Chest pain is one of the symptoms of heart disease. Heart pain: when inhaling, sharp, pressing, aching, stabbing, how to distinguish from non-cardiac Atypical chest pain

- the most important symptom of acute diseases of the chest and one of the most common reasons for patients to visit a doctor; often in these cases, emergency assistance is required.

It should be emphasized that acute chest pain, which appeared in the form of an attack, may be the earliest and up to a certain point the only manifestation of a disease requiring emergency care; such a complaint should always alert the doctor.

Such patients should be examined especially carefully, and in most cases, based on the anamnesis, examination data and ECG, the correct diagnosis can be made already at the prehospital stage.

Causes of sudden acute chest pain

The main causes of pain localized by patients in the chest are as follows.

Heart disease

• acute myocardial infarction,
• angina,
• pericarditis,
• myocardial dystrophy.

Vascular diseases

• dissecting aortic aneurysm,
• thromboembolism of the pulmonary arteries (TELA).

Respiratory diseases

• pneumonia,
• pleurisy,
• spontaneous pneumothorax.

Diseases of the digestive system

• esophagitis,
• hiatal hernia,
• stomach ulcer.

Diseases of the musculoskeletal system

• chest radiculitis,
• chest injury.

Other diseases

• Shingles.
• neuroses.

Sudden and severe chest pain may be a symptom of the following conditions

Sudden sharp chest pain due to a heart attack

The main task in conducting a differential diagnosis in a patient with acute chest pain is to identify prognostically unfavorable forms of pathology and, first of all, .

Acute strong compressive, squeezing, tearing, burning pain behind the sternum or to the left of it is the most important symptom of this formidable disease. Pain may appear during exercise or at rest in the form of an attack, or often recurring attacks.

The pain is localized behind the sternum, often capturing the entire chest, irradiation to the left shoulder blade or both shoulder blades, back, left arm or both arms, neck is characteristic. Its duration is from several tens of minutes to several days.

It is very important that pain during a heart attack is the earliest and up to a certain point the only symptom of the disease, and only later do characteristic ECG changes appear (elevation or depression of the ST segment, T wave inversion and the appearance of a pathological Q wave).

It is often accompanied by the following symptoms:

• shortness of breath
• nausea,
• vomiting,
• weakness
• increased sweating,
• heartbeat,
• fear of death.

Characteristically, there is no effect with repeated administration of nitroglycerin. To relieve pain or reduce its intensity, it is necessary to repeatedly introduce narcotic analgesics.

Sudden sharp chest pain due to angina pectoris

Short-term acute compressive pain behind the sternum or to the left of it, appearing in the form of seizures, is the main symptom of angina pectoris. Pain in angina pectoris can radiate to the left arm, left shoulder blade, neck, epigastrium; unlike other diseases, irradiation to the teeth and lower jaw is possible.

Pain occurs at the height of physical exertion - when walking, especially when trying to go faster, climbing stairs or uphill, with heavy bags (angina pectoris), sometimes - as a reaction to a cold wind.

The progression of the disease, further deterioration of the coronary circulation lead to the appearance of angina attacks with less and less physical exertion, and then at rest. With angina pectoris, the pain is less intense than with myocardial infarction, much less prolonged, most often lasts no more than 10-15 minutes (it cannot last for hours) and is usually removed at rest when taking nitroglycerin.

Pain behind the sternum, which appears in the form of attacks, for a long time may be the only symptom of the disease. On the ECG, signs of a previous myocardial infarction may be recorded, at the time of a painful attack, signs of myocardial ischemia (depression or elevation of the ST segment or T wave inversion).

It should be noted that ECG changes without an appropriate history cannot be a criterion for angina pectoris (this diagnosis is made only with careful questioning of the patient).

On the other hand, a careful examination of the patient, including electrocardiographic, even during a painful attack, may not reveal significant deviations from the norm, although the patient may need emergency care.

In cases where acute, sharp, constricting pain behind the sternum or in the region of the heart with irradiation to the left shoulder, the lower jaw develops at rest (usually in a dream or in the morning), lasts 10–15 minutes, is accompanied by a rise in the ST segment at the time of the attack and quickly stopped by nitroglycerin or nifedipine (Corinfar), you can think of variant angina (Prinzmetal's angina).

Chest pain, indistinguishable in nature from angina pectoris, occurs with stenosis of the aortic orifice. The diagnosis can be made on the basis of a characteristic auscultatory picture, signs of severe left ventricular hypertrophy.

Sudden sharp chest pain due to pericarditis

Pain occurs acutely, more often against the background of a hypertensive crisis or during stress (physical or emotional), localized behind the sternum with irradiation along the spine, sometimes spreading along the aorta to the lower abdomen and legs.

It has a tearing, bursting, often undulating character, lasting from several minutes to several days. The pain may be accompanied by asymmetry of the pulse on the carotid and radial arteries, rapid fluctuations in blood pressure (BP) from a sharp rise to a sudden drop until the development of collapse. Often there is a significant difference in the level of blood pressure on the left and right hands, corresponding to the asymmetry of the pulse.

Due to the deposition of blood under the intima of the aorta, signs of anemia increase. Differential diagnosis with acute myocardial infarction is especially difficult in cases where ECG changes appear - non-specific or in the form of depression, sometimes ST segment elevation (although without the cyclicity of ECG changes characteristic of myocardial infarction during dynamic observation).

Repeated administration of narcotic analgesics, including intravenous, often does not relieve pain.

Sudden acute chest pain due to pulmonary embolism

In this case, there is an acute, intense pain in the center of the sternum, the right or left half of the chest (depending on the location of the pathological process), which lasts from 15 minutes to several hours. The pain may be accompanied by severe shortness of breath, a drop in blood pressure, in every tenth patient - fainting (syncope).

On the ECG, signs of overload of the right heart can be recorded - a high pointed P wave in leads II, III, and VF, deviation of the electrical axis of the heart to the right, McGean-White sign (deep S wave in standard lead I, deep Q wave in lead III ), incomplete blockade of the right leg of the bundle of His. The pain is relieved with narcotic analgesics.

In lung diseases, chest pain is usually characterized by a clear connection with breathing. Localization of pain in pleuropneumonia, pulmonary infarction depends, as a rule, on the location of the inflammatory focus in the lungs.

Respiratory movements, especially deep breathing and coughing, lead to increased pain, which in these diseases is due to irritation of the pleura. In this regard, when breathing, patients usually spare the affected side; breathing becomes shallow, the affected side lags behind.

It should be emphasized that with pleuropneumonia and pleurisy in the first hours and days of illness, pain is often the main subjective symptom, against which other manifestations of the disease are less significant for the patient.

Percussion and auscultation of the lungs play the most important role in making the correct diagnosis, which makes it possible to identify objective signs of pulmonary pathology. The pain associated with irritation of the pleura is well relieved by non-narcotic analgesics.

Sudden sharp chest pain due to spontaneous pneumothorax

With spontaneous pneumothorax, pain is usually prolonged, most pronounced at the time of development of pneumothorax, aggravated by breathing, and then shortness of breath comes to the fore.

The pain is accompanied by the following symptoms:

• pallor of the skin,
• weakness
• cold sweat
• cyanosis
• tachycardia,
• decrease in blood pressure.

Characterized by lagging half of the chest during breathing and tympanitis detected by percussion on the side of the lesion, breathing over these departments is sharply weakened or not audible.

On the ECG, you can see a slight increase in the amplitude of the R wave in the chest leads or a sharp change in the electrical axis of the heart.

The appearance in a patient with pneumonia of the sharpest pain in the chest, combined with severe shortness of breath, intoxication, sometimes collapse, is characteristic of the breakthrough of a lung abscess into the pleural cavity and the development of pyopneumothorax. In such patients, pneumonia from the very beginning may have the character of abscessing, or an abscess develops later.

Sudden sharp pain in the chest due to diseases of the esophagus

Acute chest pain caused by diseases of the esophagus (ulcerative esophagitis, damage to the mucous membrane by a foreign body,) is characterized by localization along the esophagus, connection with the act of swallowing, the appearance or sharp increase in pain when food passes through the esophagus, a good effect of antispasmodics and local anesthetics.

