Chest pain is one of the most frightening experiences that can befall an individual. The majority of people tend to think of heart disease as the primary condition that is associated with it, and understandably so. However, it is not always the case. There have been instances where, despite normal heart tests, the condition is caused by something to do with the cervical spine. The condition is referred to as cervical angina, and it can often present with symptoms that mimic heart angina. Cervical angina symptoms are one of the reasons it is often misdiagnosed and presents difficulties in the early stages. The condition is caused by the compression of the nerve roots in the cervical spine, and it presents with strikingly similar symptoms to heart angina. The knowledge of the development of the condition, its symptoms, and the way it is treated can go a long way in ensuring that an accurate diagnosis is made.
What Is Cervical Angina?
Cervical angina is defined as the experience of chest pain, which is similar to the experience of angina pectoris. However, the cause of the pain is not related to heart problems. It is associated with cervical spondylosis, disc herniation, and nerve compression, particularly at the levels of C5-6 and C6-7. The nerves leaving the cervical spine are responsible for the innervation of the chest wall, the shoulders, and the arms. Hence, any irritation in the cervical spine can cause pain, which is referred to as cervical angina.
This condition is also referred to as pseudoangina. The patient is often given numerous heart-related tests, including an electrocardiogram, stress test, and even an angiogram. However, in most documented cases, the results of all the heart-related tests are normal. Yet, the patient continues to experience the pain. It is at such times that the doctor starts to suspect cervical angina.
Why Cervical Spine Problems Cause Chest Pain?
Cervical Spine: The cervical spine is made of seven vertebrae that hold the head upright and enclose the spinal cord. Between the vertebrae are intervertebral discs that provide cushioning and flexibility to the spine. With age or as a result of injury or repetitive strain, these intervertebral discs may bulge or herniate. This may cause the nerve roots to be compressed.
C6 and C7 nerve roots are of particular importance in cervical angina. Compression of these nerve roots may cause radiating pain down to the chest wall, shoulder blades, and arms. The sympathetic nervous system is also of importance here because it regulates heart functions. The sympathetic nervous system is located near the cervical spine, and irritation of this nerve may cause palpitations, shortness of breath, nausea, and sweating, thus simulating heart disease.
Common Cervical Angina Symptoms
Cervical angina symptoms must be recognized to distinguish them from genuine heart conditions. Although every individual may experience a unique set of symptoms, certain distinctive characteristics are common.
Firstly, the most common symptom of cervical angina is chest pain felt on the anterior side of the chest. The chest pain may range from a sharp, aching, crushing, or burning sensation. The pain may last from a few minutes to a few hours or more and may occur at any time. Unlike other angina conditions caused by heart disease, cervical angina pain is usually precipitated or exacerbated by neck movement.
Secondly, cervical angina is characterized by neck pain. The neck pain may range from stiffness or reduced range of motion of the neck or a painful sensation on turning the neck. In most cases, chest pain is associated with neck pain.
In addition, the pain can radiate to the shoulders, arms, or the back, especially between the blades. Tingling, numbness, or weakness in the upper limbs can also occur. These are signs of nerve root involvement.
There are some autonomic symptoms like dizziness, nausea, sweating, fatigue, and even vision problems. These are caused by the irritation of the sympathetic nerve fibers in the cervical region.
An important thing to note is that some people with cervical angina have normal heart work-ups. However, if the pain is persistent in the chest, then the cause is not the heart.
How Cervical Angina Is Diagnosed?
The process of diagnosing the condition begins with the exclusion of life-threatening heart problems. Pain in the chest area always has to be taken into consideration and addressed quickly, as it could indicate heart attack or unstable angina. After the exclusion of heart problems through proper examination, the focus is then directed towards the cervical spine.
The medical history of the patient is an important tool for the doctor. The patterns that the doctor will look for include pain in the chest area, which results from the movement of the neck, previous injury to the neck, and the presentation of neurological symptoms. The physical examination of the patient can include limited cervical movement, muscle spasm, and back tenderness.
One of the ways that the condition can be diagnosed is through the Spurling test, which involves compressing the patient’s head while it is turned towards the side of the pain.
Magnetic resonance imaging (MRI) can also be very useful in the diagnosis of the condition. This is because the MRI can show the patient the disc protrusions, foraminal stenosis, and spinal cord compression. This will be helpful in the diagnosis of the condition, especially if the results are correlated with the patient’s symptoms.
