Cervical angina is a medical condition where chest pain originates not from the heart but from an issue within the neck, specifically the cervical spine. This condition is also frequently called pseudoangina or cervicogenic chest pain. Despite the alarming name, this pain is strictly neurological or musculoskeletal and does not involve a lack of blood flow to the heart muscle. The pain is a form of referred sensation, where irritation in the neck is mistakenly interpreted by the brain as coming from the chest. Understanding the true source of the discomfort is the first step toward effective management.
Distinction from Cardiac Angina
The term “angina” is used because this neck-related chest pain closely mimics true cardiac angina pectoris. The most significant difference between the two is the underlying physiological mechanism. Cardiac angina is caused by myocardial ischemia, meaning the heart muscle is not receiving sufficient oxygenated blood, typically due to coronary artery disease. This lack of blood flow is a life-threatening event that requires immediate medical attention.
Cervical angina involves somatic or neurological irritation originating from structures in the neck, such as the vertebrae, discs, or nerve roots. This irritation is often transmitted via complex referred pain pathways, including the sympathetic nervous system or the lower cervical nerve roots (C4-C8). These nerve roots share pathways in the spinal cord with the nerves that carry sensation from the heart, causing the brain to misinterpret the spinal irritation as cardiac pain. Clinicians must first perform a comprehensive cardiac workup to definitively rule out true cardiac ischemia before investigating the cervical spine as the source.
Root Causes in the Cervical Spine
The chest pain associated with cervical angina is triggered by structural pathology in the neck that creates mechanical pressure or inflammation on nearby nerves. A common underlying cause is cervical spondylosis, which refers to the age-related wear and tear of the spinal discs and joints. As the discs degenerate and lose height, the bony openings for the nerve roots can narrow, a condition known as foraminal stenosis.
Cervical disc herniation can also be a direct cause, where the inner material of a spinal disc pushes outward, irritating or compressing an adjacent nerve root. The nerve roots most often implicated in cervicogenic chest pain are the C6 and C7 roots, although the C5 and C8 roots may also contribute. Inflammation or arthritis in the facet joints can also lead to nerve irritation and referred pain.
Clinical Presentation and Pain Patterns
The pain experienced in cervical angina can vary widely, often reported as sharp, stabbing, aching, or crushing in quality. Unlike cardiac pain, which is typically brought on by physical exertion and relieved by rest, cervicogenic pain is frequently influenced by neck movement and specific postures. Turning the head, looking up or down, or maintaining a poor sitting posture can exacerbate the chest discomfort.
The pain is often unilateral, focusing on the anterior chest wall and sometimes radiating into the shoulder or down the arm. A distinguishing feature is that palpation or gentle pressure on certain muscles or bony structures in the neck and upper back may reproduce the chest pain. The chest discomfort can also be accompanied by secondary symptoms pointing to a cervical origin, such as neck stiffness, headaches at the back of the skull, or paresthesia (tingling or numbness in the arm or hand).
Diagnostic Procedures and Treatment Approaches
The diagnostic process must first involve a thorough cardiac evaluation, typically including an electrocardiogram (ECG), blood tests for cardiac enzymes, and sometimes a stress test. Once cardiac pathology has been excluded, the focus shifts to the cervical spine. A physical examination assesses the neck’s range of motion, evaluates muscle tenderness, and includes provocative tests like Spurling’s maneuver, which attempts to reproduce symptoms by applying pressure to the head while the neck is extended and rotated.
Imaging studies are used to visualize the spinal structures and confirm the underlying anatomical issue. Plain X-rays can reveal degenerative changes and alignment issues, while a Magnetic Resonance Imaging (MRI) scan provides detailed images of soft tissues, such as the spinal discs and nerve roots. In some cases, a diagnostic nerve block, where a local anesthetic is injected near the suspected irritated nerve root, may be used to temporarily relieve the pain and confirm the cervical source.
Treatment for cervical angina centers on alleviating the underlying compression or irritation in the neck. Initial management includes physical therapy aimed at improving posture, strengthening neck muscles, and increasing flexibility. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be prescribed to manage pain and muscle spasms. Specific interventions, such as epidural steroid injections or facet joint injections, can deliver anti-inflammatory medication directly to the source of nerve irritation. If conservative measures fail and the underlying pathology is severe, surgical intervention, such as anterior cervical discectomy and fusion, may be considered to decompress the irritated nerve root.