The antispasmodic effect of nitroglycerin determines its effectiveness in pain syndrome due to spasm of the esophagus, which may complicate differential diagnosis with an angina attack.

Prolonged pain in the region of the lower third of the sternum at the xiphoid process, often combined with pain in the epigastric region and usually occurring immediately after eating, may be due to a hernia of the esophageal opening of the diaphragm with the release of the cardial part of the stomach into the chest cavity.

For these cases, in addition, the appearance of pain in the position of the patient sitting or lying down and its reduction or complete disappearance in an upright position are characteristic. Usually, during questioning, signs (heartburn, increased salivation) and good exercise tolerance are revealed.

Antispasmodics and antacids are effective (for example, Maalox, Rennie, etc.); Nitroglycerin in this situation can also stop the pain syndrome. Often, pain caused by diseases of the esophagus or, in terms of localization, and sometimes in character, resembles pain in angina pectoris.

The difficulty of differential diagnosis is aggravated by the effectiveness of nitrates and possible electrocardiographic changes (negative T waves in the chest leads, which, however, often disappear when ECG is recorded in a standing position).

It should also be borne in mind that with these diseases, true angina attacks of a reflex nature are often observed.

Sudden sharp pain in the chest with thoracic sciatica

Acute prolonged pain in the chest associated with the movement of the body (tilts and turns) is the main symptom of the chest.

For pain in sciatica, in addition, the absence of paroxysmal, increased with hand movements, tilting the head to the side, deep inspiration and localization along the nerve plexuses and intercostal nerves are characteristic; in the same place, as well as on palpation of the cervicothoracic spine, severe pain is usually determined.

When determining local pain, it should be clarified with the patient whether it is the pain that forced him to seek medical help, or is it another, independent pain.

Reception of nitroglycerin, validol almost never reduces the intensity of pain, which often weakens after the use of analgin and mustard plasters.

Sudden sharp chest pain due to chest trauma

With a chest injury, diagnostic difficulties may arise in cases where the pain does not appear immediately, but after a few days. However, indications in the anamnesis of an injury, a clear localization of pain under the ribs, its intensification during palpation of the ribs, movement, coughing, deep inspiration, i.e., in situations where there is some displacement of the ribs, facilitate the recognition of the origin of pain.

Sometimes there is a discrepancy between the intensity of pain and the nature (strength) of the injury. In such cases, it should be borne in mind that with the slightest injury, a latent pathology of the bone tissue of the ribs may be revealed, for example, with metastatic lesions, multiple myeloma.

Radiography of the ribs, spine, flat bones of the skull, pelvis helps to recognize the nature of bone pathology.

Sudden sharp chest pain in shingles

Acute pain along the intercostal nerves is characteristic of. Often the pain is so strong that it deprives the patient of sleep, is not relieved by repeated administration of analgin, and somewhat decreases only after the injection of narcotic analgesics. Pain occurs before the typical skin rash of shingles appears, making diagnosis difficult.

Pain that occurs on the left side next to the heart is an extremely frightening symptom. It may mean that trouble has happened to your heart. For example, developed ischemic or hypertension disease, heart disease or cardiomyopathy. But the same sign can be a manifestation of pathologies of the spine, ribs on the left. Pain from internal organs can radiate to the left side: stomach, spleen, colon.

Where is the heart actually located?

The topmost bone that runs horizontally on the chest wall is the clavicle. Behind it is the first rib, below you can feel a small soft muscle gap, and below it - the second rib. Further through the intervals follow 3, 4, 5, 6, 7 and 8 ribs. The following guidelines will help guide you:

• nipple in a man: it is on the same level with the 5th rib;
• the angle of the scapula directed downward corresponds to the 7th rib in persons of both sexes.

A man's heart is approximately the size of his fist, positioned so that the most protruding index finger points down and to the left. The heart lies as follows (point by point):

• from the upper edge of the second rib, where it is attached to the sternum on the right side;
• the next point to which the line goes is the upper edge of the 3rd rib, 1-1.5 cm to the right of the right edge of the sternum;
• next point: an arc from 3 to 5 ribs on the right, 1-2 cm to the right from the right edge of the sternum.

It was the right border of the heart. Now let's describe the lower one: it runs from the last described point on the right side of the chest and goes obliquely to the gap between the 5th and 6th ribs on the left, to the point that lies 1-2 cm to the right of the left midclavicular line.

Left border of the heart: from the last point, the line goes in an arc to a point 2-2.5 cm to the left of the left edge of the sternum, at the level of the 3rd rib.

This position is occupied by the heart along with large vessels flowing in and out of it:

1. superior vena cava: it is located at the right edge of the sternum, from 2 to 3 ribs; brings oxygen-poor blood from the upper half of the body;
2. aorta: localized at the level of the manubrium of the sternum, from 2 to 3 ribs on the left. It carries oxygenated blood to the organs
3. pulmonary trunk: it is located in front of the rest of the vessels, goes ahead of the aorta to the left and back. Such a vessel is needed to carry blood to the lungs, where it will be saturated with oxygen.

If it hurts in the region of the heart

Pain in the left half of the chest is caused by two types of causes:

1. cardiological, caused by diseases of the heart and blood vessels that feed it;
2. non-cardiological, initiated by many other pathologies. They have their own division depending on the organ system that caused the syndrome.

The following signs indicate that it is the heart that hurts:

• localization of pain: behind the sternum and to the left, to the left edge of the collarbone;
• the character can be different: aching, stabbing, pressing or dull;
• not accompanied by pain in the intercostal spaces or in the vertebrae;
• there is no connection with a certain type of movement (for example, turning the arm in the shoulder joint or raising the arm), pain most often appears after physical exertion;
• there may be a connection with food intake - heart pain with angina pectoris is associated with taking a large amount of food or walking immediately after eating, but then it is not accompanied by heartburn, belching or stool disorders;
• can give to the left hand (especially the little finger of the hand), the left half of the lower jaw, the region of the left shoulder blade, but at the same time there is no violation of the sensitivity of the hand, it does not freeze, does not weaken, the skin does not begin to turn pale on it and hair fall out.

Cardiac pain: what is heart pain?

The following causes of pain caused by diseases of the heart itself can be named:

angina pectoris

This is one type of coronary heart disease. It is connected with the fact that due to the atherosclerotic plaque, thrombus or spasm located in the coronary artery, the diameter of this vessel that feeds the structures of the heart decreases. The latter receives less oxygen and sends pain signals. Characteristics of the latter:

• occur most often after physical or emotional stress: lifting weights, climbing stairs, brisk walking, walking against the wind (especially cold, especially in the morning), walking after eating;
• may appear at night in the morning or after waking up, when a person has not yet got out of bed (this is Prinzmetal's angina);
• after resting or stopping in the first case or taking "Corinfar", "Nifedipine" or "Fenigidin" - in the second, the pain disappears;
• pain squeezing, baking;
• localized either behind the sternum, or to the left of the sternum, its area can be indicated with a fingertip;
• can give to the area of ​​\u200b\u200bthe left hand, shoulder blades; left half of the jaw;
• removed by "Nitroglycerin" after 10-15 seconds.

myocardial infarction

This is the second and most severe form of coronary disease. It develops when those plaques or arteries that caused short-term, only during emotional or physical stress, oxygen starvation of the myocardium, have grown and blocked the artery almost completely. This condition can happen when from somewhere (from some kind of vein, most often in the legs) a blood clot or piece of fat flew off, which clogged the artery. As a result, a section of the heart, if professional help is not provided within an hour by introducing drugs that dissolve the blood clot, will die.

Myocardial infarction can manifest itself in different ways. The classic version is:

• violent, burning, tearing pain on left side in region of heart. It is so strong that a person can even lose consciousness;
• not removed by "Nitroglycerin" and rest;
• gives to the left arm, shoulder blade, neck and jaw - on the left side;
• the pain grows in waves;
• accompanied by shortness of breath, nausea, heart rhythm disturbance;
• cold sweat appears everywhere on the skin.

A heart attack is an insidious disease: if it manifests itself typically, it gives a person a chance to save. But also with this dangerous disease, only the arm, jaw, or even one little finger on the left hand can hurt; there may be a violation of the heart rhythm or suddenly, for no apparent reason, the stomach starts to hurt or loosening of the stool occurs.

