Angina pectoris is the medical term used for chest pain. This occurs when the muscular tissue of the heart (myocardium) does not receive the amount of blood flow required, sensory nerve fibers from the heart send pain signals to the brain. The heart is not receiving enough blood because of blockage of a patient’s artery (ischemia).
Diagnosis of Angina
Often times when patients are applying for cardiac disability, claims require objective data, proving the pain is not imaginary. Many claimants who describe chest pain that could be angina based on the description they provide, turn out to have nothing wrong with their hearts after examination.
There are a number of conditions that can cause chest pain closely resembling the symptoms of angina. For example, metabolic syndrome, can have similar symptoms of angina. It can be treated similarly to angina. The difference is the level of related exertion.
Characteristics of Angina
Angina is characterized by:
- Precipitating causes
Quality – Dull, squeezing, aching, heavy
The most common way to describe chest pain is “sharp.” It is common for patients to describe their pain this way as they believe this will make their claim more believable. Sharp or shooting chest pain is commonly associated with heart attack. Because of this, a diagnosis of angina should not be overlooked.
Location – Central chest
Angina pain starts in the chest and can migrate to one or even both arms, the neck and sometimes the jaw. Angina is much less likely to be present outside of the chest area. Typically, the more unusual the location of pain, the less likely angina is the actual cause. In patients that have ischemic heart disease, any pain around the chest can be an indication of angina.
The duration of angina is extremely important in diagnosing heart disease. Angina that lasts for hours is likely to be associated with a heart attack. Normally, angina only lasts a few minutes after the precipitating cause has stopped. In some cases where a person’s angina is becoming more severe, a condition known as unstable angina – there is no way prolonged angina could be occurring on a regular basis.
Angina is caused by exertion and emotion (fear, anxiety, excitement). The heart rate rises, which can induce cardiac ischemia and the onset of ischemic chest pain – angina. Chest pain that occurs because of particular activities, such as climbing stairs or walking for a longer duration of time is characteristic of angina.
In some cases, chest pain without exertion does not always indicate angina. Chest pain that occurs randomly by exertion and occasionally during rest, does not suggest ischemia since the cause and effect element is missing.
Chest pain that is associated with emotion, but occurs at rest, could be angina. Alternatively, chest pain that occurs only with emotion and not with exertion is suspected of being non-cardiac origin.
In normal cases of angina, there is a cause and effect type of relationship between angina and exertion or emotion. That does not mean that a patient will occur angina at the same level of exertion or emotion. Angina works with multiple factors (ex. Emotional state, drugs, physical health, temperatures) that can influence its onset. An absence of chest pain during exercise testing is not sufficient enough to rule out ischemic heart disease.
Relief of Angina
Angina that is caused by exercise is relived by rest. Emotionally induced angina is lessened by emotional arousal.
Some long-lasting drugs improve cardiac ischemia and decrease the overall frequency and severity of anginal attacks. Some beta-blocker drugs like propranolol helps keep the heart rate down during times of exertional or emotional stress. Long-lasting nitrates will help keep the coronary arties wide to maximize blood flow. High blood pressure will decrease the work the heart has to do and therefore improve angina.
Nitroglycerin is the most common drug used to help combat acute angina. A small white tablet is dissolved under the tongue. This nitroglycerin tablet will typically relieve angina in as little as 30 seconds.
Metabolic Syndrome (Syndrome X)
Metabolic syndrome is not actually a disease. It is a group of risk factors – high blood sugar, high blood pressure, unhealthy cholesterol levels, and abdominal fat. Alone these factors are manageable. However, when combined they set the stage for serious problems. These factors double a person’s chance for heart disease and increase the risk of diabetes by five times.
Metabolic syndrome (also known as Syndrome X) is an angina-compatible chest pain in people with normal epicardial coronary arteries. Between 10% – 20% of patients with metabolic syndrome have normal epicardial coronaries. The problem is determining which patients have true cardiac problems and which patients have some other physical or psychiatric impairment.
Classic angina is associated with ischemia from epicardial artery obstructions. Vasospastic angina is associated with ischemia from reversible epicardial artery spastic narrowing. Individuals with metabolic syndrome have no clear cause of ischemia to explain the cause of their chest pain symptoms.
Some patients are considered to have microvascular angina resulting from smaller artery spasms, within the heart muscle. Testing for this is difficult, as very small coronary arteries cannot be directly seen on a coronary angiography – only the epicardial arteries and their branches.
Some authorities believe the metabolic syndrome occurs on a cellular level and cannot be adequately categorized without further advancements in imaging techniques on a molecular level.
Angina and Disability
If you are considering filing a long-term disability insurance claim due to angina, or your long-term disability insurance claim has been denied, you should contact an ERISA attorney to discuss your options. We are here to help and guide your through the insurance disability claims process no matter what stage you are in. Call our ERISA disability attorneys at Mehr, Fairbanks & Peterson at 800-249-3731.