What Is an Anginal Equivalent?

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  • Written By: Mary McMahon
  • Edited By: Shereen Skola
  • Last Modified Date: 14 September 2019
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An anginal equivalent is pain associated with lack of bloodflow to the heart that develops somewhere other than the chest. In classic cases of angina pectoris, where the heart does not get enough blood, patients develop symptoms like sweating, nausea, and chest pain. Some patients, however, experience pain somewhere else. Unless the symptom is identified as an anginal equivalent, care providers may not be aware that the problem lies with the patient’s heart.

This symptom can be common in some older adults, who may experience unexpected symptoms at the onset of angina. Women also experience abnormal symptoms with angina pectoris which can lead to a delay in diagnosis. The patient may experience shortness of breath, heavy sweating, fatigue, and nausea, all of which are common indicators of angina. Some patients also report anxiety or distress. Pain can appear in the jaw or arm most commonly, although it may also appear elsewhere in the body.

Sometimes, patients experiencing an anginal equivalent may not be aware that they have a heart problem. Care providers need to put together the constellation of classic angina symptoms minus the expected chest pain to determine that the issue lies with the heart. An electrocardiogram study of the heart muscle can identify abnormal rhythms and other signs of heart damage. Doppler ultrasound of the heart during an episode can also show restrictions in bloodflow.


Treatment options for a patient who develops an anginal equivalent can vary. Care providers may want to perform some testing to learn more about the cause, as this can help them decide how to proceed with treatment. Some patients need medications, surgery to address narrowed blood vessels, or therapeutic exercise to develop cardiovascular strength. Patients with a history of anginal equivalent may want to carry a medic alert card with this information, as it could be important to have in an emergency.

Early signs of anginal equivalent could be confused with other conditions by patients or care providers, especially if a detailed list of symptoms is not provided during an evaluation. A patient with asthma, for example, might be accustomed to periodic shortness of breath and discomfort. It is important to pay attention to symptoms and report all of them during doctor visits, even if they don’t appear related. An asthma patient complaining of shortness of breath, for example, might be treated very differently if sharp pain in the jaw was mentioned at the same time.


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