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Q. Can pressure with pain in chest and arm be due to angina?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Jul 05, 2020 and last reviewed on: Jul 29, 2020

Hello doctor,

Two weeks ago I was sitting in front of my computer. I suddenly felt as if a band of pressure surrounded my chest and worsened. The pressure with some pain extended down both arms to my fingers and into my neck and head. It lasted for a few minutes. I have heart disease and 5 stents including in the LAD, which at the time I had 98 % blockage and had another stent. I had never had these symptoms before but had angina that led to the angioplasties. To me these symptoms seemed very much like an infarction so I went to ER. Tests were done and they showed no evidence of infarction and perhaps that was the case.

However, the Hospitalist wanted to send me home based on my previous tests including a stress test that showed great results. The ECG and blood work showed no evidence either. I insisted on an angiogram which I got 3 days ago and show 40 % and 50 % blockage in two arteries (I was not with it enough to ask or remember which arteries). Cardiologist explained the blockages did not warrant stenting but observation over time with stress tests, etc. Also suggested muscular/skeletal possibility (not), indigestion (not) or other undiagnosed cause.

As I wrote, I have never had anything like these symptoms so is there another possibility? I should mention that I have had no similar nor any others like angina, since.

Dr. Muhammad Zohaib Siddiq

Cardiology General Practitioner
#

Hi,

Welcome to icliniq.com.

I have read your query, I can understand your concerns and worries and pain you are going through. I hope my reply will clarify your concerns and give you a sigh of relief.

- 2 arteries are blocked 40-50%, yes this is moderate disease and do not require stenting. If you have chest pain that comes and goes then a treadmill test or nuclear perfusion scan can be done to see whether this blockage is causing ischemia or not. But usually no need, only medicines are enough and lifestyle change that can even regress blockages over time.

- It can be sudden blockage which caused pain and subsequent dissolution of clot. Yes, this is possible but in your case I do not think so because sudden blockage leads to heart attack which becomes evident on ECG and on blood tests (cardiac enzymes). There are ECG changes consistent with heart attack and subsequently returning to baseline if clot dissoluts. Cardiac enzymes rise and slowly come down over days. But as your tests were normal, I do not think it was blockage.

- If your symptoms of chest pain are under control, only medicines and uptitration of medicines is all that is required.

- Just do moderate exercise, control BP, stress, anxiety, avoid sedentary lifestyle, lower salt intake and take medicines.

- Significance of blockage can be assessed with treadmill test or nuclear cardiac perfusion imaging.

If there is anything else I can do for you, please let me know, I will be more than happy to help you out.


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Thank you doctor,

Your reply confirms and is confirmed by my doctors here. It is a relief, of course, to know that I can manage this with medication and lifestyle. Unanswered and perhaps there is none, is what could have occurred to cause the symptoms that I had that day. They felt very much from my chest and radiating pressure and moderate pain into both arms and neck. Perhaps this will remain a mystery if there is no possible diagnosis for it. It seems strange to have had the experience and for it to disappear. Given the angiogram and other test results, my last stress test and your input I feel reassured, just perplexed. But perhaps the best that can be at this point.

Dr. Muhammad Zohaib Siddiq

Cardiology General Practitioner
#

Hi,

Welcome back to icliniq.com.

There are two possibilities for that:

1. Cardiac.

2. Non-cardiac.

1. Sometimes, during stress, certain hormones called catecholamines increase in blood that cause increase in heart rate and also narrowing of blood vessels. Both of these effects can lead to compromised blood flow to heart muscles which are already compromised. This leads to angina. This pain is relieved by rest and by taking Nitroglycerin tablet under the tongue.

2. Non-cardiac causes can be many. Even anxiety can lead to it. All causes are not dangerous and of little concern if any.

So, after all tests including angiography, cause of that pain could not be detected. To be on safe side, consider that pain to be of cardiac origin and wisely adopt healthy lifestyle and medication adherence. Prevention is all that matters.


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