Angina and Ischemia
Angina is chest discomfort due to decreased blood flow through the heart’s blood vessels (coronary arteries). The heart muscle becomes starved as blood flow decreases. The medical term for this is ischemia. In summary, decreased blood flow leads to ischemia, which leads to angina.
There are two ways your heart can suffer from ischemia. One is if the supply of blood flowing through the coronary arteries decreases. A new or worsening blockage in an artery leads to decreased blood flow. The second way is if the heart starts to demand more blood flow while the supply remains unchanged. For example, if you had a moderately blocked coronary artery and sat on the couch all day – you’d probably never have ischemia or angina. However, if you tried to run in a marathon with the same blocked artery you’d feel lots of discomfort and probably have to stop. The change in symptoms with movement and position helps distinguish cardiac causes of chest pain from other causes. Exertion or physical activity is one type of movement that can make chest discomfort worse.
Deep Breathing
When you take a deep breath the ribs and the lungs expand. This creates lots of stretch. Swelling of the lungs or tight chest muscles can cause pain when stretched. The tiny muscles between each of your ribs can get cramps and can feel tight if they are stretched without a pre-exercise warm up. Before starting any exercise program it’s important to talk with your doctor about the best way to start. And, always warm up.
If your chest pain increases with every deep breath and then goes away when you exhale there is a good chance the pain is not from your heart. A sharp stabbing pain which occurs with a deep breath is also unlikely to be due to coronary disease. Other important diagnoses must still be considered, but, a heart attack falls further down the list. Your doctor will likely perform a chest x-ray to take a picture of your lungs and ribs. You may also be asked to blow into a tube to measure the strength of your lungs.
Breathing is a type of movement that can cause chest pain. Fortunately, it’s rarely due to coronary artery disease and not a typical symptom of a heart attack.
“It Hurts When I Do This”
Here is the good news: If movement or touching of the arms or upper body causes chest discomfort the heart is usually not the culprit. Pain that is reproducible with either moving or touching is probably caused by ribs, muscles, or cartilage in the chest wall. Costochondritis is inflammation of the ribs and cartilage. It is not related to heart disease and can usually be treated with anti-inflammatory medication such as ibuprofen, stretching, and a warm compress. Additionally, injury to muscles or joints can cause pain that radiates down to the chest. For example, a “pinched nerve” in the neck or a rotator cuff injury can radiate pain into the left arm. A bruised rib can cause significant chest pain with movement and breathing.
A common concern is left arm discomfort. Chest discomfort from angina can radiate to the left arm and you may be concerned when your left arm starts hurting. Fortunately, this symptom usually does not occur in isolation if you are having a heart attack. Other symptoms such as chest pressure, shortness of breath, and sweating are usually present. The left arm discomfort that occurs with heart attacks will likely worsen with exertion (i.e., climbing stairs) and will not be related to lifting or moving the arm.
Position
If a changing position makes chest discomfort better or worse diagnoses other than coronary artery disease should be considered. For example, if lying down, especially after a large meal, makes chest pain worse, there is a good chance that heart burn of reflux is causing the symptoms. Reflux, also known as gastroesophageal reflux disease (GERD), is due to stomach acids entering the swallowing tube (esophagus). The treatment usually involves decreasing stomach acids. And, thankfully, the heart is not involved.
Inflammation or swelling around the heart (pericarditis) can be due to infection and other causes. The chest discomfort of pericarditis can be severe and similar to angina. In many people, the pain decreases when leaning forward. Although the heart is the cause of the pain, it’s not due to coronary artery disease and angina and the treatment is different.