What is atypical angina? Causes, symptoms, and treatment

By: Devon Andre | Pain Management | Thursday, August 10, 2017 - 02:00 PM

atypical anginaAtypical angina is a classification of a form of chest pain called angina. The term “atypical” is used to describe a form of anginal chest pain that does not fit the typical presentation. Chest pain is often characterized as squeezing, pressure, heaviness, or tightness. Typical anginal symptoms occur during times of stress or activity due to decreased blood supply to the heart.

What causes atypical angina?

Instead of being heart-related, most causes of atypical angina result from symptoms brought on by respiratory, musculoskeletal, or gastrointestinal diseases. Psychiatric causes may also be a causative factor.

Causes of atypical angina include:

  • Costochondritis – A medical condition commonly caused by the inflammation of costal cartilages, which join the ribs and the sternum (breast bone). Inflammation may be the result of respiratory infections, repetitive strain, or direct injury to the chest. Injury to these bones is frequently seen in sports players who play tennis, squash, or golf.
  • Stress – This is one of the major causes of atypical chest pain. Panic attacks, anxiety disorders, and other stress related conditions tend to cause chest pain. During these instances, a person may also feel a pressure or tightness in the chest, confusing their symptoms with a heart problem.
  • Acid reflux – A very common cause of non-cardiac chest pain. It is caused by a back flow of stomach acid into the esophagus due to a weakened esophageal sphincter. Common factors leading to acid reflux include spicy foods, caffeinated drinks, and alcohol.
  • Problems with the lungs – Conditions such as pneumonia, pneumothorax, pulmonary embolism, and bronchitis can lead to the development of atypical chest pain. They also tend to present with coughing, which causes the lung muscles to contract.

Risk factors and symptoms of atypical angina

Atypical chest pain is increasingly prevalent in the elderly and attributes to 20–60 percent of unrecognized myocardial infarction. People with diabetes, women, and the elderly have been found to have atypical symptoms, increasing the rate at which they are misdiagnosed.

Atypical chest pain symptoms include:

  • Pain that is pleuritic, pricking, sharp, knife like, pulsating, or choking
  • Onset that is random
  • Lasts longer or shorter than three to 15 minutes
  • Possible nausea and vomiting
  • Similar to pain seen in musculoskeletal, respiratory, or gastrointestinal disorders
  • Fatigue
  • Sweating
  • Lightheadedness
  • Breathing problems
  • Sleep disturbances
  • Increased heart rate

How to treat atypical chest pain

A medical evaluation ruling out the most serious causes of chest pain is often the priority when first visiting the emergency care center for a case of unexplained chest pain. Duration, intensity, and other presenting symptoms of chest pain may help locate an underlying cause, helping to determine if the pain is atypical or typical.

When an underlying cause is discovered, treatment will be tailored to the cause. Painkillers and anti-inflammatory drugs are prescribed for costochondritis, antacids might be prescribed for heartburn, and anxiolytics and mood stabilizers may be prescribed for serious anxiety issues. Relaxation techniques may also help those suffering from increased stress that causes atypical chest pain.

Typical vs. atypical chest pain

Typical angina symptoms Atypical angina (noncardiac) symptoms
Squeezing, heaviness, pressure, vice-like aching, burning, tightness Pleuritic, sharp, pricking, knife-like, pulsating, lancinating, choking
Pain that travels to the shoulder, neck, jaw, epigastrium Involves the chest wall being tender
Relatively predictable presentation Random onset
Lasts 3–15 min Lasts seconds, minutes, hours, or all day
Often relieved by nitroglycerin Variable response to nitroglycerin

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Sources:

http://www.mayoclinic.org/diseases-conditions/angina/basics/definition/con-20031194

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