Cervical angina describes chest pain that originates from issues within the cervical spine, or neck, rather than the heart. This condition can mimic the discomfort of cardiac problems, leading to confusion and concern. It is a form of referred pain, where a problem in one area of the body is felt in another.
The Connection Between the Neck and Chest
The sensation of chest pain originating from the neck is rooted in the body’s shared neurological pathways. Nerves exiting the cervical spine supply sensory and motor innervation to the anterior chest wall and upper back. When these cervical nerve roots are compressed or irritated, signals travel along these pathways.
Conditions like a herniated disc or cervical spondylosis (age-related wear and tear) can cause this irritation. Spinal stenosis, a narrowing of the spinal canal, can also contribute to nerve compression. The brain then interprets these distorted signals as pain in the chest region, even though the actual problem is in the neck.
Recognizing the Symptoms
Identifying cervical angina involves understanding its distinct characteristics, especially when compared to heart-related chest pain. Cervical angina pain can be sharp, aching, or crushing sensations in the anterior chest. This discomfort may worsen with neck movements, changes in posture, or coughing.
The pain from cervical angina can be accompanied by neck stiffness, discomfort radiating down the arm, numbness, or tingling in the hands or fingers. In contrast, cardiac angina is a feeling of pressure, squeezing, or tightness in the chest, often triggered by physical exertion and relieved with rest. Heart-related chest pain may also involve shortness of breath, sweating, or nausea. Any new or unusual chest pain warrants immediate medical evaluation to rule out a cardiac condition.
How Cervical Angina Is Diagnosed
The diagnostic process for cervical angina systematically rules out other causes of chest pain before confirming a neck origin. The first step involves assessing for cardiac causes. This includes tests such as an electrocardiogram (ECG), blood tests for cardiac enzymes, and a stress test.
Following a negative cardiac workup, a physical examination focuses on the neck and upper body. A doctor will assess the neck’s range of motion, check for tenderness along the spine, and perform specific maneuvers. For example, the Spurling test involves extending and rotating the neck while applying gentle pressure, which can reproduce chest pain if a nerve root is compressed.
Imaging tests then visualize the cervical spine and identify structural issues. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans of the neck can reveal problems such as disc herniations, spinal stenosis, or bone spurs. These images provide clear evidence of the anatomical basis for the pain.
Treatment and Management Strategies
Managing cervical angina begins with conservative approaches to reduce pain and address the underlying neck issue. Physical therapy is a common treatment, involving targeted exercises to improve neck posture, strengthen muscles, and increase range of motion. Ergonomic adjustments at work or home, along with over-the-counter anti-inflammatory medications, can also provide relief by reducing strain and inflammation.
When conservative measures are not enough, medical interventions may be considered. Prescription medications like muscle relaxants can help alleviate muscle spasms in the neck and shoulders. Nerve pain medications may also be prescribed to modulate nerve signals. For more direct relief, cervical epidural steroid injections can deliver anti-inflammatory medication directly to the irritated nerve roots.
Surgical options are reserved for severe cases where persistent nerve compression leads to ongoing symptoms despite other treatments. These procedures aim to decompress the affected nerve roots or stabilize the spine. However, surgery is a last resort, considered only after less invasive methods have been explored.