How does cervical rib mimic coronary artery disease? Cardiology Basics

How does cervical rib mimic coronary artery disease? Cardiology Basics

Cervical rib is an accessory rib in addition to the 12 pairs of thoracic ribs, which can occur in some individuals. Cervical rib is an abnormal rib arising from the vertebra of the neck. It can press on nerve roots coming out of the neck from the spinal cord and cause symptoms in the dermatomal region.

If a nerve root from the same spinal segment which also supplies the heart gets compressed, the pain produced will be similar in location. But the pain due to nerve root compression will have different characteristics from that of pain originating from the heart. Pain due to myocardial ischemia is usually produced by exercise. But the pain due to nerve root compression will be brought on by neck movement, coughing, sneezing etc.

Pain due to myocardial ischemia could be either angina pectoris, typically brought on by exertion or due to a myocardial infarction. Myocardial infarction is damage to a region of myocardium due to abrupt loss of blood supply, usually producing severe chest pain. Though pain of myocardial infarction can be precipitated by unaccustomed exertion, it is not relieved by rest, unlike effort angina. It can persist more than half an hour and needs urgent medical attention. Cervical rib also needs medical attention, but not so urgently.

Nerve root pain due to cervical rib is usually felt in the upper limbs and not in the chest. But occasionally, pain in the upper limb can be a manifestation of myocardial ischemia. This can occur as a radiation from chest pain or in an isolated fashion. When pain occurs only in the upper limb without pain in the chest, due to myocardial ischemia, it is known as an anginal equivalent. But pain due to myocardial ischemia will occur whether you exercise with legs or arm, while that due to cervical rib will not occur on lower limb exercise.