Is It Angina? The Warning Sign of Silent Heart Disease
Nicole Van Hoey, PharmD | Oct 2, 2017
When you hit middle age—however you define that—your physicals and doctor visits can become more frequent, your diet might need tweaking to keep off extra weight, and new aches creep up on you. Of these annoyances, chest pain is one of the scariest. Learn why chest pain develops, what different types mean, and when angina—the medical term for cardiac chest pain—needs attention.
A medical reminder/disclaimer
First, concern about any type of chest pain can be taken to a doctor. Any doctor, and any patient, would rather learn that pain is not related to the heart. Better to feel silly and safe.
That said, chest pain comes in all different sizes, shapes, and types. And many of them aren’t heart related.
Types of non-cardiac chest pain (NCCP)
NCCP occurs in at least 25 percent of US adults. Causes range from sites all over the body. Simple muscle soreness, arthritis, or local swelling are common explanations. Similarly, shingles, infections that cause swelling around the lungs, and asthma can increase chest pain.
One of the most common causes of NCCP is related to digestion. Heartburn often is mistaken for heart attack pain, because acid reflux burns the esophagus as high as the upper chest.
An unexpected cause of chest pain
Anxiety can cause pain that feels like a heart attack. The connection between stress and the cardiovascular system isn’t entirely understood. But, hyperventilation (fast breathing) associated with panic attacks can increase the heart’s need for oxygen and starts a cycle of stress and chest pain that feed each other.
What is cardiac chest pain?
Unlike non-cardiac chest pain, the pain of angina results directly from a lack of oxygen at the heart. This low oxygen can be caused by temporary blood vessel blockages, arrhythmias, or other silent heart problems. Although large coronary (heart muscle) vessels are common problem spots, blockages in small vessels—especially in women—can cause chest pain, too.
What angina feels like
Patients and doctors often say that angina feels like a squeezing or pressure around the upper chest. However, that isn’t always a clear enough picture. A few other key angina descriptions are pain that:
- radiates toward the back or arms
- stretches across the center of the chest
- is diffuse (not in just one spot)
What does angina feel like, continued
Even more specifically, angina pain lasts more than just a few minutes. The pain does not improve with position changes (like sitting or lying down), and the pain worsens with exercise. Some, but not all, people experience pain that radiates to the jaw or back, too. Other symptoms that can occur with angina include shortness of breath, sweating, nausea, and sudden tiredness.
How are NCCP symptoms different?
Compared with angina, noncardiac pains have a few key characteristics:
- Lightning bolt sensations: These are more likely nerve, or even rib muscle, pain.
- Pinpoint achiness: This pain is most likely from chest wall muscle damage or arthritis near the collarbone or rib cartilage.
- Pain that changes during breathing: This type of pain can be caused by a lung infection or asthma.
What about heart attacks?
It’s important to remember that angina is not a diagnosis of heart disease. Rather, it’s the pain that tells doctors when something else is wrong. Finding the cause of the heart pain is important to stop more damage. In a heart attack, parts of the heart muscle begin to die when oxygen doesn’t reach them at all. Angina pain is not always a sign of heart muscle damage.
Tests to check heart health
If your doctor thinks that your chest pain is heart related, you may need some of these tests:
- EKGs: measure different parts of the heart muscle activity
- Stress tests: measure how well your heart and blood vessels react to physical activity
- Angiographs or catheterizations: to go inside the body to take pictures of how well blood vessels are working
- Bloodwork: to use laboratory measures to find natural chemicals in the body that reflect heart damage when increased
What to do if it’s angina
After a cause of angina is found, one big distinction is whether the chest pain is stable or unstable. Stable angina occurs predictably, when the heart is working harder, and it usually is short (sometimes less than 5 minutes). Rest and medicine relieve the pain, which is similar every time it occurs.
Unstable angina, though, occurs at rest—even during sleep—and can be a surprise. This type lasts longer, can worsen with time, and doesn’t get better with rest or medicine.
Treating cardiac chest pain and its causes
Stable angina does not always mean a heart attack is coming, but it does mean paying more attention to diet, exercise, and doctor appointments. Some people with stable angina use nitroglycerin under their tongues to keep blood vessels open before an activity that worsens chest pain. Unstable angina is a precursor (warning sign) of a heart attack, though, and needs emergency treatment.
What angina means for you
If you have been diagnosed with stable angina for any reason or have already had a heart attack related to unstable angina, you should remember to exercise your heart responsibly and to rest and find help when you experience chest pain.
You can track your symptoms easily with help from the American Heart Association’s angina log. Take this log to your doctor appointments, too.