If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart, especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any symptoms. As plaque continues to build up in your coronary arteries, however, you may develop the following coronary artery disease signs and symptoms:

• Chest pain (angina). You may feel pressure or tightness in your chest as if someone were standing on your chest. This pain, called angina, usually occurs in the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain typically goes away within minutes after stopping the stressful activity. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm, or back.

• Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with activity.

• Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating.

Women are somewhat more likely than men to have less typical signs and symptoms of a heart attack, such as neck or jaw pain. And they may have other symptoms such as shortness of breath, fatigue, and nausea.

Sometimes a heart attack occurs without any apparent signs or symptoms.