticeable symptoms at all, and which may be diagnosed when you are having a cardiac evaluation for other symptoms.
These symptoms do not necessarily correlate with disease in a particular coronary artery or with a particular type of atypical CAD.
There are several serious complications of CAD. These can occur after years of untreated CAD when the arteries become so badly diseased that complete obstruction of blood flow through the coronary arteries occurs. This causes insufficient oxygen and nutrient delivery to the heart muscles, potentially causing the death of the heart muscle cells and subsequent dysfunction of a portion of the heart muscle itself.
- Myocardial infarctions (heart attacks): A heart attack is a lack of blood flow to the myocardium (heart muscle). It is typically characterized by crushing chest pain and shortness of breath. Symptoms can also include nausea; vomiting; indigestion; dyspnea; extreme fatigue; sweating; or numbness or tingling of the left side of the chest, left arm, shoulder, or jaw.
- Arrhythmia: An irregular heartbeat can begin after a heart attack. If the heart attack affects the pacemaker of the heart, it can result in an irregular heart rhythm. This may cause fatigue, lightheadedness, palpitations, or fainting.
- Heart failure: If a portion of the heart muscle becomes weak after a heart attack, heart failure (a weak heart) can result. Heart failure manifests as fatigue, shortness of breath, and swelling of the legs.
- Stroke: A blood clot in the coronary arteries can dislodge and travel to the brain, obstructing blood flow and causing a stroke. A stroke is an interruption of blood flow in an artery of the brain and can cause a variety of symptoms, depending on which part of the brain is affected. Symptoms may include the inability to speak, vision loss, weakness of one side of the face, arm and/or leg, sensory loss on one side of the body, or impairment of consciousness.
When to See a Doctor
If you experience intermittent symptoms of CAD, you should tell your doctor. Many people avoid talking about symptoms or ignore them out of fear or denial. Without treatment, CAD will get worse and can suddenly cause a fatal heart attack, or can cause a heart attack that results in lifelong complications and a diminished quality of life.
If you experience angina or symptoms of what seems to be a heart attack, you need to get emergency medical attention.
When to Talk to Your Doctor
If you have symptoms that could be CAD, such as fatigue, nausea, heartburn, or diminished physical endurance, you should call your doctor to describe how you are feeling and follow the recommendations for an appointment or diagnostic testing.
When you see your doctor, be sure to describe the timing, frequency, and duration of your symptoms. Include details such as what you were doing when they occurred and what made the symptoms go away. Our guide below can help you understand terminology your doctor may use, as well as give you questions to better understand your condition.
Coronary Artery Disease Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
When to Get Emergency Medical Care
If your symptoms worsen or become more frequent, you should get medical attention promptly. If you experience chest pain, shortness of breath, or unusual left-sided symptoms, with or without a trigger, call for emergency help. A heart attack can be fatal and prompt treatment leads to better outcomes.