Angina Versus Chest Pain

Sudden chest pain can be scary, as it is a symptom commonly associated with heart problems such as angina. But what is angina? And is all chest pain due to angina? This article will outline the many possible causes of chest pain and how it differs from angina.   

What is Angina?

Angina, also known as angina pectoris, is a type of chest pain caused by a lack of oxygen in the heart. It is not a life-threatening condition, but it can lead to more serious cardiovascular afflictions, such as a heart attack.

Causes 

Angina is caused by a lack of oxygen flow to the heart.¹ In medical terms, this is called myocardial ischemia.

All muscles need oxygen and other nutrients to function properly, and the heart is no exception. Normally, the heart muscle gets the oxygen it needs from the blood that flows through the coronary arteries, which are the vessels that surround the heart. In angina, these arteries become narrowed, either by a build-up of fat ( plaque), a blood clot, or a sudden narrowing movement (vasospasm). As a result, the oxygen within the blood cannot flow correctly to the heart. 

Symptoms

The main symptom of angina is dull chest pain.² Sometimes, discomfort can spread to the shoulders, arms, neck or jaw. Angina can also lead to other symptoms such as shortness of breath, fatigue, dizziness, nausea or sweating.

Diagnosis

Angina can be diagnosed by a doctor upon confirmation of the patient’s symptoms and after carrying out several medical tests. Common diagnostic procedures include the following;

Electrocardiogram (ECG): this common test measures electrical activity and rhythm in the heart.

Stress test: a stress test measures heart activity and rhythm with an ECG device while the patient exercises, usually by jogging on a treadmill. 

Coronary angiogram: this more invasive method involves inserting a small tube called catheter through the groin or arm until it reaches the coronary arteries. It is usually performed if ECG and stress test results are abnormal, and it helps identify any narrowed vessels that may be causing heart ischemia.

Chest X-ray: looking at an X-ray of the chest area can help rule out other causes of chest pain, such as a pulmonary embolism.

Treatment

Medication

-       Nitrates: nitrates are often used for pain relief in angina. They widen the coronary arteries, increasing blood flow – and thus oxygen flow – to the heart.

-       Beta-blockers: a common medication that reduces blood pressure and heart rate. 

-       Calcium channel blockers: this type of drug widens blood vessels. 

-       Aspirin: apart from being a useful painkiller, aspirin can help prevent blood clots, improving blood flow through coronary arteries.

Surgery

-       Coronary angioplasty: in this procedure, a catheter with a balloon tip is inserted into the narrowed artery, where the balloon is inflated to widen the vessel. Sometimes, a small wire mesh called a stent is inserted and kept in the artery so that it stays open.

-       Coronary bypass: this open-heart surgery involves taking a small piece of a blood vessel from the leg or another body part, which is used to redirect the blood that flowed through the narrowed coronary artery. 

Prevention

There are several lifestyle practices that can reduce the risk of angina.

• Stop smoking
• Manage stress
• Reduce alcohol consumption
• Follow a balanced diet that is low in cholesterol
• Control high blood pressure
• Control diabetes
• Exercise regularly
• Maintain a healthy weight

What is Chest Pain?

Chest pain refers to any type of pain sensation in the chest area.

Causes 

There are many potential causes of chest pain, ranging from slightly serious to very severe. These include:

• Muscle or rib injury
• Anxiety or panic attack
• Gastrointestinal conditions: indigestion, acid reflux, oesophageal problems
• Lung conditions: pulmonary embolism, pneumonia, pneumothorax, pleurisy, chest infection, asthma
• Cardiovascular conditions: angina, heart attack, pericarditis

Symptoms

Apart from pain, you may feel pressure, tightness, and compression in the chest. In addition, pain may spread to the neck, arms, jaw, and shoulders, and it may be accompanied by shortness of breath and nausea.³

Diagnosis 

It is advised to seek medical care as soon as possible when suffering acute chest pain. Even though most cases of chest pain do not have a cardiac cause, it is important to rule out any serious conditions.³ Once the patient is at a medical centre, be it primary care or the emergency room, a healthcare provider will ask about their medical history and perform a physical examination. 

As chest pain may have many different causes, asking about the patient’s lifestyle can help identify what they’re at a higher risk for. For example, if the individual has experienced anxiety and emotional stress recently, it is more likely that they’re suffering from a panic attack. However, if the patient is an old person assigned male at birth with diabetes, the risk for cardiac complications increases.

The type of pain can also give a good insight into the most likely cause. Pain when touching a specific area of the chest is more common in chest wall pain, while a sharp painful sensation that gets worse when coughing and breathing can signal a pulmonary condition.⁴

Most patients will undergo an ECG and a chest X-ray to rule out serious illness and, if applicable, diagnose a heart condition.⁴

Treatment

Treatment for chest pain depends on its cause. 

Muscle or rib injury

Fractured ribs may heal without medical intervention, although, in some occasions, surgery is necessary. 

Anxiety or panic attack

Psychological therapy is recommended. A psychiatrist may then diagnose medication for anxiety. 

Gastrointestinal conditions

Acid reflux is usually treated with antacids. A doctor can prescribe a proton pump inhibitor, a drug that reduces the amount of acid the stomach produces.

Lung conditions

A serious pneumothorax may require needle aspiration to extract excess air from the lungs, while a pulmonary embolism is treated with anticoagulants. Pneumonia, pleurisy and other chest infections are managed with antibiotics.

Cardiovascular conditions

Treatment for angina includes medication and, in some cases, surgery; more detail is provided above. A heart attack may also involve surgical intervention as well as anticoagulants and beta blockers.

Prevention

The best way to prevent chest pain and its associated illnesses is by leading a healthy lifestyle. This includes following a balanced diet, exercising regularly, avoiding alcohol and tobacco, and correctly managing any chronic diseases such as hypertension or asthma.

Differences between angina and chest pain

It’s not always easy, even for medical professionals, to tell apart angina from chest pain without undergoing any medical procedures such as an ECG or chest X-ray. Chest pain is more likely to be a symptom of angina when accompanied by a tight sensation, nausea, dizziness, and pain in the arms, neck, or jaw.

Complications

As mentioned before, chest pain can be a symptom of serious illnesses. 

Acute chest pain may be caused by a heart attack (myocardial infarction), which is a potentially fatal condition in which cells in the heart die due to a prolonged lack of oxygen. A heart attack needs immediate medical attention and treatment. 

Non-cardiac conditions that cause chest pain can also have negative consequences. A pulmonary embolism can damage the lungs and even become life-threatening, as it involves a lack of blood flow. Pneumothorax may also lead to complications such as a haemorrhage and respiratory failure.⁵ Regarding gastrointestinal diseases, acid reflux can lead to inflammation or ulcers in the oesophagus.

When to see a doctor

It is recommended to seek medical attention whenever experiencing new chest pain, especially if it spreads to the arms or neck, and if also feeling dizzy or nauseous.

Summary

Chest pain is a main symptom of angina; however, it can have many different causes. Although it is often not life-threatening, one must seek a medical professional when experiencing unfamiliar chest pain.