Pericarditis

This is the name of the inflammation of the heart bag caused by an infectious cause. People describe such pain as:

• chest pain (or they say: "Localized in the depths of the chest");
• stabbing character;
• aggravated in the supine position;
• weakens if sitting or standing to lean forward a little;
• long, in many cases passes from time to time;
• does not give anywhere;
• not removed by nitroglycerin;
• occurs after acute respiratory infections, pneumonia, other diseases caused by microbes;
• accompanied by weakness, fever.

Mitral valve prolapse

Such a “bulging” of the valve into the left atrium (normally, its petals should open in systole and close tightly in diastole) either has a congenital cause, or develops after suffering rheumatism, myocardial infarction or myocarditis, against the background of lupus, IHD or other heart diseases.

Characterized by:

• not intense bursting heart pain;
• bouts of rapid heartbeat;
• interruptions in the work of the heart;
• dizziness;
• fainting;
• nausea;
• sensation of "coma" in the throat;
• increased sweating;
• due to insufficient blood supply to the brain, a person with mitral valve prolapse is prone to depression, periods of bad mood.

Dissecting aortic aneurysm

This is the name of the condition when in the aorta - the largest vessel in which the highest pressure, an expansion occurs - an aneurysm. Then, against this background, between the layers that form the wall of the aneurysm, an accumulation of blood appears - a hematoma. It "creeps" down, peeling the layers of the aortic wall from each other. As a result, the vessel wall becomes weak and can be torn at any time, causing massive bleeding.

A dissecting aneurysm rarely occurs "by itself", most often it is preceded by a period when a person has constantly high blood pressure, or he suffers from atherosclerosis, when plaques form in the aorta, or syphilis or Marfan's syndrome becomes the cause of the condition.

Pain from a dissecting aortic aneurysm:

• strong;
• located behind the upper part of the sternum;
• can give to the neck, lower jaw;
• can be felt throughout the chest;
• lasts from several hours to several days;
• not removed by nitroglycerin;
• may be accompanied by a blue face and swelling of the jugular veins located on the lateral surfaces of the neck.

Aortitis

This is the name of the inflammation of all three (panaortitis) or parts (endoortitis, mesaortitis, peraortitis) of the membranes of the thoracic aorta. The cause of the disease can be:

• infection (streptococcus, syphilis, tuberculosis, brucellosis);
• autoimmune diseases (Takayasu's disease, collagenosis, Bechterew's disease, thromboangiitis obliterans);
• inflammation can "pass" from inflamed organs located near the aorta: with pneumonia, lung abscess, infective endocarditis, mediastinitis.

The disease is manifested by a group of symptoms: some of them are signs of the underlying disease, others are manifestations of impaired blood supply to internal organs or the brain, and still others are symptoms of direct inflammation of the aorta. The latter include:

• pressing and burning pains in the chest;
• most often - behind the handle of the sternum, but the pain can give to the left;
• give in the neck, between the shoulder blades, in the "pit of the stomach" area;
• the pulse on the carotid and radial arteries is not symmetrical, may be completely absent on one side;
• blood pressure may not be measured on one arm.

Endocarditis

This is the name of the inflammation of the inner shell of the heart, from which the valves are made, the chords of the main "pump" of a person. Pain in this disease rarely occurs - only in its later stages, when the patient performs physical activity or experiences a strong emotion. It is aching, not intense, it can give into the arm and neck.

Other signs of endocarditis are:

• rise in temperature, often to low numbers;
• body temperature drops and rises for no apparent reason;
• fever is accompanied by a feeling of cold or severe chills;
• skin is pale, may be sallow;
• nails thicken, becoming like glass in a watch;
• if you pull back the lower eyelid, some people can find pinpoint hemorrhages on the conjunctiva;
• small joints of the hands are affected;
• rapid weight loss;
• periodically dizzy and headaches, but in a horizontal position, these symptoms disappear.

Cardiomyopathy

There are 3 types of this disease, but pain in the region of the heart is typical only for the hypertrophic variant. The pain syndrome does not differ from that of angina pectoris, and even appears after physical exertion.

In addition to pain, hypertrophic cardiomyopathy manifests itself:

• shortness of breath;
• increased heart rate;
• cough;
• dizziness and fainting;
• swelling of the legs (see);
• increased fatigue.

Heart defects

They are either congenital in nature, or develop against the background of rheumatism. Heart pain most often accompanies only aortic stenosis - a decrease in diameter in the place where the aorta leaves the heart.

The pain syndrome in this case is constant, its character is pinching, stabbing, pressing. In addition, blood pressure often rises, swelling appears on the legs. There are no other signs specific to aortic stenosis.

Myocarditis

Inflammation of the heart muscle, which is most often a consequence of influenza or enterovirus infection, is also manifested by pain in the heart in 75-90% of cases. They have a stabbing or aching character, they arise both in connection with physical activity, and in a state of relative rest, after exercise. There are also increased fatigue, increased body temperature. Nitroglycerin does not help relieve pain.

Myocardial dystrophy

This is the name of a group of heart diseases in which the heart muscle is not inflamed and does not undergo degeneration, but the main functions of the heart associated with its contractility and rhythm suffer.

The disease can be manifested by a pain syndrome of a different nature. Most often, these are aching or aching pains that appear against the background of a feeling of heat or, conversely, increased chilliness of the limbs, sweating. In addition, weakness, fatigue, frequent headaches are noted.

Hypertonic disease

Constantly high blood pressure can be manifested not only by a headache, “flies” before the eyes, or a feeling of “tide”. In this case, pain may appear in the left half of the chest, which has an aching, pressing character or a feeling of "heaviness" in the chest.

These are, in principle, all heart diseases that may be accompanied by pain in the left side of the chest. There are much more non-cardiac pathologies that cause this symptom, and now we will analyze them.

Non-cardiac diseases

They are divided into several groups, depending on which organ system was the cause of this symptom.

Psychoneurological pathologies

Pain in the heart area may be due to cardioneurosis and cyclothymic states, which are identical in their manifestations. In these cases, despite the richness of symptoms, no pathology is detected during examination of the heart and internal organs. A person notes the following symptoms:

• pain in the left side of the chest appear in the morning before waking up or during it;
• attacks almost always occur when overheated, rather than on cold and windy days, as is the case with angina pectoris;
• it can be provoked by depression or a conflict situation;
• pain does not disappear if you stop or take nitroglycerin; it can last up to several days, or it can appear several times a day (up to 5), lasting for 1-2 hours. In this case, the nature of the pain can change each time;
• if you perform a few light physical exercises, it can relieve pain;
• the nature of the pain can be different: squeezing, heaviness, tingling, it can be described as an "emptiness" in the chest or, conversely, bursting. There may be a "pressing pain" or a syndrome of severe intensity, accompanied by a fear of death;
• pain radiates to the neck, both shoulder blades, can capture the right half of the chest, the region of the spine;
• you can accurately indicate the point at which maximum pain is noted;
• increased sensitivity of the left nipple;
• the condition worsens when experiencing any - positive or negative - emotions;
• during an attack, a person begins to breathe often and superficially, as a result of which the carbon dioxide content in the blood decreases, which is accompanied by dizziness, a feeling of fear, and can serve as the basis for the development of arrhythmia;
• with all the frequency and intensity of seizures, drugs such as Nitroglycerin or Anaprilin do not affect them; lasting for years, nor do they lead to the development of heart failure phenomena: shortness of breath, swelling in the legs, changes in the chest x-ray or ultrasound picture of the liver.

Patients with cardioneurosis are talkative, fussy, change body position during an attack, looking for a local remedy to help relieve pain. When taking Nitroglycerin, the effect does not occur after 1.5-3 minutes, as with angina pectoris, but almost immediately or after a long time. Such people are more effectively helped by drugs such as Valocordin, Gidazepam or valerian tincture.

