Angina: Jaw Pain Only

Introduction

Have you been negligent in seeking medical attention for the root cause of your recent onset of jaw pain? Did you know that the abrupt onset of jaw discomfort that you initially thought was coming from a tooth cavity could instead be radiating chest pain brought on by angina?

What is Angina?

Angina, sometimes referred to as angina pectoris, is a classic sign of coronary artery disease (disease of blood vessels that surround and supply the heart). This is characterised by short episodes of chest pain or discomfort due to insufficient blood flow and oxygen supply to the heart muscles, known as ischemia. The main causing factor is one or more restricted or blocked coronary blood vessels.

Despite the fact that it is not a life-threatening condition, it is rather a sign of a greater risk of heart attack and stroke and should not be overlooked. To prevent a heart attack, it's critical to seek medical attention at the first outward sign of angina.

Types of Angina

There are four types of angina, here is a brief overview that will help you understand each type:

Stable Angina

Stable angina, also known as exertion angina and classic angina, is the most common type. A terrible life event, climbing a flight of stairs, or engaging in intense aerobic activity are a few examples of intense mental or physical stressors that frequently result in this kind of angina. It only lasts for a brief period of time and goes away with rest and relaxation. It unfolds in a manner that is predictable.

Unstable Angina

Unstable angina is a sudden, unexpected onset of angina without an identifiable cause, and it can even happen at rest. Rest and relaxation do not make it go away. It frequently lasts longer than the usual stable angina. It can be a new symptom or an alteration in the intensity of stable angina. It is a more serious condition in comparison.

Vasospastic Angina 

The quick onset of this angina, also known as Prinzmetal angina, is caused by a sudden coronary artery or blood vessel spasm (contraction and stiffening) that causes reduced blood and oxygen supply to heart muscles. It occurs more frequently in women and smokers. Even though it is unpredictable and frequently happens when people are at rest, it typically happens in the morning or at night.

Microvascular Angina

Microvascular angina, as its name suggests, is a type of angina that develops when the microvessels that carry blood to the heart become nonfunctional or stiff and contracted (spastic). Since it can happen both at rest and during physical activity, there is no regular pattern.

Signs and Symptoms

Dull pain in the chest is a telltale symptom of angina.1 The features and severity of the pain can range from a dull ache to tightness or heaviness in the chest, with discomfort extending to the back, shoulder, arm, neck, and even jaw. The start of symptoms is typically brought on by high levels of physical exertion and emotional stress. The signs and symptoms frequently include heavy sweating, shortness of breath, and dizziness. The person who is affected might suddenly feel quite ill or possibly start coughing or wheezing.

Causes and Risk Factors

Myocardial ischemia, or a reduced flow of blood and oxygen to the heart muscles, is what inevitably leads to angina.2 Atherosclerosis, which is the accumulation of plaque (fatty substances) in the coronary vessels that narrows the blood and oxygen supply to the heart, or a thrombus, which is a clot or dislodged plaque, or a spasm (contraction) of the heart vessels, are the causes of the restricted blood flow to the heart muscles.

There are two types of risk factors for diseases including angina, these include: 

Non-Modifiable Risk Factors

Non-modifiable risk factors, as indicated by the name, are not subject to change and include:

  • Genetic predisposition for cardiac disease
  • Ethnicity
  • Advancing age
  • Diabetes Mellitus
  • Hypertension

Modifiable risk factors

It refers to the risk factors that are subject to change by lifestyle modifications. The list includes:

  • Smoking
  • High cholesterol level
  • An unbalanced diet rich in saturated fats
  • Lack of physical activity
  • Obesity
  • High stress levels

Diagnosis

The diagnosis of angina cannot be made solely on the basis of signs and symptoms. A deep investigation into the family and personal history, along with detailed assessment and medical tests, is required to reach a definitive diagnosis.

The diagnosis modalities are not limited to but generally include the following:

  • Blood tests for diabetes and cholesterol levels
  • Stress test
  • Standard and Exertion Electrocardiogram (ECG)
  • Echocardiogram
  • Coronary angiogram
  • Cardiac MRI

Can Jaw Pain Alone Diagnose Angina?

Jaw pain is a common symptom of angina, but it is not sufficient to make a diagnosis because jawline discomfort can be brought on by a variety of different conditions.3 There must be other symptoms before angina can be definitively diagnosed.

Pain Radiating from the Chest

Angina can result in jaw discomfort that frequently radiates from the chest and can also radiate to other areas of the body, such as the left shoulder, left arm, back, and neck, but because of the fluctuating nature of the pain, it is frequently challenging to pinpoint. The production of nerve impulses in the nearby body regions is what causes this radiating discomfort.

