Angina: Unexplained Chest, Neck or Arm Pain When You Ride a Bicycle or Exercise

By Gabe Mirkin, M.D.

If you develop repeated chest, jaw, arm, or neck pain when you exercise, you could have angina, pain caused by reduced blood flow through narrowed arteries leading to your heart. You should check with a doctor as soon as possible.

Other symptoms of angina include feeling lightheaded, overly tired, short of breath or nauseated.

Other conditions that can cause chest pain with exercise include eating too quickly, acid reflux, muscle spasms or breathing problems.

Can Exercisers Suffer from Blocked Arteries?

Exercise is supposed to help prevent arteriosclerosis, but regular exercisers can suffer from blocked arteries because diet is even more important than exercise is preventing heart attacks. Regular exercisers as well as non-exercisers should avoid red meat, sugar-added drinks and foods, and fried foods, and they should eat lots of fruits and vegetables.

What Causes Angina?

The heart is a muscle that must receive oxygen all the time. Angina means that the heart muscle starts to hurt from not receiving all the oxygen that it needs. The most common type of angina is called stable angina. That means that, at rest, the narrowed arteries leading to the heart can supply enough blood flow to the heart.

However, during exercise, the heart muscle needs so much extra oxygen that the blood flow through the narrowed arteries may be inadequate to supply all the oxygen that it needs. So it hurts. Unstable angina means that you can get heart pain when you are not exercising or excited. This is far more serious and puts you at greater risk for a heart attack.

What Causes the Narrowing of the Arteries Leading to the Heart?

We are all born with clean inner linings to our arteries. Then inflammation, an overactive immunity, punches holes in the inner linings of arteries. The holes bleed, clot and then start to heal, and with healing a plaque forms and covers the inner lining of the artery. With time, the plaques can increase in size and narrow the channel through which blood flows.

So the heart muscle can get enough oxygen at rest, but cannot increase the blood flow during exercise. Then the heart muscle suffers from lack of oxygen during exercise and starts to hurt. Usually when you stop exercising, the heart muscle pain will go away.

Inflammation is the process that starts the formation of plaques. Anything that turns on your immunity, and keeps it on, can cause inflammation. That includes chronic infections and diseases of inflammation, behaviors that increase risk for chronic infections, eating too much red meat, sugar-added drinks and fluids, fried foods, and not eating enough fruits and vegetables, being overweight, not exercising, and lack of vitamin D.

What Causes a Heart Attack?

Heart attacks are caused by a sudden breaking off of plaques from the inner lining of an artery leading to the heart. They are not caused by narrowed arteries. After the plaque breaks off, the area there bleeds and clots. Then the clot extends to block completely the flow of blood to the heart muscle, and the heart muscle can die.

A Quick Selt-Test If You Have Chest Pain When You Exercise

Place your finger on the place where you feel the pain. If it hurts to touch that area, the odds are overwhelming that the pain is not coming from your heart.

For example: if it hurts to touch anywhere on the side ends of your sternum, the large bone in the center of your chest, you probably have a benign condition called costochondritis, swelling of the ends of your ribs where they enter your chest bone.

What Test(s) Should Your Doctor Order?

If your doctor thinks that you have unstable angina (chest pain when you are not exercising), a heart attack, or heart pain other than stable angina, he/she may hospitalize you.

Again, stable angina means that you develop chest pain when you exercise, and the pain goes away soon after you stop.If your doctor thinks that you have stable angina, he/she may order the following tests:

• EKG (Electrocardiogram that measures the electrical activity of your heart)
• Stress Testing (an EKG in which you exercise, often on a treadmill, to make your heart work hard and beat fast)
• Chest X Ray (pictures of your heart, lungs, and blood vessels)
• Coronary Angiography (injecting dyes into your bloodstream to see if your arteries leading to your heart are narrowed or blocked)
• Cardiac Catheterization (a thin, flexible catheter is put into a blood vessel in your arm, groin, or neck and is threaded into your coronary arteries)
• Blood Tests (cholesterol, triglycerides, sugar, CRP, proteins in your blood, etc.)

If You Do Have Angina

Your doctor may prescribe many different medications, but no drugs cure angina. The only way to reverse plaques in arteries is to change the lifestyle that caused the plaques to form in the first place. You may be given nitrates (nitroglycerine) to temporarily open your arteries to prevent or treat chest pain. Doctors also prescribe beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet medicines, or anticoagulants (blood thinners) to do such things as lower blood pressure, lower cholesterol, slow heart rate, relax blood vessels, reduce heart strain, and prevent blood clots.

Lifestyle Changes to Cure Angina

Angina is caused by plaques inside your arteries, and we have known since 1974 that plaques are reversible. That means that you can get rid of plaques that you already have by:

• Avoiding red meat, sugar-added foods and drinks, and fried foods. Eat lots of fruits and vegetables.
• Avoiding being overweight
• Getting hydroxy vitamin D levels above 50 nmol/L
• Avoiding alcohol, smoking/people who smoke, and recreational drugs,
• Trying to restrict exposure to air pollution, and
• Exercising

Why Your Doctor Will Prescribe Exercise

Regular exercise can lower high blood pressure and cholesterol, treat diabetes and obesity, and increase blood flow to the heart.

However, people with angina have blocked blood flow to their hearts and are at increased risk for suffering heart attacks when they exercise. So whatever exercise plan your doctor prescribes, start each session slowly with an adequate warm-up, stop exercising immediately if you have chest pain, difficulty breathing or extreme fatigue, and probably you should not exercise outdoors in temperatures below 50 degrees Fahrenheit (10C).

The Good News

Arterial plaques are reversible. We have guys over 70 who previously had angina (and even those who have had heart attacks) riding very fast with us where I live in Florida. Some average faster than 20 mph and some can finish a ride at much faster than that. Virtually all of them know that they must follow (and DO follow) all of the lifestyle changes noted above, including riding their bikes almost every day as their main form of exercise.

Caution: Exercise can cause heart attacks in people who have blocked arteries.

Read More About Heart Issues and Exercise

A Cautionary Tale: How Cycling Saved my Life

Guide to Atrial Fibrillation A-fib for Cyclists

Irregular Heartbeats in Senior Athletes

Can a Heart Rate Monitor Help Detect Heart Problems?

High Resting Heart Rate Unsafe

Book Review: the Haywire Heart