Cardiopsychoneurosis- the second main pathology, in which there are no changes in either the function or the structure of the internal organs, but at the same time the person suffers from "heart" pains. They may be of this nature:

1. Localized in the area near the nipple, have a mild or moderate severity, last several minutes - several hours. Validol and nitroglycerin help relieve pain. This is the most common type of cardialgia.
2. To be aching or pressing, accompanied by an increase in blood pressure, fear, trembling, sweating, shortness of breath. You can remove such an attack with the help of Anaprilin (Atenolol, Metoprolol, Nebivolol) in combination with valerian or motherwort tincture.
3. Possess a burning character, be localized behind the sternum or to the left of it, accompanied by increased sensitivity of the intercostal spaces when they are probed. Nitroglycerin, validol or valocordin do not stop the attack. This is done by mustard plasters applied to the region of the heart.
4. Have a pressing, squeezing, aching character, localized behind the sternum, aggravated by walking and physical exertion.

Pain in diseases of the musculoskeletal system and nerve endings

Pain syndrome can occur with irritation of the nerves innervating the intercostal muscles, with inflammation of the costal and cartilaginous parts of the ribs

Neuralgia of intercostal nerves

The pain is constant, aggravated by breathing (especially a deep breath), tilting the body in the same direction. One or more intercostal spaces are painful. If intercostal neuralgia is caused by the herpes zoster virus, then in one intercostal space you can find bubbles filled with a clear liquid.

Apart from these pains, there are no other symptoms. Only if neuralgia is caused by the varicella-zoster virus, the temperature can be raised. In the case of a weakened organism, complications from the nervous system may occur: meningitis, encephalitis.

Myositis of the intercostal muscles

In this case, there are pains in the muscles of the heart area. It intensifies with a deep breath and when the body tilts in a healthy direction. If you start to feel the affected muscle, pain is felt.

Shoulder-costal syndrome

In this case, the pain occurs under the scapula, radiates to the neck and shoulder girdle (what we used to call the “shoulder”), the anterior-lateral part of the chest wall. The diagnosis is made quite simply: if the patient puts his hand on the opposite shoulder, then at the upper corner of the scapula or at the spine in this place you can feel the point of maximum pain.

Interscapular pain syndrome

This condition occurs when the complex of structures located between the shoulder blades is inflamed: muscles, ligaments and fascia. It begins with the appearance of heaviness in the interscapular zone. Then a pain syndrome develops, which has a breaking, boring, burning character. Its intensity increases during emotional stress, during a night's sleep, when breathing and turning the body, it radiates to the neck, shoulder, forearm and arm. What distinguishes the syndrome from intercostal neuralgia and heart pain is that pain points can be found in the area of ​​the scapula, and the intercostal muscles are painless.

Inflammation of the costal cartilage (chondritis) on the left side

It is manifested by the appearance of swelling of one of the cartilages; she is sick. After a while, the edematous area softens, it can open with the release of pus. In this case, the temperature may rise to subfebrile numbers. Even after opening the abscess in the area of ​​the inflamed rib, pain persists, which can disturb for 1-3 years.

Tietze syndrome

This is the name of a disease of unknown cause, in which one or more costal cartilages become inflamed at the point where they connect to the sternum. The syndrome is manifested by pain in the localization of inflammation, which is aggravated by pressing on this area, sneezing, movements, and also with deep breathing.

The disease proceeds with periods of exacerbation, when all symptoms appear, and remissions, when a person feels healthy.

Injuries, fractures, bruises of the ribs

If an injury was inflicted, and then pain is noted in the chest, it is impossible to differentiate by symptoms whether it is a bruise or a fracture. Both of these pathologies are manifested by severe pain that extends to the entire chest; it gets worse with breathing. Even if it was a fracture and it healed, chest pain will still be noted for some time.

Tumor of one of the ribs on the left - osteosarcoma

It can appear in people of any age. Oncopathology is manifested by a pain syndrome localized in the region of the ribs. It intensifies at night, is characterized by a pulling character. In the later stages, swelling is noted in the area of ​​the affected rib.

Osteochondrosis

When squeezing the bundles of the spinal nerves on the left, pain appears in the region of the ribs. She is:

• aching;
• constant;
• changes intensity with a change in body position;
• increases with physical exertion, overheating, drafts and hypothermia;

Additional symptoms are:

• tingling and numbness in the left arm,
• her muscle weakness
• there may be pain in the left arm,
• which has three distribution options:
  • along its outer surface to the thumb and forefinger;
  • on the inner, closest to the little finger, area of ​​\u200b\u200bthe hand;
  • along the back-outer part, heading towards the middle finger - this will depend on which of the roots is pinched.

Osteoporosis

This is the name of the pathology in which the bones (including the ribs) are too low in calcium. It occurs due to its insufficient intake, poor absorption or increased destruction.

The pathology is asymptomatic, you can find out about it if you perform an ultrasound densitometry of the ribs (find out their density). The first symptoms appear when small cracks appear on the ribs or such fractures that appear when the body is tilted or sharply turned. During such movements, a strong, sharp pain usually appears in the region of the ribs, which then persists even when the position of the body changes.

Herniated disc

This pathology - akin to osteochondrosis, is associated with malnutrition of the intervertebral disc with its subsequent destruction. Only in the case of a hernia, that part of the disk that cannot be destroyed begins to protrude beyond the vertebrae and compress the nerves passing there.

Hernia manifests itself as a pain syndrome:

• growing gradually;
• intensifying to the most pronounced degree, leading even to loss of consciousness;
• gives to the neck or arm, where it has a shooting character.

Symptoms can be confused with myocardial infarction. The main difference is the fact that with a herniated disc, the general condition of a person does not suffer.

fibromyalgia

This is the name of chronic musculoskeletal pain that occurs for no apparent reason in symmetrical areas of the body. In this case, the pain syndrome appears after stress or emotional trauma. The ribs hurt not only on the left, but also on the right, the pain is aggravated by rain and a similar change in weather conditions.

A person notes a feeling of stiffness in the chest, complains of poor falling asleep, periodic headaches. Decreased coordination of his movements; quality of life suffers.

Musculoskeletal syndrome

This disease is not rare. Its cause is an injury to the soft tissues of the chest (in this case, on the left), in which blood enters the muscles, sweats out its liquid part and deposits the fibrin protein, which the blood needs to ensure the clotting process. As a result of such impregnation of the muscles, their tone rises sharply, which causes pain syndrome, described as "in the muscles" or as "in the ribs", of varying intensity, which changes with movement.

All of the above diseases from the described group, there is pain in the ribs. This symptom will also be noted with pleurisy, pleural tumors and cardioneurosis. We will talk about diseases of the pleura a little lower.

When the cause is in the disease of one of the internal organs

Pain syndrome, localized near the heart, can be caused by pathology of the lungs and pleura, in which they are wrapped. It can occur due to diseases of the mediastinal organs - that complex of organs that is located between the two lungs, next to the heart. Diseases of the esophagus, stomach, gallbladder and liver can also cause pain resembling heart pain.

lung disease

1. Pneumonia. Most often, the area of ​​\u200b\u200bthe heart will hurt if an entire lobe (croupous pneumonia) of the lung is inflamed. Less often, "cardialgia" will be noted with pneumonia of a focal nature. The pain syndrome is stabbing in nature, aggravated by inhalation and coughing. In addition, there is fever, weakness, cough, nausea, lack of appetite.
2. Lung abscess. In this case, fever, lack of appetite, nausea, muscle and bone pain come to the fore. The pain syndrome to the left of the sternum differs in intensity, especially it increases if the abscess is about to break through into the bronchus. If the abscess is located near the chest wall, pain will increase when you press on the rib or intercostal space.
3. Pneumoconiosis is a chronic disease caused by the inhalation of industrial dust, which the lungs try to delimit from healthy areas with the help of connective tissue. As a result, the respiratory zones become smaller. The disease manifests itself as shortness of breath, cough, pain in the chest of a stabbing character, which radiates to the interscapular region and under the shoulder blade. The progression of the disease is characterized by fever up to 38 degrees, weakness, sweating, weight loss.
4. Tuberculosis of the lung. Chest pain in this case appears only when the specific inflammation characteristic of the tuberculous process extends to the pleura enveloping the lungs, or the chest wall (rib-muscular frame). Prior to this, attention is paid to weight loss, sweating, lack of appetite, increased fatigue, subfebrile temperature, cough. The pain syndrome is aggravated by breathing, coughing, pressing on the chest.
5. Tumor of the lung. There is constant pain of a different nature: aching, pressing, dull, burning or boring, aggravated by coughing and deep breathing. It can give to the shoulder, neck, head, stomach; may radiate to the right side or be encircling.
6. Pleurisy is an inflammation of the pleura, that is, the membrane that covers the lungs. It is almost always a complication of pneumonia, lung tissue tumors or injuries. If left-sided pleurisy develops, the pain syndrome can be localized in the region of the heart. It is associated with breathing, and is also aggravated by coughing. In addition, there is an increase in temperature, shortness of breath.
7. Pneumothorax. This is the name of the condition in which air enters between the pleura and the lung. It is incompressible, therefore, with an increase in its volume, it compresses the lung, and then the heart with blood vessels. The condition is dangerous, requires urgent hospitalization. Pathology is manifested by stabbing pain on the side of the lesion. She gives in the arm, neck, behind the sternum. Increases with breathing, coughing, movements. May be accompanied by fear of death.

