Cervical angina, also known as pseudoangina, may resemble true angina, but arises from cervical spine pathology: herniated disc, spinal stenosis, or cervical spondylosis. Even progressive paraplegia due to compression of the anterior spinal artery has been described as being preceded by repeated episodes of pre-cordial pain.
Often cervical angina is difficult to distinguish from true angina using classical criteria of chest pain quality, duration, and response to nitrates. However, chest pain can vary from severe pain of short duration to longer episodes of dull, nagging pain and may or may not be associated with arm pain. Patient with cervical angina may partially respond to nitrates and may have positive EKGs and stress tests especially if concordant cardiac pathology is present. A more accurate diagnosis of cervical angina can be made with a negative cardiac angiogram and with a positive MRI study of the cervical spine revealing a neuro-compressive lesion. Often times further testing is required of the cervical spine, such as myelogram or discography. Most patients have a history of neck pain, although often times considered minor in nature.
Treatment is tailored to the pathology, but often times responds to a three-month period of conservative methods; anti-inflammatory medications, traction, isometric exercises or a cervical collar. Some patients will benefit from surgical decompression and/or cervical fusions, depending upon the pathology present.
Studies suggest that cervical angina is not a rare entity. However, duration of symptoms prior to the diagnosis being made can vary from months to years. Consideration of this entity when encountering a patient with chest pain with either a negative cardiac work-up or a refractory response to cardiac treatment in the presence of cardiac disease may lead to an earlier diagnosis and treatment.
MD News February 2008