by Carolyn Thomas ♥ Heart Sisters (on Blue Sky)
On November 25th (the morning of my mastectomy), I was lying on a hospital gurney in a wide sunlit corridor, waiting to be wheeled into Operating Room #4 for surgery. I eavesdropped on small talk from hospital staff coming and going around me who were pausing to chat with waiting patients. I was surprised when one of the random surgeons stopped alongside my gurney to say hello. I can’t recall how that brief conversation with a surgeon I did not know somehow morphed into the topic of angina symptoms, but here’s how it went.
When he learned that I’d been a heart patient for many years (long before this past spring’s breast cancer diagnosis), he asked if I ever still have chest pain. My answer: yes! But I couldn’t quite answer his next question (Does your chest pain became worse with exertion and better with rest? ) My answer: yes – and no! I then surprised him by adding that over the years, my most severe angina episodes have actually worsened because of cold temperatures – much more often than by exertion.
The random surgeon shook his head, interrupting me to say he’d never heard of cold temperatures affecting chest pain. For many surgeons, that kind of dismissal would have meant the end of our little chat, but I happen to love it when health care professionals seriously underestimate credible info when it comes from a lowly patient. So just for fun, I said to him in my cheeriest lowly-patient tone:
“It’s funny you should say that, Doctor, because I was just thinking that the first time I experienced a dramatic increase in angina symptoms after my heart attack was while walking down the frozen food aisle at the grocery store.”
I added that, happily, my chest pain on that long ago morning eased up after I took these swift actions:
- two sprays of my nitroglycerin (which I’d never leave home without)
- moving out of that frozen food aisle as fast as I could possibly move (HINT: go stand by the rotisserie chicken display when looking to warm up at the grocery store!)
And since then, I’ve learned to never stroll leisurely down any frozen food aisle. No slow browsing, no dawdling – just jog in, pick up the bag of frozen peas, and jog back out.
It turns out I’m not alone among heart patients who prefer to avoid the frozen food aisle – or the ski hill, or the hockey rink. According to the British Heart Foundation:
“Cold temperature is known to commonly precipitate angina pectoris in patients with symptomatic coronary artery disease.”
Many of those heart patients have shared their own experiences of cold-induced chest pain with me. Some examples from my readers include:
- “As a heart girl with cold weather angina, I love covering my chest with the protection of a silky soft pashmina scarf that doesn’t make me look sickly.”
- “When it’s cold or windy, I put a mask on and I do love a nice pashmina that is a staple of most of my outfits when the weather gets cold.”
- “Cold temperature is a huge trigger! Cold is always the worst for me.”
- “When I was in cardiac rehab, our instructor warned us that we might get increased angina in cold weather. He was right. Especially on days with cold plus wind.”
- “In cold weather, if I MUST go out it is from home to my underground parking to car to store, and I only expose myself to the cold between car and store.”
- “I dress in many layers under a coat that has a hood and wind-breaking material on the outside. Then in the car or the store, I can ‘un-layer’ if I need to.”
- “I found that in really cold weather, putting on one of my cloth face masks is helpful in providing warmed air to the lungs.”
That chatty surgeon was in fact mostly correct about angina, but other influences – like the cold temperatures mentioned here – can also affect the pain of angina. Its name (‘angina pectoris’) translated from the Latin as “strangling in the chest” can feel truly frightening for many of us heart patients who worry: “Is this another heart attack? Is it something? Is it nothing? Should I call 911? ”
According to the British Heart Foundation, “Cold weather temperature is known to commonly precipitate angina pectoris in patients with symptoms of coronary artery disease.” And remember that referred angina pain also may be felt in the arms, neck, jaw, shoulder or upper back – not just the chest area.
Mayo Clinic cardiologists describe four types of angina:
-
Stable angina – the most common form, often lasting five minutes or less – and likely the kind of angina that the random surgeon had learned back in med school, which does usually start during exertion or taking angina medicine like nitroglycerin. Mayo cardiologists also confirm that “chest pain that starts when you’re walking uphill or in the cold weather may be stable angina.
