Differentiating and contrasting features of anxiety pain, myocardial infarction pain, and angina pain.

Chest pain is a vague central symptom of a number of physiological conditions and diseases. The single chest pain symptom may be misleading unless we take into account the other accompanying symptoms. Chest pain may refer to heart, lungs and muscles. No doubt, chest pain is common and very characteristic symptom of cardiac conditions. But it can equally signify diseases of lungs, muscoskelton system and less commonly the gastro intestinal systems. The key characteristics help us to differentiate and distinguish cardiac pain from other pains and that of other causes.

The location of pain in chest is of prime significance for distinguishing purposes. The cardiac pain is typically centrally located in the chest on account of derivation of the nerve supply to the heart and mediastinum. The pain felt at the peripheral site of chest is rarely of cardiac origin. Secondly, the cardiac pains are very radiating in nature. The ischemic pains generally radiate to neck, jaws, teeth, upper or lower arms or shoulder. Pains situated over the left anterior chest or right anterior chest and radiating radially are rarely of cardiac origin. These are generally of pleural or lung origin. The chest wall injury pains are more diffused in nature. Soreness of chest walls characterizes these pains. The plerurodynia type pains caused by sever cold winds are of muscular origin.

Anxiety or phobic chest pains.

These pains are most simulating to heart attack pains. But the intensity of these pains is very intense and these are of nervous, hysterical or psychic origin. An anxiety attack or phobic or panic attack may simulate a true heart attack exactly. These vague pains have potential to execute a pain very similar to heart attack. But their nervous or hysterical origin distinguishes these at once from heart attack pains. More over these are of very recurring nature and periodical in nature. The exciting factors or trigger factors are not physiology of body but psychic and emotional upsets and swings. The hypochondrical nature of these pains greatly contrasts these pains from cardiac pains. The real cardiac pains are never of hysterical or psychic origin. The fear and apprehension of immediate impending death, anticipatory anxiety with restlessness, and thirst for small sips of water is very characteristic feature of anxiety and panic attacks. I have also observed that these pains are accompanied by tumultuous beating or violent palpitation of heart. Patient feels as if she is dying. People generally think of panic attacks as heart attacks. The neurotic patients are so apprehensive of heart attack that they will keep sorbitrate tablet ready in their pockets so that they may take it in emergency. But it never happens with them to take the sorbitrate tablet

Angina pains

Angina pain is centrally located pain which is induced by labor or exertion and is completely relieved by rest and is due to myocardial ischemia. It is felt generally retrosternally and radiates to left arm as a rule. It may also radiate to throat, jaws, teeth, neck, arms and shoulders or through the back. The nature of pain may be described as squeezing, crushing constriction, tightening, griping but seldom pricking, stitching or stabbing. The patient may feel choking sensation simulating breathlessness and dyspnoea. The angina stable pain may be brought or exacerbated by sudden emotional upsets and swings. It is apt to increase with heavy or loaded meals. It is totally relieved by nitrates. unstable angina describes a pattern of severe angina which may be precipitated by minimal work or execution.

Myocardial infarction

Severe unbearable Pain is the cardinal symptom of myocardial infarction. Breathlessness or dyspnoea, vomiting and syncope are other features accompanying this condition. It very much simulates in nature and distribution with angina pain but it is very severe in nature. The distinguishing and contrasting feature between angina and infarction is that latter is very intense in severity. While angina pains readily respond to sorbitrate, myocardial infarction pains don’t respond to sorbitrate. There is apt to be vomiting due to involvement of sympathetic nervous system. There may be anxiety and frightening feeling of impending death. In elderly persons the myocardial infarction is silent and symptoms are atypical and may simulate other conditions.