Mediastinal pathologies

There are not very many of them:

• Pneumomediastinum (mediastinal emphysema)- the ingress of air into the fatty tissue, which is located around the heart and blood vessels. It occurs as a result of injury, damage during surgery or purulent fusion of air-containing tissues - the esophagus, trachea, bronchi or lungs. Symptoms: a feeling of pressure behind the sternum, difficulty breathing, shortness of breath.
• Pulmonary embolism. This is a life-threatening condition characterized by sudden, sharp pain behind the sternum, which is aggravated by taking a deep breath and coughing. Shortness of breath, palpitations, loss of consciousness are also noted.
• Tracheitis is an inflammation of the mucous membrane of the trachea. It is manifested by cough, dry burning pain behind the sternum.
• Spasm of the esophagus. The symptoms of this condition are difficult to distinguish from an attack of angina pectoris: the pain syndrome is localized behind the sternum, in the region of the heart and scapula, and is relieved by nitroglycerin.

Diseases of the abdominal organs

The following pathologies can cause pain similar to heart:

1. Esophagitis is inflammation of the lining of the esophagus. It is characterized by a burning sensation behind the sternum, which is aggravated by swallowing especially hard, hot or cold food.
2. Achalasia cardia is the expansion of the esophageal opening of the stomach. Retrosternal pain syndrome is associated with food intake. Heartburn and nausea are also noted.
3. hiatal hernia. Pain syndrome appears or intensifies after eating, as well as in a horizontal position. The pain goes away with a change in body position.
4. Peptic ulcer of the stomach or duodenum. The pain in this case either occurs on an empty stomach, or 1-2 hours after eating. Heartburn is also noted.
5. Exacerbation of chronic cholecystitis most often accompanied by pain under the ribs on the right, but can also be given to the left half of the chest. In addition, there is bitterness in the mouth, loosening of the stool.
6. Exacerbation of chronic pancreatitis if the inflammation is localized in the tail of the pancreas, in addition to nausea, vomiting and loosening of the stool, it is accompanied by pain in the left side of the chest.

Diagnosis depending on the characteristics of pain

We examined pathologies that cause pain syndrome localized in the left half of the chest. Now let's look at what pain each of them gives.

It's a dull pain

Aching pain is typical for:

• angina;
• myocarditis;
• cardioneurosis;
• peptic ulcer of the stomach and duodenum;
• scoliosis;
• osteochondrosis of the thoracic spine;
• exacerbation of pancreatitis.

The stabbing nature of the pain syndrome

Stinging pain occurs when:

• myocardial infarction;
• pericarditis;
• cardioneurosis;
• hypertrophic cardiomyopathy;
• neurocirculatory dystonia;
• intercostal neuralgia;
• pneumonia;
• pleurisy;
• tuberculosis;
• shingles;
• cancer of the lung or bronchus.

Pressing character

Pressing pain can be a manifestation of:

• angina;
• myocarditis;
• mitral valve prolapse;
• pericarditis;
• foreign body of the esophagus (in this case, the fact of swallowing some inedible object, for example, a fish bone is noted);
• cardiomyopathy;
• myocardial dystrophy;
• heart tumors (eg, myxoma);
• poisoning with drugs, alcohol, drugs, phosphorus-organic compounds, poisons. In this case, there is the fact of taking drugs, alcohol, treating plants from pests, and so on;
• ulcers in the stomach at the junction with the esophagus.

If the nature of the pain is sharp

The word "sharp pain" is usually used only to describe myocardial infarction. In addition to cardialgia of a similar nature, there is a general deterioration in the condition, cold sweat, fainting, heart rhythm disturbance. Irradiation of cardialgia - in the left shoulder blade, arm.

If the pain feels like "severe"

Severe pain occurs when:

• myocardial infarction;
• osteochondrosis of the cervical and thoracic regions;
• intercostal neuralgia, especially caused by herpes zoster;
• thromboembolism of the pulmonary artery;
• rupture of a dissecting aortic aneurysm;
• myocarditis.

Pain is felt all the time or most of the time

Constant pain is characteristic of osteochondrosis. At the same time, there is no deterioration in the condition, but “goosebumps” and numbness in the left hand, a decrease in its strength, may be noted. A similar complaint is described and pericarditis - inflammation of the outer shell of the heart - the heart bag. It is also characterized by general malaise and fever. Pericarditis can also be a source of frequent pain that goes away from time to time. This is how you can describe the pain syndrome with menopause or anxiety disorders.

Pain syndrome of blunt nature

If a dull pain is felt in the region of the heart, it may be:

• anterior chest wall syndrome;
• arterial hypertension (in this case, high blood pressure is recorded);
• overload of the intercostal muscles, for example, during very active physical training or playing wind instruments for a long time.

Sharp pain in the region of the heart

Acute pain is observed with pleurisy or pericarditis. Both diseases are characterized by fever and weakness.

Nagging pain

It is typical for:

• thrombosis;
• neuro-circulatory dystonia;
• angina;
• osteochondrosis;
• diseases of the gastrointestinal tract.

Pain syndrome of a burning character

Such a symptom is noted with myocardial infarction, in which case there will be a sharp deterioration in the condition, there may be clouding of consciousness due to pain shock. Pain in neurosis is described in the same way, when psycho-emotional disorders come to the fore.

Diagnosis depending on the conditions for the occurrence of pain syndrome and associated symptoms

Consider additional characteristics of the pain syndrome:

1. If the pain radiates to the shoulder blade, it can be: angina pectoris, spasm of the esophagus, myocardial infarction, cardioneurosis.
2. When the pain increases with inspiration, this indicates: intercostal neuralgia, pleurisy or myositis of the intercostal muscles. When the intensity of the pain syndrome increases with a deep breath, it can be: pneumonia or pulmonary embolism. In both cases, there is a deterioration in the general condition, but with inflammation of the lungs this happens gradually, and with PE, the count goes on for minutes.
3. If the pain syndrome increases with movement, this may be a sign of osteochondrosis of the cervical or thoracic region.
4. When arm radiating pain appears, a person may have one of the following conditions:
   • osteochondrosis;
   • myositis of the intercostal muscles on the left side;
   • myocardial infarction;
   • angina;
   • interscapular pain syndrome;
   • endocarditis;
   • pneumothorax.
5. When the pain syndrome is accompanied by shortness of breath:
   • myocardial infarction;
   • pneumothorax;
   • pulmonary embolism;
   • pneumonia;
   • ruptured aortic aneurysm.
6. If both weakness and pain in the region of the heart appear, it may be tuberculosis, pleurisy, pericarditis, dissecting aortic aneurysm, pneumonia.
7. The combination "pain + dizziness" is typical for:
   • mitral valve prolapse;
   • cardiomyopathy;
   • cardioneurosis;
   • osteochondrosis or hernia of the cervical region, accompanied by compression of the vertebral artery.