- Unstable angina: A MEDICAL EMERGENCY! Unstable angina is typically severe and unpredictable, and may occur at rest or with minimal physical effort, often lasting 20 minutes or longer. Unlike stable angina, this pain doesn’t go away with rest or the usual angina medicines. If the blood flow to the heart muscle doesn’t improve, the heart does not get enough oxygen and a heart attack will occur. Unstable angina is very dangerous and needs emergency treatment.
- Variant angina, also called Prinzmetal angina. This type of angina isn’t due to coronary artery disease. It’s typically caused by a spasm in the heart’s arteries. This spasm temporarily reduces blood flow to the heart muscle – which is what causes the pain. Severe chest pain is the main symptom of variant angina, typically at rest or overnight. The pain may be relieved by angina medicine.
- Refractory angina. These angina episodes are stubbornly frequent even with a combination of heart medicines or other treatments.
With colder weather looming during the winter ahead – even here on the balmy west coast of Canada, it seems like an appropriate time to think about preventing cold-induced angina before it starts.
Q: Have you ever experienced cold-induced chest pain?
NOTE FROM CAROLYN: In my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press), I wrote much more about angina pain. You can ask for this book at your local library or bookshop (please support your favourite independent booksellers!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press. Use their code HTWN to save 30% off the list price when you order.
Heart Sisters 
I read this post after several days managing weather in the single digits or minus numbers. Minus 9 Fahrenheit Sunday night. I called for extra dog walking help, because even with many layers and a balaclava, angina, chest pressure and fatigue wiped me out. When I was in cardiac rehab, I was warned that cold would be equal to the angina of heat. Yep!
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Hello Sara – I agree with that cardiac rehab response – both cold AND HEAT can indeed cause all those distressing things! Some of my readers told me that they found the heat harder to deal with than the cold, perhaps because you can bundle up to protect against many of the effects of cold weather (or a cold frozen food aisle!) but when it’s HOT, it’s just hot. I never appreciated this until I bought my first car with air conditioning – heaven!
I was thinking while reading your comment that dog-walkers are in a specific situation in which walking the dog must be done every day, twice a day in many cases, not just when the weather is lovely. And this often (or almost always?) involves going outdoors for the walk – to face whatever Mother Nature has planned for us each and every day!
Stay warm and take care. . . Happy Christmas to you ❤️
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Interesting topic- I have a friend who had a spasm heart attack in her 30’s – now nearly 35 years ago- possibly brought on by OTC decongestant who was told by the cardiologist to avoid going outside in temps below 40-45 F. Seems there’s a connection. I remember because we’d had an ice storm, but we had heat and they didn’t. So they came and stayed until their heat was restored.
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Hello Helen – your friend was lucky that you had heat to share. She was so very young to suffer that heart attack! I recall a cardiologist speaking about non-obstructive coronary artery disease in women at Mayo Clinic who said: “You can be just as dead if a spasm prevents blood flow to your heart muscle as you’d be if it were a massive blockage made up of plaque!”
Take care – and Happy Christmas to you and your family. . . ❤️
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Thank you, Carolyn, and Happy Christmas and a happy and healthy new year to you and your loved ones. 🥰💕
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Thanks Helen – and all the same good wishes to you and your family, too. Take care and stay safe. . .❤️
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Hello Carolyn,
How opportune that was for a random surgeon to drop by and chat with you! And hopefully learn something he could apply to his practice.
Cold does not affect me so much as heat – even a warm shower has me lying down afterwards to recover. Walking in the cold leaves me breathless so I tend not to do that much. But I will tell my husband with 7 stents not to linger in the frozen food aisle!
I’m appalled at the lack of empathy and help that you’ve been experiencing with the Cancer Clinic oncology staff. At a time when you need assistance the most. Time for a shakeup there I think.
Wishing you a quick recovery from your recent mastectomy.
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I avoid cold weather so vigorously that I have not noticed this phenomenon.
However, hot weather and minimal exertion will do me in quite rapidly.
My last experience with angina that sent me to the Cath lab for a couple stents was 3-4/10 random low level chest pain usually at rest.
