Basically I'm somewhat paranoid about my chest health - I suffered from panic attacks a couple of years back and pretty much have an underlying anxiety all the time nowadays.
I'm also stupidly unfit and overweight (6'5", 300lbs/135kg - should be about 220lbs/100kg), but it's falling (I was 320lbs/145kg 2 and a half months ago). In addition my chest gets quite tight quite often (not 'elephant sitting on my chest' tight, but as if the muscles are twisted a little).
I just want to know if angina always causes pain or can it manifest in a painless but still restrictive sensation such as this 'twisty' tightness that I feel? I only ask because sometimes it feels worse after light exercise (a walk round the shops, a Theraband chest exercies etc) and dissipates after a while.
I know it's entirely plausible that it's just the anxiety doing it (coupled with muscle weakness) and it's also true that I passed a stress test and an echocardiogram 1 year ago (almost to the day) but it doesn't stop me worrying about whether I've develped something now (and I guess the more I hear that I'm fine, the more I can push on and just get the things done that I need to do in order to get over everything)
"Discomfort" is a better term than pain. Sometimes it's pressure, sometimes a burning sensation, sometimes throat tightness.
Thing is, the heart is near a plexus of nerves and that can account for some weirdly "unheart-like" sensations.
Perhaps the twisty tightness that you feel from a walk round the shops would be much closer to pain if you tried to run up a long hill...perhaps pursued by an angry dog.
Anxiety and fear can definitely bring on angina especially when combined with effort.
(Keep up the weight loss and gradually increase your exercise.)
From my experience with angina and heart blockages...during my first go-around with CAD, back in 1979, I would get chest tightness enought to cause a visit to the doc. I walked a stress test, almost to max rate and tilt, and never felt the first pain--however, the wave form was distorted enough that they did an angiogram and found I was 95%+ blocked in the LAD. And no pain during exertion.
Right now, on my third go around (talk about not learning - hit me in the head with a 2x4), I am getting left finger numbness, progressing to some slight inner left elbow pain, and then finally some chest discomfort. As was said, there are a lot of nerves in the area, and blocked arteries do not have to result just in chest pain.
But what about shortness of breath? Is that always present? And what does it feel like? Basically is it different than just being normally out of breath? If not then surely there's no real way to distinguish angina from normal exercise feelings?
All i can add to this is that shortness of breath is always followed by chest pressure when walking. I never had a problem unless i was walking. The breathlessness for me was more pronounced than you would expect but what made me 'run' to the doctor was the slight chest pressure in the middle of my chest that went away when i stopped walking. With, as you say, normal exercise feelings you dont get this chest pressure or at least you shouldnt!