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Causes of pain in the heart area
Last reviewed: 04.07.2025
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There are 2 types of pain in the heart area caused by heart disease:
- anginal pain associated with myocardial ischemia resulting from coronary circulatory failure;
- non-anginal pain, or cardialgia, which is based on mechanisms other than those that cause myocardial ischemia.
Coronary circulatory insufficiency, which causes pain in the heart area, may be a consequence of:
- anatomical damage to the coronary arteries or their dysfunction (spasm or inability to adequately expand with increased myocardial oxygen demand) - the so-called coronarogenic forms of myocardial ischemia. This mechanism is most clearly represented in atherosclerosis and thrombosis of the coronary arteries - the substrate of various forms of coronary heart disease (angina pectoris, acute infarction, intermediate forms), inflammatory changes in the arteries (coronaritis), spasm of unchanged or atherosclerotic coronary arteries;
- increased myocardial oxygen demand with unchanged coronary arteries - the so-called non-coronary forms of myocardial ischemia. This mechanism is present with inadequate physical activity, atherosclerosis, myocardial hypertrophy due to valve defects or hypertension of the large or small circle of blood circulation, as well as with an increase in body temperature;
- reduction of the oxygen capacity of the blood in anemia of various origins, carbon monoxide poisoning, and impaired oxyhemoglobin dissociation. This mechanism is observed in combined organ damage (including the heart) in a number of internal diseases and acute poisoning.
Non-cardiac (non-anginal) pain, the origin of which is not associated with myocardial ischemia, is observed in a large number of cardiovascular diseases, for example, in neurocirculatory dystonia, myocarditis, pericarditis, storage diseases, etc.
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