Other Possible Causes of Jaw Pain

There are a range of other causes of jaw aches and discomfort. Usually, if the jaw pain is not accompanied by chest pain, it is of a non-cardiac origin and can be caused due to:

  • Dental origin: A tooth that is carious or decaying, especially one that is in the lower arch and located toward the inner end of the oral cavity, can also cause jaw pain. Generalized jaw pain is another common side effect of impacted (deep-seated inside the bone) wisdom teeth. Typically, a dentist can identify the discomfort during an oral examination if it radiates to the TMJ (temporomandibular joint - a joint between the lower jaw and side of the head near the ear region) and the surrounding region. Dental pain typically lasts for a long time, does not subside, and is not soothed by rest.
  • Sinusitis: Due to the pressure in the sinus cavities (space), sinusitis (inflammation/swelling of the inner lining of the sinus cavity) can also produce jaw discomfort, which can be similar to the jaw pain brought on by angina. Nasal and postnasal drip, a dripping or congested nose, and a nasal voice are the distinguishing characteristics. It is typically bilateral in nature.
  • Clenching teeth: Also known as bruxism, it leads to jaw pain on both sides, muscle soreness, increase in size (hypertrophy), and tooth structure deterioration.
  • Other causes: Include neuralgia (nerve pain), temporomandibular joint disorders, and arthritis (swelling and pain in joints). 

How to Tell if Jaw Pain Might Indicate a Heart Attack

It's crucial to have a thorough understanding of the warning signs of a heart attack, especially with regard to jaw discomfort, so you can respond immediately and seek emergency medical attention. One of the most typical indicators of angina pectoris is pain in the left lower jaw, which is difficult to pinpoint and is one of the most common symptoms of angina. The shift in nature suggests that nerves near the heart are involved in the pain, which moves to the jaw and causes pain which is called referring pain, as it originates from different places.

Jaw pain from angina typically appears in the early hours of the day, either at rest or whilst working out. Along with the fact that the jaw discomfort is brought on by an episode of emotional disturbance or physical activities, further indicators include the accompanying symptoms of nausea, lightheadedness, and shortness of breath. The jaw discomfort in angina normally goes away after a few minutes, but it gets more severe during a heart attack.

When to Dial 999

Ideally, it is recommended to seek medical assistance on the first episode of angina, but it is vital to dial 999 if you or someone around you experiences the following symptoms:

  • Progressively worsen pain in the jaw, particularly on the lower left side, that also radiates to other adjacent structures including the arm, shoulder, neck, earlobe, and back.
  • Jaw pain that fails to subside after a few minutes of rest and relaxation or a constant jaw pain that occurs at rest.
  • Presence of other signs including shortness of breath, dizziness, sweating, and nausea

It is important to act promptly if you suspect a heart attack and dial 999 without any delays, as every minute is critical for the survival rate in the event of a heart attack.

Summary

Jaw discomfort is not sufficient evidence for the definitive diagnosis of angina pectoris, as a range of other factors may also lead to aching jaws. However, it's crucial to get medical assistance right away if you suspect you could be experiencing angina. Your general practitioner can then perform a complete history, physical examination, and further testing to establish a conclusive diagnosis and rule out any other potential causes.

References

  1. Ford T, Berry C. Angina: contemporary diagnosis and management. Heart. 2020;106(5):387-398. http://dx.doi.org/10.1136/heartjnl-2018-314661 
  2. lgendy I, Winchester D, Pepine C. Experimental and early investigational drugs for angina pectoris. Expert Opinion on Investigational Drugs. 2016;25(12):1413-1421. https://doi.org/10.1080/13543784.2016.1254617
  3. López-López J, Garcia-Vicente L, Jané-Salas E, Estrugo-Devesa A, Chimenos-Küstner E, Roca-Elias J. Orofacial pain of cardiac origin: Review literature and clinical cases. Med Oral Patol Oral Cir Bucal [Internet]. 2012 Jul [cited 2022 Sep 2];17(4):e538–44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476012/

Sidra Irfan

Bachelors of Dental Surgery, Dentistry, Lahore Medical & Dental College, Pakistan

Sidra is a general dentist who enjoys writing in general but particularly enjoys compiling health tech innovation and patient awareness material. She is an equal healthcare access advocate who is currently engaged in research and public health. She also works as a medical, health, and wellness SEO content writer.

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