What to do with cardialgia

If you have pain in the heart area, what to do:

• Stop performing any action, take a semi-lying position, put your legs just below the body (if there is dizziness - above the position of the body).
• Unfasten all interfering clothes, ask to open the windows.
• If the pain is similar to that described for angina pectoris, take "Nitroglycerin" under the tongue. If the syndrome is stopped by 1-2 tablets (they act within 1.5-3 minutes), on the same day or the next, contact a therapist to diagnose coronary heart disease and prescribe appropriate treatment. You can’t drink more pills - from them, among other things, pressure decreases (P.S. headache after taking nitroglycerin is a normal phenomenon, it is removed by Validol or Corvalment, which contain menthol).
• If nitroglycerin did not help, and at the same time there is difficulty in breathing, weakness, fainting, severe pallor - call an ambulance, be sure to indicate that there is pain in the heart. You can first drink an anesthetic tablet: Diclofenac, Analgin, Nimesil or another.
• If the pain in the region of the heart disappeared after you stopped, this condition requires an early diagnosis using an ECG and ultrasound of the heart. Not paying attention threatens to aggravate the situation with the development of heart failure.

Treatment is prescribed only by a doctor - based on the results of the examination. Self-medication is unacceptable, since the diseases manifested by this symptom are radically different. Self-medicating, for example, osteochondrosis, which actually turns out to be myocarditis, can lead to the development of heart failure, when any wrong movement will be accompanied by shortness of breath, a feeling of lack of air and swelling.

Thus, pain syndrome localized in the region of the heart can be caused not only by heart diseases. Much more often, its causes are pathologies of the ribs and intercostal muscles, spine, esophagus and stomach. In order to start moving towards a diagnosis, you need to state your complaints to the therapist. The doctor will either sort out the problem on his own, or refer you to the right specialist. This will be a better solution than to undergo examinations on your own, wasting time and money.

Pain in the chest area can be a reason to suspect diseases and disorders of varying severity and risk to the general health of the patient. First of all, when a sharp pain behind the sternum appears, people suspect the worst thing - a heart attack. Of course, chest pain is not a phenomenon that should be ignored, but in addition to a heart attack, there are many more possible pathologies that cause pain.

Pain in the chest area can be caused by pathologies in the lungs, esophagus, muscles, ribs or nerve plexuses. And only some of these conditions are serious and life-threatening, the rest are not a serious cause for concern. However, in any case, if the pain intensifies or recurs, a visit to the doctor is necessary.

If a patient presents with chest pain, our first priority is to identify the underlying cause.

To do this, it is necessary to conduct a full-fledged examination, the features of which may vary, depending on what kind of complaints a person has, his physiological parameters, health status and previously transferred or currently existing concomitant diseases.

Basically, the diagnosis includes: laboratory diagnostic studies, electrocardiogram, chest X-ray, MRI of the chest.

In addition, additional consultation of highly specialized specialists may be required to clarify the diagnosis.

Types of chest pain

As a rule, the sensation can spread all over the area from the neck to the upper abdomen.

Depending on the cause, pain can be characterized by:

• Suddenly appearing, sharp, depending or not on the position of the body or physical activity.
• Dull or sharp, cutting pains.
• Persistent burning sensation in the chest.
• Slight but constant pain.
• Pains that change their character and strength are intermittent.

The specific localization of pain sensations, as a rule, does not specify the cause of their appearance. This is due to the fact that large nerve trunks are often involved in the process, serving as a thread of sensory transmission to other areas. Pain that spreads to areas remote from the pathological focus is called irradiating pain. However, in some cases, the descriptive nature of the pain may actually provide some information for the diagnostician.

According to the patient, the pain may be of the following nature:

1. Pain behind the sternum, radiates to the back.
2. Why does chest pain radiate to the arm?
3. Chest pain with shortness of breath.
4. Pain in the chest on the left or right.
5. Pain in the chest when inhaling, if it hurts to breathe.
6. Why does chest pain occur when coughing?

As a rule, pain associated with the respiratory process is related to the upper respiratory tract and lungs, however, this phenomenon is not always visible - coronary heart disease can also provoke severe pain during inhalation or during the cough reflex.

Diseases in which it hurts in the chest: in the middle, on the right, on the left

One of the most dangerous causes of discomfort in the chest area are disorders in cardiac activity. Causes of pain in heart disease can be as follows.

Ischemic heart disease or ischemic heart disease

Reason - blockage of the heart blood vessels, which causes a decrease in blood flow pressure and, as a result, stimulates oxygen deficiency of the heart muscle itself. This phenomenon can cause severe pain, known as angina pectoris.

Such symptoms indicate disorders in the work of the heart, but, as a rule, do not cause irreversible damage to the tissues of the organ. However, such processes are a sign that the patient may develop a heart attack at some point in the future.

Ischemic heart pain can spread to:

• Left hand.
• Shoulder.
• Jaws.
• Give back.

The patient feels well the pulsation as pain. Angina can be triggered by increased physical activity, excitement, or emotional stress. Pain usually subsides at rest.

myocardial infarction

At the heart of the pathology is a sharp decrease in blood flow through the heart blood vessels, which causes acute oxygen deficiency and subsequent death of heart muscle cells. Although the pain is similar to angina pectoris, in a heart attack it is usually more severe, throbbing, located in the center or left side of the chest and not relieved by rest. Associated symptoms will include:

• Sweating.
• Nausea.
• Labored breathing.
• Increased weakness in all muscles.

Myocarditis

Inflammation of the heart muscle. In addition to persistent, throbbing chest pain, you may experience:

• Fever.
• Fatigue.
• Rapid heartbeat.
• Breathing problems.

Although there is no destruction in the myocardium, the pain symptoms of myocarditis can resemble those of a heart attack.

Pericarditis

Inflammation of the pericardium, the thin membrane that surrounds the outside of the heart. Often infectious. Pericarditis causes pain similar to angina pectoris. However, there may be sharp, sustained manifestations along the top of the neck to the muscles of the shoulder. Sometimes the pain is aggravated by breathing, swallowing or lying down.

Hypertrophic cardiomyopathy

This genetic disorder causes the heart muscle to grow abnormally in thickness.. Sometimes this leads to problems with pumping blood to the heart. Chest pain and difficulty breathing often occur with increased exercise.

Over time, cardiomyopathy causes the development of heart failure, when the heart muscle becomes very thickened, and then becomes thinner and loses tone . This phenomenon increasingly burdens the work of the heart when pumping blood. Along with chest pain, this type of cardiomyopathy can cause dizziness, thought disturbances, fainting, and other symptoms.

Mitral valve prolapse

Mitral valve prolapse is a pathological condition in which a valve in the heart cannot close properly. A variety of symptoms are associated with this heart condition, including chest pain, palpitations, and dizziness, although sometimes the disease is asymptomatic, but with age it will certainly lead to heart failure.

Ischemic rupture of the heart arteries

A variety of factors can lead to this rare but deadly disease, which is based on coronary artery embolism. A sudden blockage of an artery can lead to sudden, severe, tearing pain that radiates up into the neck, as well as into the back and abdomen.

Causes of pain in lung diseases

Inflammation or irritation of the mucosal part of the two-layer film located between the lung and chest. Pleurisy, especially of an infectious nature, is characterized by severe pain at the time of breathing, coughing or sneezing. The most common causes of chest pain in pleurisy are bacterial or viral infections, pulmonary embolism, pneumothorax, or hydrothorax. Other, less common causes include rheumatoid arthritis, lupus, and cancer.

Pneumonia or lung abscess

These infections in the lungs can lead to pleurisy and other types of chest pain, characterized by sensations deep in the chest, directly dependent on the processes of inhalation and exhalation. Pneumonia often comes on suddenly, causing the temperature rises sharply, chills, cough, often mixed with pus and blood.

Pulmonary embolism

When a blood clot travels through the blood and becomes lodged in small blood vessels in the lungs, it can lead to acute pleurisy, breathing problems and heart palpitations. Fever and shock are also possible. Pulmonary embolism is most often caused by deep vein thrombosis, a separate disease, most often in the lower extremities or after an immobile lying position is abruptly changed within a few days after surgery. Thrombosis is often the result of complications of cancer.

Pneumothorax

A frequent result of trauma to the chest is pneumothorax - air entering the pleural cavity from the external environment, or due to partial destruction from the lungs. The compression effect that has arisen in the pleural cavity has a pressing effect on the rest of the lungs and provokes, thereby, severe pain, usually during inhalation. A common accompanying symptom of this condition is low blood pressure.

Pulmonary hypertension

Characterized by chest pain resembling angina pectoris due to abnormally high blood pressure in the arteries of the lungs, which greatly complicates the work of the right side of the heart.

