What causes chest pain when walking fast

Angina pectoris

Angina pectoris (chest tightness) is the name for the typical pain that is associated with one Lack of oxygen to the heart occurs. The chest tightness most often arises in the context of coronary heart disease. A distinction is made between stable and unstable angina pectoris.

Stable angina pectoris

“Stable” means that the symptoms always occur under the same circumstances. It should be noted that the Severitynot defined in the severity of the pain, but in the ease with which the pain can be triggered. Angina pectoris, which is only triggered by very heavy physical exertion, is to be regarded as a lighter form of disease than angina, which occurs even with the slightest stress (e.g. when getting dressed in the morning) or when at rest. Accordingly, the classification of stable angina pectoris is (according to the Canadian Heart Society):

  • Stage 1 (very light form): No complaints in daily life. Angina pectoris only with heavy exertion
  • Stage 2: Activities of daily life only slightly restricted: Angina pectoris when climbing stairs or walking quickly, walking uphill, walking at normal speed or climbing stairs after meals, in cold weather, against wind, when climbing more than 1 floor of stairs at normal speed
  • Stage 3: Activities of daily living significantly restricted: Angina pectoris when climbing 1 floor of stairs or less at normal speed
  • Stage 4 (very severe form): Even light activities of daily life are not possible without angina pectoris, complaints even at rest

Unstable angina pectoris

“Unstable” means that the angina pectoris changes the character of its occurrence that was used until then. Until then, angina only occurred with heavy loads and now occurs with light loads, this change is called "unstable angina". Likewise, “unstable angina” means the unusual occurrence of angina pectoris under resting conditions, if it has so far only occurred under physical exertion. Unstable angina pectoris is classified as follows:

  • Resting angina: Angina that occurs at rest with attacks of pain lasting more than 20 minutes
  • New angina: Severe angina with light exertion (e.g. when climbing 1 floor of stairs) that has newly developed within 2 months or already known angina pectoris that has worsened to such an extent in terms of the frequency of its occurrence, the duration of the pain attacks or the ease with which it is triggered that it occurs even with light loads
  • Increasing angina: Angina that has worsened by at least 1 degree of severity within 2 months of the classification of stable angina pectoris

Causes of Angina Pectoris

The most common cause is coronary artery disease, which leads to narrowing of the coronary arteries (coronary arteries). Other possible causes are:

  • Valvular heart disease
  • Heart defect
  • Increase in blood pressure (high blood pressure disease): On the one hand, leads to narrowing of the coronary arteries in the event of a chronic increase in blood pressure and, on the other hand, to relative oxygen deficiency and chest tightness in the event of an acute increase in blood pressure. Comparable to a car engine with a narrowed gasoline line: the engine gets enough gasoline when idling, but not enough gasoline flows through the line at full throttle and the engine stutters.
  • Anemia (decrease in the red blood pigment): The red blood pigment (hemoglobin) is responsible for the transport of oxygen in the blood. If the blood contains too little hemoglobin, the blood cannot carry enough oxygen, too little blood is supplied to the heart muscle and the (relative) oxygen deficiency of the heart muscle and angina pectoris occur.
  • Irritation of the esophagus: The esophagus is immediately behind the heart. Painful irritation of the esophagus (e.g. in the case of esophagitis due to the backflow of stomach acid into the esophagus) can therefore radiate to the heart and appear like angina pectoris.
  • Hiatal hernia (protrusion of the stomach or part of the stomach into the chest due to an enlargement of the hole in the diaphragm through which the esophagus enters the abdomen)
  • Stomach ulcer
  • Biliary colic
  • Inflammation of the pancreas
  • Diseases of the muscles, ligaments and bones of the chest and shoulders
  • Wear and tear on the cervical spine: Causes irritation of the nerves that are responsible for the sensation of pain in the chest
  • TIETZE syndrome: painful inflammation of the cartilage between the ribs and the sternum

Symptoms of typical angina pectoris

Typical angina is a pain that includes the following characteristics.

Type of pain in typical angina pectoris:

  • Pressure around the heart, heaviness or tightness in the chest
  • Burning pain, shortness of breath with a feeling of constriction in the throat or behind the breastbone (as if it were constricting your air)
  • Slow swelling of the pain (no sudden onset and no abrupt end)

Location of pain in typical angina pectoris:

  • Above or near the breastbone
  • Any point between the middle of the upper abdomen and the neck
  • Occasionally in the left shoulder or arm
  • In the left shoulder blade or above the left shoulder blade
  • Lower jaw
  • Neck area

Duration of pain in typical angina pectoris:

30 seconds up to 30 minutes

Triggering causes of typical angina pectoris:

  • Physical stress
  • Work in which you work with your arms above your head
  • cold
  • Walking against the wind
  • Walking after large meals
  • Excitement, stress, anger
  • Sexual intercourse

Effect on nitro-containing drugs in typical angina pectoris:

The pain subsides within 45 seconds to 5 minutes after taking nitro-containing medication (e.g. Nitrolingual-Spray®)

Radiation of pain in typical angina pectoris:

  • Inside of the left arm
  • Left shoulder
  • Lower jaw
  • Occasionally right arm

Symptoms of atypical angina pectoris

Atypical complaints can manifest as sharp and stabbing pain. The causes that trigger the pain can be in unusual situations, such as certain postures. For example, the pain may only appear at night or it may appear during physical exertion, but then disappear as the exertion continues.

Measures to prevent angina pectoris

Chest tightness is usually a symptom of coronary heart disease. Preventive measures therefore relate on the one hand to preventing coronary artery disease. On the other hand, if you have coronary artery disease, you can prevent seizures from occurring. This prevention includes:

  • Avoid doing heavy exercise that is known to lead to angina pectoris
  • Do not exercise on a full stomach
  • Physical rest or even bed rest in the event of febrile infections (e.g. flu)
  • In cold weather, put a scarf over your mouth to avoid breathing in cold air, which can trigger angina attacks
  • Avoid sudden heavy loads
  • Also take nitro spray or capsules before exposure, which usually leads to a seizure

Are there behaviors that promote the healing of angina pectoris?

The disease cannot be cured. One can only "defuse" the disease and its dangerous complications. Treatment measures are, for example, bypass surgery and PTCA.

Dr. Andreas Lauber