Are your recurring chest pains angina pain?

Angina pain may not be in your chest, actually. It can be anywhere mentioned on the previous page.

How long do these attacks of pain last?

Do you experience recurrent chest pains? How long does each of your episodes last for?

This single question goes a long way to sorting out angina pain from other causes. You need to be very clear on this point when you see your doctor.

I'm not suggesting for one moment that you should diagnose yourself in this situation. Coronary artery disease is dangerous and unpredictable. Modern treatment has definitely improved the outlook for cardiac conditions.

Nevertheless, pains lasting only 1 or 2 seconds or lasting all day, are unlikely to be angina pain coming from ischemic heart disease.

Repeated attacks lasting a few minutes may be heart pain, called angina pectoris. The story is likely to be of attacks brought on by exertion, excitement or upset, especially after meals.

In coronary heart disease, partially blocked coronary arteries may be allowing enough blood through to the heart muscle, for it's requirements when you are resting. In the circumstances mentioned, more is needed than can get through. The muscle becomes ischemic (short of supplies.) It complains.

This situation takes more than a few seconds to remedy itself enough for your pain to subside.

Someone with a long history of chest pains lasting hours is equally unlikely to have coronary artery disease as the cause. If cardiac pain lasts 20 minutes even, it probably means one is having a heart attack.

Have your chest pains altered recently? Unstable angina?

If these attacks have just started or have altered, within the last few weeks, urgent medical assessment is again needed, within days ideally.

This is possibly “unstable” angina, due to some recent increase in a coronary artery blockage. Particularly if the attacks have become more frequent or severe over this time, this can be a prelude to a full blown heart attack.

Chronic stable angina pain, and other types

This condition has been known since the 17th century, long before the 20th century epidemic of heart attacks.

It can go on unchanged for many years.

Fifty years ago, cardiologists had their eyes, ears, hands and ECG to diagnose angina or otherwise².

These days a suspicion of this is often enough to have a cardiologist wanting to arrange a coronary angiogram. There is an old saying that to a man with a hammer, everything starts to look like a nail.

Research just published³ (in 2012) from Europe found that in a large group of suspects (from clinical and stress electrocardiogram (ECG) evaluation,) instead of the 60% expected to have coronary artery narrowing, only 25% did so.

From this research "Preliminary results suggest that heart disease can be diagnosed in the majority of cases without needing a catheterization and that many patients with chest pain receive unnecessary invasive procedures."(Medscape)

Even non-invasive stress testing or coronary CT angiography has trebled the rate of subsequent invasive "revascularization" with angioplasty and stents. The question is being asked⁴ "Does our current practice lead to the stenting of asymptomatic patients in the inevitable cases where the inciting pain was noncardiac? And, most importantly, does our practice improve outcomes?" (Medscape)

The answer to the first question is almost certainly yes. The second question has not been answered yet.

Various other types have been described, including angina of first arising and postural angina where a change in blood pressure may be the factor precipitating angina pain.

Mesenteric angina is the same condition in the bowel - blocked mesenteric artery, pain when the bowel has to work harder, after a meal.

Prinzmetal (variant) angina is due to the coronary artery suddenly tightening up. I suspect this is related to disturbance in the thoracic spine and to emotional tension.

Management of your angina.

Assuming that you have been diagnosed as having angina, and that it is long standing and not changing, you are probably best to experience it often!

Yes, that's what I said.

In the great majority of instances, each episode of angina is a complaint, no more. Some people do develop potentially dangerous irregularities of the heart beat or inadequate pumping of blood, during attacks. For this reason you need to check with your doctor before following this type of plan. One way of checking is to wear a halter monitor, which records your EKG continuously for a day.

Why put yourself through pain? It is giving your blocked circulation a strong message to find a way around the blockage. Small blood vessels here, can enlarge and carry blood around the blocks. The stimulus for these collateral vessels to enlarge, is the ischemia of the muscle beyond the block.

I am usually able to continue walking when angina starts,usually at the same pace. I slow down or stop if the pain worsens. Follow your doctor's advice on this.

Some notes on angina pain plus anxiety combination

Diaphragmatic flutter and tachyarrythmias

Angina type pain may be produced from your diaphragm in the rare condition of diaphragmatic flutter.

Your diaphragm is a sheet of muscle stretched across your trunk between your chest and tummy.

You contract it when you poke your tummy out, and should use it when you breath in deeply.

