Angina and Neck Pain

Introduction

Angina, commonly known as angina pectoris, is a chest ailment that causes squeezing, pressure, heaviness, tightness, or discomfort.¹ Some have described angina symptoms as a “vice crushing their chest”. An angina event can occur when your heart works really hard and isn’t receiving enough blood supply. It is usually not life-threatening, but it may be a symptom of coronary heart disease and could be a precursor of a heart attack or stroke.²  “Even though angina is very prevalent, it can be difficult to distinguish it from other forms of chest pain, such as indigestion discomfort”, excerpt from Angina at 30.

Angina can usually be relieved by stopping to rest. The discomfort might extend to the shoulders, arms, neck, jaw, or back like a heart attack. Heart attack signs differ from person to person, although there are a few common ones. Pain radiating to the jaw, back, or neck may signal a heart condition, especially if the origin is hard to pinpoint. Chest pain may feel tight, dull, or heavy – although some people (especially women) may have sharp, stabbing pain that spreads to the neck.^3,4 The discomfort of angina is temporary, usually lasting a few seconds or minutes.

Causes/Risk factors for Angina

Angina is caused by a lack of blood flow to the heart muscle. To live, the heart muscle needs oxygen, which is transported via the blood. Ischaemia is a condition in which the heart muscle receives insufficient blood and therefore oxygen, causing hypoxia. Coronary artery disease (CAD) is the most prevalent cause of decreased blood flow to the heart muscle. Atherosclerotic plaques, which are fatty deposits, can constrict the heart (coronary) arteries. This is referred to as atherosclerosis.^5,6

A blood clot or plaque rupture in a blood vessel can immediately block or restrict flow through a constricted artery. This might result in a significant reduction in blood flow to the heart muscle. The heart muscle may perform on a lower volume of blood flow without producing Angina symptoms during periods of low oxygen demand, such as when resting. Angina can develop when the need for oxygen increases, such as during exercise.⁷

The following factors can put one at risk of developing angina:

• Old Age: Angina is more frequent in persons aged 60 and more.
• Heart disease runs in the family: If your mother, father, or any siblings have had heart disease or a heart attack, tell your doctor.
• Tobacco use: Smoking, chewing tobacco, and long-term exposure to secondhand smoke can cause damage to the artery lining, causing cholesterol deposits to build up and restrict blood flow.
• Diabetes: Diabetes accelerates atherosclerosis and raises cholesterol levels, increasing the risk of CAD, which leads to angina and heart attacks. Sedentary behaviour is connected to high cholesterol, high blood pressure, type 2 diabetes, and obesity. High blood pressure harms arteries over time by hastening the hardening of the arteries.
• High triglycerides or cholesterol: Low-density lipoprotein (LDL) is a kind of “bad” cholesterol that causes arteries to narrow. Angina and heart attacks are more likely when LDL levels are high. A high triglyceride level in the blood is also harmful.
• Obesity: Obesity may increase the significant risk of heart disease, leading to angina. The heart then has to work harder to provide blood to the body when you're overweight.
• Emotional stress: Anger and stress can cause blood pressure to rise. Stress-induced hormone surges can constrict arteries and exacerbate angina.

Symptoms of Angina

Angina symptoms include chest pain and discomfort.⁸ Chest pain, characterised as pressure, squeezing, burning, or fullness, is the most common symptom of angina. Other symptoms of angina include dizziness, nausea, sweating, exhaustion, and breathlessness.⁹ It has the potential to extend to your arms, neck, jaw, and back. It generally occurs after you have exerted yourself and subsides with rest. Angina, for example, is a type of discomfort that occurs while you're walking uphill or in cold temperatures. 

Neck pain due to angina involves: radiating pain into both arms or legs (myelopathic pain); numbness, tingling, or weakness in arms or legs; problems with balance or coordination; loss of bowel or bladder control; unintended weight loss; and fever or chills. Angina can also cause chest discomfort, making some activities difficult. The most lethal complication is a heart attack.

Other symptoms include:

• Shortness of breath, sweating, pressure, fullness
• A squeezing pain in the centre of the chest that will last a few minutes
• Pain extending beyond the chest to the shoulder, arm, back, or even the teeth and jaw
• Fainting
• An impending sense of doom
• Increasing episodes of chest pain
• Nausea and vomiting
• Continued pain in the upper belly area (abdomen) 

Other Causes and Symptoms of Neck Pain

Tingling or numbness

When the muscles, bones, or tissues surrounding a nerve put too much pressure on it, the nerve can become pinched. As a result, you may have pins and needles, numbness, or a tingling feeling that runs down your arm and into your fingers. The numbness and tingling will subside after the situation has been resolved. If your symptoms are severe, consult your doctor; they may be able to give drugs such as gabapentin or pregabalin, which target the pinched nerve.^10,11

Spasms of the muscles

Muscle spasms occur when a group of muscles in your body suddenly contracts and stiffens. There is usually no apparent cause, and they can be highly distressing. When it happens in the neck, it usually causes pain and stiffness on one side, making it difficult to tilt your head.  It usually lasts a few hours or days, although it can occasionally last several weeks. Gentle stretches, over-the-counter medications, and heat or cold packs can all be used at home to help relieve discomfort. Heat is said to be very relaxing for people who have muscular spasms.

