Classically, angina presents as substernal chest discomfort that occurs with exertion, but it also may occur at rest. The discomfort is frequently described as a pressure or heaviness. Other commonly used adjectives for anginal pain include dull, aching, or squeezing. Pain may radiate to one or both arms, to one or both shoulders, or to the neck or jaw. Symptoms are highly variable. The entity cannot be expected to present with the classic triad of chest pressure with exertion radiating to the left arm. The diversity of disease expression is likely related to a patient's age, sex, race, and culture.

The caveat is to have a high index of suspicion for the disease. Many factors influence the expression of anginal symptoms. Familiar terms such as anginal equivalent and atypical chest pain are frequently used in these cases. In addition, systemic diseases, such as diabetes mellitus or chronic pain syndromes, may alter presenting anginal symptoms; while other diseases, such as prior cerebral vascular accident or dementia, may limit the patient's reporting of symptoms. A pain-free variant of angina—sometimes referred to as silent chest pain—also exists. These patients can present with complaints of shortness of breath, nausea, altered mentation, or abdominal pain.

• Chest discomfort quality
  • Pain
  • Pressure
  • Squeezing
  • Dullness
  • Burning
  • Heaviness
  • Absent chest discomfort (eg, dyspnea, vomiting, altered sensorium)
• Location (often diffuse to any location of C7-T4 dermatomes)
  • Retrosternal or substernal
  • Inframammary
  • Left sided
  • Right sided
  • Upper abdominal
  • Shoulder, neck, arm
  • Teeth, jaw, lower face (above C7 unclear etiology)
  • Back, scapular region
• Radiation
  • Unilateral or bilateral arms
  • Unilateral or bilateral shoulders
  • Back
  • Neck
  • Jaw, ear, or lower face
• Temporal
  • Onset to maximum discomfort is progressive.
    • With exertion (with or without increasing frequency)
    • At rest
  • Alleviation to relief is progressive.
  • Alleviation mediators
    • Oxygen
    • Nitroglycerin
    • Reduction of stressful activity
    • Pain medication
    • Placebo effect (eg, "GI cocktail")
• Severity
  • Mild to severe (1/10 to >10/10)
  • "Like my heart pain" - Patients in the emergency department (ED) may refer to the pain as being consistent with prior heart pains.