How To Differentiate Angina Pain

Angina pectoris, commonly known as angina, typically presents as discomfort or pain in the upper part of the sternum or the area around the heart. This pain can sometimes radiate to the back, shoulders, and even the arms. The sensation is often described as a pressing or squeezing discomfort, rather than a sharp, stabbing, or pulsating pain. In some cases, it may feel like tightness or pressure in the throat or chest. Importantly, angina is not usually related to breathing or movement. Episodes generally last between 3 to 5 minutes and rarely extend beyond 10 minutes.

Key Characteristics Of Angina

During an angina attack, an electrocardiogram (ECG) often reveals specific changes such as ST-segment depression, flattened T waves, or biphasic T wave inversion. These findings support the diagnosis, although they are not definitive on their own. It's also important to note that not all chest pain is caused by angina. Several other conditions can mimic angina and need to be considered during evaluation.

1. Cardiac Neurosis

Cardiac neurosis, often seen in young women or those going through menopause, can cause chest discomfort that feels sharp or stabbing. Unlike angina, this type of pain is usually localized to a very small area—sometimes no larger than the tip of a needle—and lasts only a few seconds. Symptoms may actually improve with deep breathing or physical activity, which is contrary to what is observed in true angina. Emotional stress or anxiety often plays a significant role in these episodes.

2. Gastroesophageal Reflux Disease (GERD) Or Hiatal Hernia

Chest pain caused by GERD or a hiatal hernia typically occurs behind the sternum and is often accompanied by a burning sensation. Patients may also experience heartburn, acid regurgitation, bloating, or difficulty swallowing. The discomfort usually improves after taking proton pump inhibitors like omeprazole. Unlike angina, this pain tends to be related to meals or lying down and is not triggered by physical exertion.

3. Costochondritis Or Intercostal Neuralgia

Costochondritis is an inflammation of the cartilage that connects the ribs to the sternum, while intercostal neuralgia involves irritation of the nerves between the ribs. Both conditions cause localized chest pain—often described as a coin-sized area of tenderness on either side of the sternum. The pain is typically sharp and worsens with movement, deep breathing, or pressing on the affected area. Importantly, ECG findings in these cases remain normal and do not show the dynamic changes associated with angina.

Conclusion

Accurately identifying angina requires careful evaluation of the symptoms, triggers, duration, and associated features. While angina is typically brought on by exertion and relieved by rest, other non-cardiac causes of chest pain have distinct characteristics that help differentiate them. When in doubt, seeking prompt medical evaluation is essential to rule out life-threatening conditions and ensure appropriate treatment.