Several million people in the US suffer from angina, a prevalent illness. However, most people aren’t aware of the various signs and forms of this ailment in both men and women. Atypical angina is a kind of chest pain condition that does not meet the conventional presentation, referred to as “atypical.” Squeezing, pressure, weight, or tightness frequently describe chest pain. The heart’s reduced blood supply causes typical angina symptoms during stress or exertion.

The discomfort felt when the heart does not receive enough blood or oxygen is known as angina pectoris or “classic angina.” Usually, the coronary arteries become blocked or clogged with plaque. However, the heart won’t get enough oxygen if one or more coronary arteries are entirely or partially obstructed.

Angina typically manifests as a tightness or weight in the middle of the chest. Perspiration and shortness of breath may also be related to it. Atypical chest pain is referred to as pain in the chest that doesn’t fit the angina criteria. It differs from typical chest pain as it doesn’t originate in the sternum and may radiate or moves to the other parts of the body.

  • Quality: Atypical chest pain can be acute, stabbing, or tearing as compared to typical chest pain, which is mild discomfort or pressure sensation. Unusual chest discomfort may worsen when you push on the chest, improve when you lean forward, and worsen when you breathe in. It’s possible that eating makes the pain worse, which points to a gastrointestinal origin.
  • Location: Unlike conventional chest pain, atypical chest pain may be localized in a particular chest place. The back may also experience unusual chest pain that is more often characterized by radiating to the arms or neck.
  • Timing and onset: Unlike conventional chest pain, atypical chest pain may appear suddenly and persist for hours or days.

Causes of atypical angina

Those who experience unusual chest discomfort or atypical angina report symptoms that resemble those of gastrointestinal, respiratory, and musculoskeletal conditions. Chest pain can also have non-cardiac origins, such as musculoskeletal problems or a psychological disorder, even though a heart condition frequently causes it. Atypical chest pain may also be caused by;

  • Heart-related causes: Atypical chest pain can result from heart-related conditions other than a heart attack, such as;
  • Heart inflammation can affect the heart’s lining (pericarditis) or the heart muscle (myocarditis).
  • An illness affecting the heart valve
  • Failure to pump the heart
  • An aortic dissection is a rupture of the major blood vessel that carries blood away from the heart.
  • Lung-related causes
  • Lung problems can also cause unusual chest pain. Lung-related causes include:
  • Pulmonary embolism (PE): a pulmonary blood clot
  • Pneumothorax: a lung collapse
  • Pneumonia: lung infection 
  • Asthma
  • A persistent obstructive pulmonary disease (COPD)
  • Chest cancer
  • Gastrointestinal causes
  • Atypical chest pain can result from conditions affecting the esophagus and stomach. These conditions include the following;
  • Gastroesophageal reflux disease (GERD): A principal cause of atypical chest discomfort develops when stomach acid refluxes back into the esophagus and irritates it.
  • Gastritis: It is an inflammation of the stomach lining.
  • Esophageal inflammation.
  • A hole in the esophageal lining.
  • Stress
  • One of the main factors contributing to atypical angina chest pain is stress. Chest pain is a symptom of anxiety disorders, panic attacks, and other stress-related ailments. In these circumstances, a person could also experience chest pressure or tightness, mistaking their symptoms for a heart condition.

Symptoms of atypical angina: Following are some typical signs of atypical angina;

  • Breathing problems
  • Excessive tiredness
  • Lightheadedness
  • Heavy sweating

The pain will throb and be acute. It could happen anytime and linger for anything from five to fifteen minutes. As previously stated, the symptoms are remarkably similar to respiratory, musculoskeletal, and gastrointestinal illnesses. 
When to see the doctor:
If you encounter any of the following atypical angina symptoms, you should seek medical assistance right away;

  • A severe chest ache that worsens with breathing in or changing positions
  • Backache
  • Breathing difficulty

Risk factors of atypical angina:
Atypical chest discomfort, which accounts for 20–60% of undiagnosed myocardial infarctions in the elderly, is becoming more common. Diabetes patients, women, and the elderly have been reported to exhibit unusual symptoms, increasing the likelihood of receiving a false diagnosis. Symptoms of unusual chest pain include:

  • Pleuritic pain, pricking pain, sharp pain, knife-like pain, pulsing pain, or choking pain
  • The random onset of symptoms
  • Varies in length from three to fifteen minutes
  • Possibility of vomiting and nausea
  • Similar to the pain experienced with musculoskeletal, respiratory, or digestive issues
  • Fatigue
  • Sweating
  • Lightheadedness
  • Breathing difficulties
  • Disruptions in sleep
  • Higher heart rate

Treatment of atypical angina:
If you frequently have chest pain, your doctor will conduct a medical examination to ascertain if the pain is cardiac- or non-cardiac-related. A few methods for treating atypical chest discomfort are listed below;

  • Medications: Following medication may be used to address specific causes of unusual chest discomfort;
  • Aspirin, ibuprofen (Advil, Motrin), or indomethacin (Indocin) are typically taken in combination with colchicine to treat heart lining inflammation (Colcrys).
  • People with a blood clot in their lungs (pulmonary embolism) may be treated with blood thinners like heparin or warfarin (Coumadin).
  • People who have pneumonia may need to take an antibiotic treatment course.
  • To treat gastroesophageal reflux disease (GERD), patients may benefit from taking a course of drugs such as omeprazole (Prilosec) or pantoprazole, which lower stomach acid levels (Protonix).
  • Surgeries: Treatment options for atypical angina may include surgery in the following cases;
  • Unblock the heart’s blocked blood vessels or open heart surgery to treat a heart attack.
  • To re-inflate the lung.
  • To treat the esophageal tear.
  • Lifestyle modification: Your doctor will advise you to adopt heart-healthy lifestyle modifications regardless of the angina treatment you decide to use. You can lessen or even eliminate angina by reducing your risk for heart disease, which includes;
  • Smoking: Quit smoking immediately. You should discuss smoking cessation treatments with your doctor if you need assistance quitting.
  • Poor diet: Consume a healthy diet low in sodium, sugar, trans fat, and saturated fat. Vegetables and fruits of all colors, whole grains, lean meats, and low-fat dairy products should be part of your diet.
  • Insufficient exercise: To begin a safe exercise program, discuss it with your doctor. Pace yourself and take a rest if your angina was triggered by activity.
  • Extra weight: Find a technique to balance your food intake and exercise levels if you are overweight to reach and maintain a healthy weight. What is a healthy weight for you? Find out from your doctor.
  • Medical conditions: Get therapy for illnesses including diabetes, high blood pressure, and high cholesterol that might raise your risk of angina.
  • Stress: Avoid stress, and try to find ways to unwind. It would help if you discussed stress-reduction strategies with your doctor.

References:

  • https://www.ppschicago.com/pain-management/chest-pain/atypical-chest-pain/
  • https://www.harringtonhospital.org/typical-and-atypical-angina-what-to-look-for/
  • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02329-1/fulltext
  • https://www.buoyhealth.com/learn/atypical-chest-pain
  • https://www.belmarrahealth.com/atypical-angina-causes-symptoms-treatment/
  • https://www.timeofcare.com/typical-vs-atypical-chest-pain/
  • https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/in-depth/angina-treatment/art-20046240

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