The heart is a muscle and if it does not get enough blood, it goes into a reversible cramp (angina) when exercising, just like muscles in the rest of the body. If the lack of oxygen continues, it can cause muscle damage. We refer to the latter as a myocardial infarction or “heart attack”. Typically the patient with angina has pain on exertion that is relieved by rest. The pain can be across the chest, up into the neck and jaw, in the upper back, down the left arm, both arms or in the upper epigastric (abdominal) area. It can be associated with nausea, diaphoresis (sweating), dyspnea (shortness of breath). Quite often it is mistaken for indigestion.
There are many variations of angina. I have seen a patient with typical angina symptoms involving the right arm only, who was misdiagnosed because it was in the right arm (this is rare and is not described in the books). The diagnosis might have been suspected if a careful history had been taken. Instead the patient presented several times in an urgent care setting and was sent home with the diagnosis of musculoskeletal pain until finally he was hospitalized with a heart attack. No one obtained the history that he only had the pain when he exerted himself and that it went away with rest.
It has been well publicized recently that women with angina often do not have typical symptoms. It can be easy to miss a woman with angina symptoms, which could be a complaint as subtle as “unusual tiredness when making a bed that goes away with rest.” Again this kind of diagnosis is made by listening carefully to the history. In cases like this, it is also helpful to take into consideration other risk factors for heart disease, such as, family history, the age of the woman (post-menopausal women have increased risk), lifestyle, blood lipid status, etc. If the history report is not thorough, the appropriate diagnosis cannot be concluded.
There are many other atypical presentations of angina. Any new chest pain should be referred out for consultation and diagnosis unless you are very sure of what you are dealing with.
Many students use review summaries to study western medical concepts when preparing for qualifying exams in TCM. Keep in mind that occasionally, some TCM board reviews or TCM websites describe "angina" as "left arm pain and weakness". A history of weakness is not a symptom of angina from the western point of view. Weakness or paralysis is due to a problem with the motor nerves. Angina is transmitted by sensory nerves. Weakness or paralysis by itself can be a symptom of stroke. New weakness and arm pain together can be a symptom of a pinched nerve in the neck or other musculoskeletal problem. Neither stroke nor angina present with both weakness and pain in the arm normally. Once again, the history is a clinician’s most important tool.
The list of causes of chest pain is too long to discuss in this article but you might want to get a pocket-sized booklet of differential diagnoses for various presenting symptoms. These are usually inexpensive and easily transported. Or if you are a "techie" access the iTunes application: "Diagnosaurus", a program that gives you a differential diagnosis list for symptoms like "chest pain". It is also quite handy to carry around and to consult when you are seeing patients. And it sells for the exorbitant price of "99 cents":)