Asthma

Shortness of breath, wheezing, coughing, and sometimes chest pain are common clinical signs of asthma.

Causes of pain in diseases of the gastrointestinal tract

Gastroesophageal reflux disease (GERD)

Also known as acid reflux. Symptoms of GERD are manifested at the time of the return of the contents of the stomach into the lumen of the esophagus. This phenomenon can lead to a sour taste in the mouth and a burning sensation in the chest and throat, a phenomenon better known as. Factors that can cause heartburn include obesity, smoking, pregnancy, and eating large amounts of spicy or fatty foods. Heart pain and acid reflux heartburn pain are similar in part because the heart and esophagus are close together and share a network of nerves.

Hypersensitivity of the esophagus in relation to the mechanical effects of the food coma and gastric acid, with reflux, can also give pain sensations that vary in strength and character and, as a rule, occur during meals.

Esophageal contraction disorders

Uncoordinated muscle contractions (spasms) and high pressure of the food bolus on the walls of the esophagus can provoke the development of intermittent chest pain.

Rupture of the esophagus

Sudden, severe chest pain followed by vomiting can be signs of rupture of the walls of the esophagus.

Peptic ulcer of the stomach and duodenum

Disease is often the source radiating pain in the sternum and can be given to the back. Stomach ulcers often occur in people who smoke, drink a lot of alcohol, or take painkillers such as aspirin or non-steroidal anti-inflammatory drugs. Pain is often relieved with meals or antacid medications.

hiatal hernia

This common pathology occurs when the upper part of the stomach penetrates into the lower part of the chest after eating. The process often leads to reflux symptoms, including heartburn or chest pain. Pain tends to worsen when lying down.

Pancreatitis

Inflammation of the pancreas is characterized pain in the lower chest worse lying down and bending forward.

Gallbladder problems

After eating fatty foods feeling of heaviness or pain in the right lower chest or right upper abdomen. It is these symptoms that can be caused by disorders of the functionality of the gallbladder.

Diseases of other organs and systems that cause chest pain

Sometimes chest pain can be the result of excessive pressure or blunt trauma to the chest area from a fall or accident. Viruses can also cause chest pain.

The pain from intensifies, usually with deep breathing or coughing. The sensations are often limited to one area and intensify when pressed. The area of ​​the fracture is characterized by signs of inflammation on the outside of the chest.

Increased tone of the intercostal muscles

Deviation provokes severe pain even with a slight cough. The disorder occurs, as a rule, in diseases associated with inflammation - intercostal neuralgia, myositis and others. B The pains are aggravated at the time of physical activity and acquire a aching character at night.

smallpox virus

Causes the formation of shingles, can cause a sharp surge in pain before the main symptoms of the rash appear after a few days.

Anxiety and panic disorders

This is another potential cause of chest pain. These pathologies belong to the group of psychopathological conditions and directly depend on the emotional state of the patient. Some associated symptoms may include:

• Dizziness.
• Feeling short of breath.
• Palpitation.
• Tingling in chest.
• Trembling in the region of the heart.

When to See a Doctor for Chest Pain

If doubts prevail, it is worth consulting a doctor for manifestations of any pain in the chest area, especially if it is a sudden manifestation of indomitable pain that does not respond to the use of painkillers.

In addition, it is imperative to go to the hospital if any of these symptoms are present along with chest pain:

• Sudden feeling of pressure, constriction, heaviness under the sternum and a feeling of lack of air.
• Pain in the chest that radiates to the jaw, left arm, or radiates to the back.
• Sudden sharp pain in the chest with shortness of breath, especially after a long period of inactivity.
• Nausea, dizziness, fast heart rate or rapid breathing, confusion, ashy skin or excessive sweating.
• Very low blood pressure or very slow heart rate.

Cardiovascular diseases today occupy a leading position among the dangerous and common diseases in the world.

At the heart of such diseases, a genetic predisposition is most often distinguished, as well as an incorrect lifestyle.

There are many cardiovascular diseases and they proceed differently: they can occur as a result of inflammatory processes in the body, intoxication, injuries, birth defects, metabolic disorders, etc.

However, the variety of reasons for the development of these diseases is connected by the fact that their symptoms can be common.

Chest pain as a harbinger of heart disease

A symptom such as an unpleasant feeling of discomfort and pain in the chest area may portend a violation of the heart and blood vessels.

If the pain is burning in nature, then this condition indicates a spasm of the coronary vessels, leading to malnutrition of the heart. This kind of pain in medicine is called angina pectoris.

There are such pains as a result of:

• physical activity,
• at low temperature,
• often in stressful situations.

The phenomenon of angina pectoris occurs when the blood flow ceases to satisfy the needs of the heart muscle masses for oxygen supply. In people, angina pectoris is called "angina pectoris". The doctor recognizes such a disease literally at the first visit of the patient.

Diagnosing abnormalities in this case is difficult, because to make the correct diagnosis, it is necessary to monitor the development of angina pectoris and additional examinations (for example, daily ECG monitoring). There is a difference between angina pectoris and angina at rest.

1. rest angina. Usually not associated with physical activity, shares characteristics with severe angina attacks, and may be accompanied by a feeling of shortness of breath. Often occurs at night.
2. angina pectoris. Attacks of such angina pectoris occur almost with a certain frequency, which is provoked by the load. When the load decreases, the seizures stop.

However, they also distinguish unstable angina, which is dangerous for the development of myocardial infarction. Patients with an unstable form of angina pectoris are necessarily hospitalized.

Heart disease causing chest pain

According to the patient's description of the sensations of pain in the chest area, an experienced doctor draws a conclusion about the nature of the disease. The cardiovisor device in such cases helps to determine whether this deviation is associated with a disease of the cardiovascular system.

Diagnosis of chest pain

Clarification of the duration, localization, intensity and nature of chest pain, as well as reducing and provoking factors is very important.

Previous abnormalities in the work of the heart, the use of potent drugs that can cause spasms of the coronary arteries (for example, cocaine or phosphodiesterase inhibitors), as well as the presence of a pulmonary embolism or a risk factor for coronary heart disease (travel, pregnancy, etc.) are of considerable importance.

A burdened family history increases the possibility of developing coronary artery disease, but it makes no sense to specify the causes of acute pain.

Additional research methods

The minimum examination of a patient with chest pain may consist of:

• pulse oximetry,
• chest x-ray.

For adults, screening for markers of myocardial tissue damage can be done. The effectiveness of such tests with anamnesis data, as well as an objective examination, make it possible to form a preliminary diagnosis.

At the initial examination, a blood test may not be available. If the indicators of the markers indicate damage to the myocardium, then they cannot ascertain about the damage to the heart.

Diagnostic sublingual nitroglycerin tablets or liquid antacids cannot reliably differentiate between gastritis, GERD, or myocardial ischemia. Each of these medical drugs is able to reduce the signs of disease.

Treating chest pain

Medical and therapeutic treatment of chest pain is carried out in accordance with the diagnosis.

If the causes of chest pain are not fully understood, the patient is taken to the hospital for an in-depth examination, to monitor heart conditions. Of the drugs, only opiates can be prescribed until a correct diagnosis is made.

Prevention of heart disease

To prevent the occurrence of heart ailments, doctors have developed several recommendations:

1. Walk more, regularly do feasible and simple physical exercises. It is not recommended to start physical exercises with the greatest loads, and before starting such training, it is imperative to consult with doctors so that the chosen program will only benefit the body.
2. Try to maintain an optimal body weight.
3. It is imperative to keep under control possible factors for the development of atherosclerosis, for example, high blood pressure, the amount of cholesterol, etc.
4. Nutrition should always be regular and complete, more protein food and vitamins with minerals should be in the diet.
5. It is recommended to visit a doctor regularly and carry out the necessary laboratory tests.
6. Remember the golden rule of health: it is always easier to prevent a disease than to treat it later.

Prognosis of symptom of chest pain

Predicting a symptom that subsequently develops into a cardiovascular disease is very difficult. The fact is that it all depends on the provision of first aid to the patient.

When something hurts, we try by all means to alleviate the condition and get rid of the pain. But it is not always possible to achieve the desired effect, and the reason for this is the lack of necessary knowledge. In order not to get lost in such situations, one must not only be able to determine the possible cause of the disease, but also know what measures should be taken.