Discography and nerve root blocks are invasive diagnostic tests that are normally used for patients who are considering surgery.
Risk Factors and Age Considerations
Degeneration of the cervical spine is common with age. The intervertebral discs degenerate and become stiffer. This increases the risk of bulging or herniation of the discs. Hence, cervical angina is common in middle-aged and elderly people.
Young people can also experience cervical angina. This is mainly due to trauma, sports injuries, or strain from computers. Poor posture, especially forward head posture, can cause strain on the cervical spine.
Treatment Options for Cervical Angina
The majority of patients tend to respond well to conservative treatment. Non-steroidal anti-inflammatory medications, such as NSAIDs, are often recommended to control pain and inflammation. Muscle relaxants may also be recommended to control associated spasm.
Physical therapy plays a vital role in the treatment of patients with cervical spondylosis. Therapeutic exercises help strengthen the muscles of the neck, improve posture, and increase flexibility. Traction of the cervical spine relieves pressure on the compressed nerves.
Manual therapies, including chiropractic care, have been found to be effective. These therapies help restore the normal alignment of the spine.
Acupuncture has been found to be effective in the treatment of cervical spondylosis. Patients often report rapid relief from pain after the procedure.
Lifestyle modifications are equally important. Ergonomic modifications in the workplace, maintaining good posture, and regular exercise can help in preventing further episodes.
Surgery is recommended only when conservative treatment has failed or when there is significant neurological compromise. Procedures like anterior cervical discectomy and fusion can help relieve nerve compression.
Distinguishing Cervical Angina from True Cardiac Angina
It is important to distinguish these two conditions. True angina is usually brought on by exercise and is relieved by rest or nitroglycerin. It is often associated with risk factors like high blood pressure, diabetes, high cholesterol, or previous heart disease.
On the other hand, the presentation of cervical angina is often influenced by movement of the neck rather than physical exercise. The pain is often made worse by turning the neck, lifting objects, or even by posture. Neurological signs like tingling and numbness are not seen in true heart disease but are common in cervical-related pain.
Despite the fact that the consequences of missing heart disease are serious, physicians always need to rule out heart disease before attributing the patient’s pain to the cervical spine.
Prognosis and Long-Term Outlook
The prognosis for patients suffering from cervical angina appears to be good. Once the diagnosis is made and treatment initiated, the symptoms tend to improve significantly. In fact, the symptoms completely disappear.
In addition, patients suffering from cervical angina should seek treatment to avoid complications resulting from the compression of nerves. Once the nerves become compressed, the condition might persist.
When to Seek Medical Attention
New or severe chest pains must always be considered a medical emergency until proved otherwise. Individuals must seek emergency care if their chest pain is associated with shortness of breath, fainting, sweating, or radiating to the jaw or left arm.
If cardiac causes are ruled out and chest pain persists, especially if associated with neck discomfort or neurological symptoms, consultation of a spine specialist may be necessary.
Conclusion
Cervical angina is an underappreciated yet important cause of noncardiac chest pain. Due to the similarities in cervical angina symptoms and those of true angina, the patient often has to undergo considerable testing before the true cause is diagnosed. Compression or stimulation of cervical nerve roots, particularly those at the C5-6 and C6-7 levels, can cause chest pain, tingling in the arm, neck stiffness, and autonomic nervous system manifestations, which can mimic heart disease.
Familiarity with cervical angina symptoms by medical staff and the patient is critical in the diagnosis of the disease. After eliminating the possibility of heart disease, examination of the cervical spine can lead the patient to the true cause of the disease. Conservative management is effective for the majority of the patient population.
By understanding the relationship between the cervical spine and chest pain, the patient can avoid unnecessary medical interventions and receive the appropriate treatment. Understanding cervical angina symptoms not only ensures the patient the best medical outcomes but also alleviates the fear and anxiety associated with the disease.
Reference Links:
- https://www.wikidoc.org/index.php/Cervical_spine_disorder#:~:text=as%20a%20whole.-,Symptoms,the%20most%20are%20the%20elderly.
- https://www.ijcriog.com/archive/article-full-text/100050Z09MH2019#:~:text=ABSTRACT,and%20lipid%20profile%20were%20normal.
- https://caringmedical.com/prolotherapy-news/phrenic-nerve-2/#:~:text=Like%20many%20problems%20that%20come,than%20I%20can%20remember%20taking.