Locations of Pain

The tiny bones that make up the neck and back are vertebrae. Stacking them on top of each other creates the spinal column. The spinal column protects and supports the spinal cord. This is the main structure that links the nerves in your body. Pain and other sensations are sent to the brain via this network. The cervical vertebrae are the top seven bones that make up your neck in the spinal column. The bones are joined together by facet joints. These are small joints between your vertebrae that allow you to move your head in any direction when paired with your neck muscles. There are cartilage discs between the vertebrae. The discs operate as shock absorbers and provide flexibility to the spine. When one of these discs moves slightly out of its usual place in the spine, it is called a slipped disc.

Easing neck pain 

Treatment

Treatment includes intermittent cervical traction, physical therapy, nonsteroidal anti-inflammatory drugs, and muscle relaxants. If these measures fail to alleviate the patient's pain, referral to a spine surgeon may be indicated. If the neck pain is due to angina, there are a few drugs that can help, including:

• Nitrates
• Beta-blockers
• Statins
• Calcium channel blockers
• Ranolazine 

Neck traction devices

Cervical traction might be a safe and efficient solution for getting rid of your neck pain.¹⁴ It may bring several benefits to your body, motivating you to undertake it regularly. In theory, it should help reduce neck discomfort and improve general function. A cervical traction device is a neck stretcher; it cannot be used as an ordinary pillow. However, an electric heat massage cervical support pillow is an overnight version that can be used for sleeping.

Cervical pillows

A neck or cervical pillow may improve your mood and sleep.¹⁵ According to studies, a cushion with good cervical support might help relieve neck discomfort and improve sleep. The best neck and shoulder pillows are hard enough to keep the head at a healthy posture while soft enough to relieve pressure points. Memory foam, latex, buckwheat, or feather pillows are popular because they provide the ideal blend of support and pressure reduction.

The best sleeping position for the neck is on your back or side. The back is especially recommended; be sure to use a pillow that supports the curve of the neck and a flatter pillow to cushion your head.

Neck support collars

A neck collar supports your head while your neck muscles and bones mend.¹⁶ Chronic neck discomfort could be caused by various factors, ranging from a heavy backpack to more severe issues such as bone spurs or arthritis. In these situations, the collar aids in pain relief while therapy is underway.

Prevention of Angina

Exercising and not smoking are both beneficial to heart health. We recommend reading some of our most recent blog pieces for tips, such as this one on why running a marathon is good for your heart health.¹⁷ Because poor heart health is such a severe condition, you should consult a doctor as soon as possible.

Stop smoking

Coronary heart disease can be caused by smoking. The most significant change you can make to live longer is stopping smoking.¹⁹

Maintain a healthy blood pressure level

High blood pressure causes your heart to work harder and causes artery damage.²⁰ If you already have angina, high blood pressure can exacerbate your symptoms and raise your risk of a heart attack. If you have high blood pressure, you must make every effort to lower it. Your doctor may prescribe medications to help manage your blood pressure and minimise the burden on your heart. You may also lower your blood pressure by maintaining a healthy weight and shape, being active, and avoiding salt and alcohol.^{21,22,23,24,25}

Consume a healthy, well-balanced diet

A healthy, balanced diet with at least five pieces of a variety of fruits and vegetables each day and more beneficial fats will help minimise your risk of coronary heart disease.^26,27 If you eat two fish meals every week, your cholesterol levels will improve, and your heart will be protected. Oily fish, such as trout, sardines, herrings, mackerel, or fresh tuna, should be one of these servings.²⁸ Be sure to consume fibre-rich foods, particularly oats, beans, and lentils, and reduce your intake of salt and sugar.

Reduce your stress levels

It's critical to learn how to relax if you have angina.^29,30 Physical activity, yoga, and other relaxation practices are helpful for some people. It may help if you also learn to recognize events that cause you stress and how to deal with them appropriately.

Summary

Angina is largely characterised by chest pains which may spread to your neck, causing discomfort. If you are worried about persistent chest pains that spread to the neck, consult your doctor so that you can move forward with a treatment plan. Alongside this, living a healthy lifestyle and reducing your stress is critical to reducing your risk of experiencing angina-related chest pain.