In this condition, it contracts regularly at upwards of 35/minute, up to 480/minute even. This can produce pain like angina.

The first account of diaphragmatic flutter was written by Antony van Leeuwenhoek, the renowned microscopist, in 1723. It should be called Leeuwenhoek's disease.

Tachyarrythmias are episodes of very rapid abnormal rhythm of the heart. The heart has no time between contractions to fill with blood, so can't pump much, at the same time as it needs more blood supply itself. Pain again - angina pain this time, but not indicative of coronary artery disease.

If you suspect one of these conditions, immediately feel your pulse and time it over 5 seconds even. In the first condition, the pulse and the contractions of the diaphragm will be felt to be quite different (van Leeuwenhoek's observation.)

In supra ventricular tachycardia (SVT) you will count more than 15 beats in the 5 seconds. It is not too difficult to count as it is very regular in this condition.

Achalasia of the oesophagus or cardiospasm

This condition can cause retrosternal chest pain which could be confused with angina pain.

Here your gullet doesn't open at the bottom end, to allow swallowed food to enter your stomach. The causes are failure to develop the nerves involved, or damage to them as in Chagas disease, and chronic inflammatory diseases.

Nitric oxide synthase containing nerve cells in the myenteric nerve plexus, are reduced.

It causes difficulty swallowing as well as regurgitation of food you attempt to swallow. You may need to sit up straight and swallow slowly and deliberately. It may be worse if you eat when emotionally distressed.

Saliva may well up into your throat and need to be spat out, as it can't be swallowed.

This condition can come on at virtually any age, and younger children may simply refuse to eat or get choking and coughing fits.
Very small infants can lose weight and get repeated pneumonia from aspiration of food into their air passages. Their regurgitation may be mistaken for vomiting.

If you try the drug nifedipine for this condition, it needs to be the quick acting formulation, taken before meals. Viagra is also used for treating achalasia!

Barlow's (Floppy-valve) syndrome, mitral valve prolapse

You may have asked your doctor about chest pains or palpitations, and ended up with this label.

You may also have fatigue, lightheaded dizzy feelings, inability to take in a deep breath, anxiety, headaches, poor exercise tolerance or mood swings.

Research¹ has shown magnesium deficiency in this condition, which I think leads to potassium deficiency and weakness of the papillary muscles which hold back the mitral valve leaflets.

This mechanism may contribute, along with weakness of the fibrous tissue of valve and chordae. I would just about guarantee that mechanical disorder of the thoracic spine is involved as well at times, leading to the chest pain and breathing difficulty.

mitral valve diagram

The two leaves of the mitral valve slam together when the main pumping chamber of your heart pumps, so blood cannot go backwards.

They have to be held tight to achieve this, so the papillary muscles contract and pull on the guy ropes (chordae tendineae) to stop them billowing back.

References for angina pain etc.

1. Mariusz Kitliński et al Magnesium Research. Volume 17, Number 1, 39-45, March 2004

2. An example is in an article "Chest pain due to Depression" by J. E. Gault MRACP in the Medical Journal of Australia December 3rd 1966.

He wrote up a series of people he saw with chest pain like angina, but due to depression. One passage from the article is about the duration of pain and speed of relief...

"The opening gambit – “tight pain across the upper chest,” or “pain when I work relieved by rest” – is immediately suggestive of angina, and several patients have been referred with such a diagnosis.
However, the duration of the pain is never brief (a few minutes or so), but is always longer lasting (half an hour or longer), and sometimes present for days at a time.
The pain of coronary insufficiency may be longer lasting, but when it is described the intensity of the pain always comes through in the description, and there is never much delay in seeking medical advice. However , with these patients the pain is described in a more placid manner while at the same time their underlying nervous state often shows through. When rest, or sometimes trinitrin, is described as giving relief, one finds that it takes half an hour or longer for the pain to disappear, unlike that of angina" (relieved within a few minutes.)

My old boss Dr. Kenneth Grice, was flown from one little jungle landing strip to another, in the New Guinea highlands. There would be a group of children waiting for him at each, for him to decide on the spot which of them should be sent to Australia for possible cardiac surgery.
He had only his eyes, hands, ears and stethoscope to use in this.


4. Dr Vinay Prasal et al: Rethinking routine testing of chest-pain patients The Heart Sep 26, 2012


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Nitric oxide (NO) is a neurotransmitter molecule, here involved in passing on the message via the nerves for the smooth muscle cells to relax

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