Pain is the first symptom to appear, mostly in the early morning, at the same location and of the same nature as angina, but the cause is not obvious and often occurs in silence, is more severe and lasts longer, up to several hours or more, and is not relieved by rest or nitroglycerin.
Patients are often irritable, sweaty, fearful, with chest tightness or a feeling of near death. Some patients have pain radiating to the upper neck and back and are mistaken for toothache or bone and joint pain.