MODEL RELEASED. Angina or heart attack. Elderly man clutching his chest in pain during angina pectoris or a heart attack. Angina is a feeling of severe pain and constriction in the chest. The pain typically spreads to the left shoulder and arm as in a heart attack. Both conditions are caused by a deficiency in the oxygen supply to the heart muscle. The lack of oxygen is usually caused by obstruction of the coronary arteries due to the formation of fatty atheroma plaques within them (atherosclerosis). In a heart attack the heart muscle is damaged, which can be fatal. Both conditions may require drugs or surgery.