Atypical Chest Pains: Could it be Angina?

Introduction

Have you ever experienced any types of chest pain, such as a twinge or uncomfortable strain in your chest? Do you wonder whether these symptoms are normal? Chest pains are very complicated and can be caused by several reasons. This article will review the symptoms, causes, and management of chest pain, to help you understand the difference between atypical chest pain and angina (indicative of a heart attack). 

What is Angina? ¹

Angina is a type of chest pain produced by decreased blood flow to the heart muscles. Although this is rarely life-threatening, it is a warning sign that you may be at risk of having a heart attack or stroke, which are medical emergencies. There are two common types of angina that you may experience:

• stable angina – attacks have a trigger and stop within a few minutes of resting
• unstable angina – attacks are more unpredictable and can continue despite resting

The main symptom of angina is chest pain, where you feel a tight, dull, or heavy discomfort around your chest.

Angina is often caused by a build-up of fatty substances in the arteries that supply blood to the heart muscles, a disease known as atherosclerosis. Some risk factors can increase your chance of developing angina, most of which can be prevented. 

• An unhealthy diet
• A lack of exercise
• Smoking and excessive alcohol intake
• Increasing age (>65 years old)
• A family history of atherosclerosis or heart problems

More on Chest Pains

A Typical Symptom of a Heart Attack

A heart attack is a potentially fatal condition caused by a shortage of blood in the heart muscle. Chest pain or pressure, palpitations, chills, and shortness of breath are all common symptoms of a heart attack. However, it is critical to understand that not everyone suffers from chest pain when having a heart attack. This is especially true for many people assigned female at birth, as the pain is moderate and is misdiagnosed as indigestion. One of the most common causes of heart attacks is coronary heart disease (CHD), in which plaque formation (cholesterol deposits) clogs the main blood arteries.²

Atypical Chest Pains

Atypical chest pain is a type of chest pain that does not meet the criteria for angina. Instead of originating in the sternum, as with typical angina, this type of chest pain can spread to various parts of the body.

Many of the symptoms associated with gastrointestinal, respiratory, and musculoskeletal diseases can be found in those who suffer from atypical chest pain. Non-cardiac causes of chest pain, such as musculoskeletal difficulties or psychological disorders, can also lead to chest pain. Your symptoms and triggers might give you an idea of the cause.^3-6

The pain will be pulsating and sharp. It can come at any time and last between five and fifteen minutes. Additionally, some individuals claim that the pain travels to the neck, left arm, or back. Other common symptoms of atypical chest pain are³:

• Breathing difficulties
• Excessive fatigue
• Lightheadedness
• Profuse sweating

Managing Chest Pain

Having said that, even if there is a less severe cause of atypical chest pain, chest pain is a serious issue in medicine and should never be dismissed or taken lightly.

If you have not been diagnosed with angina, schedule an urgent GP appointment if you experience chest pain that subsides after a few minutes of rest. 

If you have chest pain that does not subside after a few minutes, dial 999 for an ambulance. This could be a heart attack. However, do not worry - with treatment and healthy lifestyle changes, it is possible to control angina and reduce the risk of these more serious problems.^1,7

• Quit smoking: try a smoking cessation service or take some nicotine replacement therapies

• Lose weight: make sure your BMI is under 25 and that your waist circumference is less than 94 cm (37 inches) for people assigned male at birth and less than 80 cm (31.5 inches) for people assigned female at birth⁸

• Exercise regularly: NHS recommends that adults do at least 150 minutes of moderate-intensity (e.g. dancing, riding a bike, hiking) aerobic activity each week, or 75 minutes of vigorous-intensity activity (e.g. running, swimming, skipping) a week⁹

• Have a healthy diet: eat a low-fat, high-fibre diet, including whole grains and at least five portions of fruit and vegetables every day. Cut down sugar and processed meat

• Cut alcohol consumption: the UK's Chief Medical Officer recommends that adults drink no more than 14 units per week, which is equivalent to six pints of average strength beer

Summary

Atypical chest pain is different from chest pain associated with a heart attack. Because most of the symptoms are similar to those of gastrointestinal, respiratory, and musculoskeletal disorders, they may help you determine the reason. Do not self-diagnose – consult a physician if you are concerned.

FAQs

Are there other names that this disorder goes by?

• A variety of terms have been used to describe patients experiencing atypical chest pain. Your doctor or other health care practitioner may refer to it as "non-cardiac chest pain, non-angina chest pain, unexplained chest pain, or functional chest pain."¹⁰

Why are angina and atypical chest pain similar?

• The heart and oesophagus are situated adjacent to one another in the chest cavity (thorax). They both receive a relatively similar supply of nerves. Thus, pain emanating from either organ is sent to the brain via the same nerve sensory fibres. As a result, the pain emanating from either organ can be extremely similar, making it difficult to distinguish heart discomfort from oesophageal pain.¹¹ 

What causes atypical chest pain?

• In most cases, atypical chest pain is caused by an oesophageal problem, such as gastroesophageal reflux disease. Additionally, muscular or bone disorders, lung diseases, stomach difficulties, stress, anxiety, and depression can all contribute.

What does atypical chest pain feel like?

• It is often described as feeling like angina, but the pain can spread to the neck, left arm, or back depending on the origin of the cause.^3-6 

Who experiences atypical chest pain?

• In the United States, up to 25% of individuals have experienced an episode of atypical chest pain. There are no known risk factors that increase the likelihood of experiencing atypical chest pain.¹⁰