I call it Enigma Angina. Because it left my cardiologist scratching his head. He finally agreed with me that a cardiac Cath was the only reliable way to know what was going on.
My theory is that besides the usually unusual nature of women’s chest pain; having Diabetes type 2 for twenty years is affecting the nerves that relay the sensations of chest pain, just like the neuropathy in my feet and legs.
It is getting up to 47 degrees in Denver today, so I may venture outside for a bit of sunshine!
Blessings!
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Hello Jill – a great example of how random low-level chest pain needs to be investigated in all patients. When we “learn” about heart attacks in the media, the accompanying photos are almost always men (old, white men) grimacing in agony while clutching their chests. That’s what we’ve been taught is a heart attack. Heart patients, especially women, show up in Emerg apologizing for being a bother because they were able to talk and walk into Emerg. I love your Enigma Angina theory!! How lucky you were to have your cardiologist agree with your own assessment! You convinced him to BELIEVE PATIENTS WHEN WE TELL YOU WE’RE SICK.
Illegal Topic Change: I too have been diagnosed with neuropathy (feet and lower legs, painful side effects of my chemotherapy drugs). I’ve been searching for credible info nonstop – can you recommend any resources or treatments you’ve found to be helpful? Thanks Jill ❤️
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Hello Carolyn,
People with Peripheral Neuropathy are a vastly underserved community. The advice I have gotten from physicians is “keeping my blood sugar under control to stop further nerve damage” Duh! Or start taking Neurontin which has too many side effects for me. I tried Accupuncture, too expensive for minimal results. I tried a compounded pharmacy cream that had amytriptoline in it and it gave me horrible nightmares!
There are some compression socks that seemed to help and might be worth trying.
My feet bother me more at night than during the day so , right now I slather them with Aspercreme Lidocaine lotion before bed abd that is the extent of my interventions.
Sorry I am not much help….Maybe Canada’s resources are better.
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Yoiks. You’re facing the same list of barely useful ‘treatments’ that I’m discovering. The only physician who has taken an interest in my painful feet is at the Urgent Care Clinic (he’s the one who has surgically removed the most infected of my chemo-damaged fingernails so far (another appointment booked this week), oh joy. He is such a kind and compassionate doc, who asked what my oncologist has recommended so far to address my neuropathy symptoms; I felt embarrassed to tell him “nothing”.
The PATIENT is feeling embarrassed for disclosing the lack of help from my DOCTOR?!?
The Urgent Care doc was the first and only to discuss with me the pros and cons commonly prescribed nerve damage meds for neuropathy. And I only found him by accident!
Another bright spot so far is my Nurse Practitioner – who has a social worker one day a week in her clinic for patient referrals to community resources – including a “Foot Care Nurse“. My oncologist has never mentioned a foot care nurse. I didn’t even know we have Foot Care Nurses. The Social worker has now referred me to both the foot care nurse and an occupational therapist for basic help in mobility problems. I’m so disillusioned by the utter lack of interest that so many of the Cancer Clinic oncology staff appear to have when addressing debilitating side effects caused by these toxic chemotherapy drugs they order for us. They regularly ask us about new side effects, type our lists carefully into their laptops, then stand up and leave the room. In my experience, I’ve seen very little if any concern about the quality-of-life issues specifically caused by those chemotherapy treatment plans.
ARRRGH! 😦
P.S. Your brother’s story is dreadful, Jill – but the really distressing part is how common this disconnect seems to be between patients who need help and the professionals we turn to for help…
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I tend to agree with the disinterest in side effects….I overheard my brother firing his PCP on the phone because he didn’t seem to understand that his “life saving” medications could only be vaguely tolerable if he stayed in bed all day.
My current cardiac evaluation is wearing a monitor for a month! I’m recording on the symptom recording: ”I’m trying to chop vegetables for a salad and I have to sit down every 5-10 mins because of tachycardia and shortness of breath.”
Followed by a recording to say: “This is getting ridiculous, I’m going to go lay down and try to chop vegetables later, good bye”
I’m sure they think I’m a lunatic LOL.
PS I emailed you a picture of the neuropathy socks
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