Most often, people are concerned about pain behind the sternum in the middle, which can be either the result of ordinary indigestion or a sign of the development of a dangerous disease. Having studied the symptoms of the most common diseases, you will know exactly what to do: undergo an examination at the clinic, solve the problem yourself, or call an ambulance at home.

Most often, pain behind the sternum is associated with problems of the cardiovascular system. And in most cases, such assumptions are fully confirmed during the survey. Some forms of ischemic disease and aortic aneurysm are distinguished among the most serious pathologies.

Ischemia of the heart

IHD (ischemic heart disease) is one of the most common causes of disability and death. Its development provokes a lack of oxygen in the heart muscle due to the narrowing of the coronary arteries. Despite all the advances in medicine, no means have yet been found to completely cure coronary artery disease. All known methods of treatment can only control the disease and slow down the development process. Depending on the degree of lack of oxygen and its duration, there are several forms of cardiac ischemia.

Forms of coronary artery disease have different duration, intensity of development, often combined with each other. Depending on the individual characteristics of the organism, the course of the disease is acute or chronic.

Symptoms of the disease:

• dull, pressing or sharp burning pain behind the sternum, radiating into the arm, under the shoulder blade, into the neck;
• shortness of breath during walking, climbing stairs, other physical exertion;
• frequent heartbeat, irregular heartbeat;
• increase in pressure;
• headache;
• the appearance of edema;
• pallor of the skin.

If you experience pain for the first time, you must immediately stop moving, sit down, and even better lie down and try to calm down, even out your breathing. If the room is cold, you need to cover yourself with a blanket, as hypothermia can also cause heart attacks. The pain usually goes away on its own within a minute.

For repeated attacks, it is advisable to have nitroglycerin on hand. As soon as the pain appears, you need to take a supine position, straighten up, put a pill under the tongue and hold until completely absorbed. If 5 minutes have passed and the pain has not disappeared, take another tablet. At one time, you can take no more than 5 tablets of nitroglycerin at five-minute intervals. If after that it does not get better, it is urgent to call an ambulance.

As a rule, pain manifestations of the chronic form of coronary artery disease are quickly removed with pills or drops. Aerosols act a little slower, but give a longer lasting effect.

Here it is very important to notice in time the moment when the disease begins to progress: seizures become more frequent, shortness of breath appears faster when walking, to eliminate pain, not 1, but 2-3 tablets are required. Having found such signs, it is necessary to be examined by a cardiologist as soon as possible.

Aortic aneurysm is a dangerous disease. It is an expansion of individual sections of the aorta due to the thinning of the vascular walls. As a result, pressure on the walls of the aorta increases, fibrous tissues stretch, rupture and hemorrhage occur. As a rule, without the provision of qualified assistance, a person dies.

Aneurysms almost always develop asymptomatically, and this process can take years. Only at a late stage, when the blood vessel increases significantly and presses on adjacent organs, the patient begins to be disturbed by attacks of pain in different parts of the body. It is possible to detect an aneurysm using x-rays and ultrasound, examining the patient for other diseases. A timely detected pathology must be urgently treated, since a rupture can occur at any time.

Symptoms:

• very sharp, deep pain behind the sternum of a pulsating nature;
• back pain along the spine;
• shortness of breath and cough;
• pale skin;
• a sharp decrease in pressure;
• pulse asymmetry;
• darkening in the eyes;
• dizziness and weakness.

Sharp pain, pallor, and other symptoms of an aneurysm

What to do in such a situation? First of all, you need to call emergency help. Before the arrival of the doctor, the patient should lie down so that the upper part of the body is raised. It is impossible to move, as well as take any drugs - this can increase the hemorrhage. All further actions are taken by the doctor, the patient is hospitalized and the operation is performed.

With heart pain, you should reduce the load, avoid stressful situations as much as possible, give up coffee and bad habits. It is advisable to always have medicines with you, because it is not known when an attack will occur. If suddenly there was no nitroglycerin at hand, you can chew 1 aspirin tablet. You can’t get up, strain, walk until the pain disappears completely. And even after that, it’s better to lie down a little calmly for a while.

If there is no one around, and there are no medicines either, and the symptoms of an attack are already manifesting, use a very effective and simple method. You need to take a deep breath and cough hard, as if getting rid of sputum. Again a strong breath and cough, and so every 2 seconds for several minutes in a row.

What it does: when you inhale, the blood is saturated with oxygen, and coughing accelerates its circulation, causing heart contractions. Very often, this technique allows you to normalize the heart rhythm even before the ambulance arrives.

Autonomic disorders are most often observed in children and adolescents, and the causes of their occurrence include psycho-emotional factors, perinatal lesions of the nervous system, and hereditary predisposition. Usually the disease is mild and treated on an outpatient basis. In rare cases, VVD acquires a severe degree, in which the patient's ability to work sharply decreases or is completely lost. Such patients are treated only permanently.

Symptoms:

• sudden attacks of retrosternal pain of a compressive or pressing character;
• cardiopalmus;
• suffocation;
• feeling of panic;
• pressure surges;
• low temperature;
• nausea and vomiting;
• stool disorders for no apparent reason;
• severe dizziness;
• sleep disorders;
• increasing lethargy;
• frequent depression.

Choking, panic, depression and other symptoms

In addition, many patients complain of constant cold feet and fingers, excessive sweating, and abdominal pain. During the examination, most of the physical parameters are within the normal range. Attacks can last from several minutes to several days, and the pain either increases or decreases. Usually the onset of an attack is preceded by a strong excitement or sudden physical exertion.

If you feel the approach of an attack, you need to take any sedative drug - validol, motherwort tincture, valerian, and find a quiet, calm place where you can lie down or at least sit comfortably.

Validol (Validol) - tablets

Try to breathe evenly and deeply, disconnect from all problems and external irritating factors. Self-massage of the head for several minutes helps to relieve tension. When the intensity of the attack begins to subside, you need to go out into the fresh air and walk a little - this will improve your well-being, reduce pain and tension. As soon as possible, it is necessary to be examined by a neurologist.

Pain in pathologies of the gastrointestinal tract

Pain in diseases of the stomach, intestines, certain types of hernias differ in nature from those of the heart, although they are localized in the chest area. Taking heart medications in this case has no effect, it can even aggravate the situation. To relieve a pain attack, you need to know what exactly causes it.

Diaphragmatic hernia

This type of hernia is characterized by the displacement of the peritoneal organs through the openings of the diaphragm into the chest cavity. Most often, this is part of the esophagus and the cardial part of the stomach, but intestinal loops can also be displaced. The cause of the pathology is congenital or acquired defects of the diaphragm, tissue weakness, regular overeating, hard work.

Symptoms:

• heartburn and frequent belching;
• moderate chest pain;
• fast saturation;
• vomit;
• rumbling and gurgling in the chest.

Heartburn, vomiting, pain behind the sternum - symptoms of diaphragmatic hernia

If the hernia is complicated by infringement, a person feels sudden pain in the left side of the sternum and abdomen, severe vomiting appears, and stool disorders may occur. This condition requires hospitalization and surgery. With a sliding hernia, surgery is not needed, the patient is simply prescribed a special diet with fractional nutrition, means to reduce acidity and reduce the production of gastric juice. In addition, it is necessary to exclude physical activity, wearing tight bandages or belts that squeeze the stomach and increase pressure inside the abdominal cavity.

To alleviate the condition, you should eat in small portions, sleep in a half-sitting position, putting 2 or 3 pillows under your head, and avoid sharp torso bends.

Take only those medicines prescribed by your doctor.

Gastritis and peptic ulcer disease are diagnosed in people of almost all age groups. With timely detection, these diseases can be successfully cured. One of the common symptoms of both pathologies is pain in the chest, the attacks of which are sometimes very painful. Pain is accompanied by other symptoms:

• dyspepsia;
• belching;
• severe heartburn;
• a feeling of fullness and burning in the stomach;
• irritability;
• tachycardia.

In case of an acute attack, it is best to call a doctor, in other cases, you can alleviate your well-being on your own. The most effective pain relievers are antacids, acid-neutralizing agents. These include Gastal, Rennie, Maalox, Almagel, Megalac and others.