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Heart Disease  (Expert Forum)
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atypical angina?
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MedHelp Member's Question

atypical angina?

by andie3330, Feb 19, 2006 12:00AM
I'm worried I might have angina. I'm 39, female, good weight, exercise 3x/wk. Never had chest pain, but sometimes when I exercise, I have pain in the upper left side of my abdomen, near the bottom edge of my rib cage, in an area about 2 inches from the bottom tip of my sternum. It can be a fleeting pain or can ache for 15-30 min. or more. Q#1: Is this particular area a place to feel angina? When I work out, my HR is about 125, my resting HR is 65. I also have occasionly felt a similar pain just walking around the house when my HR is under 80. On the other hand, I can climb up and down my steps 10xs or more to get my HR up to 160 and have no pain, no shortness of breath and feel fine. Question #2: If I had CAD bad enough to feel "angina" at rest (ie when my HR is under 80) would it still be possible to exercise strenuously with a HR of 160 and have no symptoms (like I can do)? I hope that if I feel this pain at rest then it couldn't be angina because unstable angina would preclude me from ever being able to exercise strenuously without symptoms.



I saw a cardiologist - she didn't "think" my symptoms were related to my heart, but she said to do a echo stress test for reassurance. My treadmill stress test was normal. I reached a heart rate of 185 with no symptoms, but they didn't get a great resting echo image because I was so nervous before the test that my HR was 110 before I began. Otherwise, echo was fine. Other general info about me: BP 115/70, Total Chol 162, HDL 44, LDL 108, no family history, non-smoker, no diabetes. I do have a lot of anxiety. Please advise. Thanks
Doctor's Answer

by CCF-M.D.-MJM, Feb 19, 2006 12:00AM
Hello,



Thanks for posting.



Q#1: Is this particular area a place to feel angina?



I am glad you already saw a cardiologist.  Based on the description you provided, it does not sound like angina.  You are correct that stable angina will usually cause angina consistently at a certain level of exertion.  Based on your history and the absence of significant risk factors, I have a hard time imagining that this is angina.



Question #2: If I had CAD bad enough to feel "angina" at rest (ie when my HR is under 80) would it still be possible to exercise strenuously with a HR of 160 and have no symptoms (like I can do)?



Stable angina typically causes chest pain at the same level of exertion.  Unstable angina could cause symptoms like you described.  This wouldn't mean you couldn't exercise long term, you would need to stop exercise when the angina is unstable.  Unstable angina is a reason for hospitalization.



I hope this answers your questions.  Don't give up on the exercise but stay in touch with your doctors if your symptoms continue.
Member Comments (20)

by andie3330, Feb 19, 2006 12:00AM
One more question please: If you experience angina but continue to exercise at a constant intensity, would it definitly get worse or might it eventually go away. Thank you. Also, I forgot to mention that I can't seem to easily reproduce my upper abdominal pain with any kind of body movement.

by PED, Feb 19, 2006 12:00AM
So here is the big question for those of you able to exercise.



Does the angina stay stable, or get slightly worse.  I can exercise at 80% or above of my HR for an hour easy, and the pains, never, ever have been worse, 95% of the time better.  I've NEVER had tightness when exercising, but DO get center tightness at times when not exercising.



Also, my pains are shooting for 95% of them.  The center chest pain has rarely happened, usually under a stressful situation, and it will last for a while.  But again NEVER during or after exercise.



I'll get bi-lateral tightness after a long day of talking at work (work a lot of trade shows) and the tighness is upper pectoral in nature.



I"m now leaning towards a GERD/Anxiety combo...

by andie3330, Feb 19, 2006 12:00AM
To: Al Dente
Thank you for your comments. If angina goes away with rest,how is it that you can have an episode hours after you stop exercising. Do you mean that the episode lasts for hours after you exercise or that it begins hours after exercise? Do you have unstable angina? Can a pain that comes and goes all day long for 30 minutes or more at a time be angina? Do you know if angina pain in the jaw feels diferent from muscle tension pain in the neck and jaw - like that which results form stress and very tight shoulder and back muscles. Do you mind if I ask your age? Sorry so many questions, but I'm just trying to figue all of this out and I'm very anxious.

by Carolina03, Feb 19, 2006 12:00AM
Andie,



If you can, search the Wall Street Journal on Feb. 14 or the Wash. Post or NYTimes on Feb. 2; they did a comprehensive story on the difficulty in diagnosing female-pattern heart disease.



I'm not suggesting that THAT is what you have. Your symptoms could be related to stress. (Are you under a great deal of stress? Does exercise and breathing help with the chest pain?) BTW, chest pain causes anxiety. Chicken or egg? Hard to say.



It may be worth your while to ask for a thallium stress test. The stress