It indicates severe coronary vessel narrowing from atherosclerotic plaque. Because atherosclerotic lesions are inflexible, they limit the vessels' ability to dilate in response to nitroglycerin. Myocardial infarction or cell death is caused by a prolonged interruption of myocardial perfusion. The patient may describe this chest pain as the worst he's ever experienced and have a sense of impending doom. Contrary to popular belief, the pain of MI isn't always excruciating.
Many patients describe a nagging sensation of heaviness, pressure, or tightness.
Patients more likely to experience these symptoms instead of severe chest pain include women of any age and race, people with diabetes, and the elderly. Patients experiencing unstable angina or MI are now grouped together under the diagnosis acute coronary syndrome. Chest pain that is stabbing or sharp, increases with deep inspiration, or changes in intensity with changes in body position is usually musculoskeletal or pleuritic in origin. Her diabetes is normally controlled by diet and oral hypoglycemic medication. Although she's postmenopausal, she's not on hormone replacement therapy.