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Dr. Leonid STERNIK
Cardiologist, cardiac surgeon

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Cardialgia

 
, medical expert
Last reviewed: 12.07.2025
 
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When pain is felt localized on the left side of the chest - where the heart is located, then when you see a doctor, the medical report will indicate cardialgia.

A symptom of a wide variety of diseases in the form of cardialgia (pain in the heart area) has the code R07.2 according to ICD-10.

Epidemiology

As a rule, medical statistics on the frequency of symptoms are not kept. However, cardialgia syndrome is in the area of increased attention of doctors of various specializations.

According to some data, in at least 80-85% of cases, the development of pain in the heart area is not associated with a violation of coronary circulation. Cardialgia due to osteochondrosis of the spine (cervical-thoracic region) accounts for, on average, up to 18-20% of cases.

But the most common are psychogenic pains in the heart region, as well as cardialgia in patients with VSD and neurocirculatory dystonia, intercostal neuralgia and GERD. [ 1 ]

Causes cardialgia

The causes of cardialgia, as well as the characteristics of its appearance (intensity and nature of painful sensations, presence or absence of heart rate disturbances, breathing problems, etc.), are quite numerous and varied, read the publications:

In addition, clinical symptoms felt as pain in the chest on the left or thoracalgia - pain in the chest, which occur in disorders of cardiovascular etiology, as well as in problems with some other organs and systems, are defined by specialists as cardialgia syndrome (cardialgic syndrome). [ 2 ]

The classification of cardialgia, which distinguishes between coronary and non-coronary pains, gives an idea of the origin of these pains. By the way, there is no single classification of this pain syndrome due to the terminological variants of its systematization.

Coronarogenic cardialgia is associated with impaired blood circulation in the vessels of the heart muscle - coronary (coronary) circulation insufficiency, and these include:

As the name suggests, non-coronary cardialgias have nothing to do with the heart vessels; another definition is functional cardialgia. In particular, this is:

  • cardialgia in myocarditis (inflammation of the heart muscle of any etiology);
  • cardialgia with pericarditis - an acute inflammatory process in the outer membrane of the heart (including tuberculosis);
  • heart pain in cardiomyopathy due to hypertrophic changes in the atria, as well as cardialgia against the background of remodeling of the myocardium of the left ventricle associated with thickening of the walls - hypertrophy of the left ventricle or post-infarction aneurysm of its wall;
  • cardialgia in case of heart defects and heart valve pathologies;
  • cardialgia in aortitis, aneurysm or aortic dissection.

Non-coronary reflex cardialgia is also non-coronary, including the following types:

Associated with dysfunctions of the autonomic nervous system and is one of the symptoms of vegetative-vascular dystonia autonomic cardialgia, cardialgia with VSD, with neurocirculatory dystonia (cardioneurosis). More details in the publication - Syndrome of vegetative dysfunction

Psychogenic or neurotic cardialgia accompanies depressive and obsessive states, psychoemotional overload, hypochondriacal syndrome and neurasthenia, anxiety and panic disorders.

In postmenopausal women, the level of sex hormones (estrogens) in the blood drops sharply, and some have high levels of the male hormone (testosterone) in the blood. This has a negative impact on the cardiovascular system of women over 50 and can manifest itself as dyshormonal cardialgia - with an increased risk of developing coronary heart disease. [ 4 ]

In cases where the cause of pain in the heart region cannot be determined, idiopathic cardialgia is determined.

Many of the listed reasons can cause cardialgia in a child, more details in the materials:

Risk factors

The risk of developing pain in the heart area is increased by factors such as high blood cholesterol and vascular atherosclerosis; arterial hypertension; diabetes and excess body weight; degenerative diseases of the spine (cervical-thoracic region); the presence of cardiovascular diseases, as well as psychovegetative and psychoneurotic disorders in the family history; chest trauma; old age, etc. [ 5 ]

Pathogenesis

Depending on the origin, the pathogenesis of cardialgic syndrome is also considered.

The innervation of the heart is provided by the thoracic cardiac branches, which extend from the left vagus nerve (nervus vagus). Sympathetic and vagal afferent nerve fibers respond to neurotransmitters produced by receptors involved in the transmission of pain (nociceptive) signals.

Thus, with angina pectoris or coronary heart disease, the sensation of pain appears as a result of the excitation of the chemo- and nociceptors of the heart (endings of afferent neurons) by neurotransmitters adenosine, acetylcholine, norepinephrine, substance P, etc. Then, electrical impulses by synaptic transmission enter the nerve plexuses of the spinal cord and the thoracic part of its trunk, and then - into the nuclei of the thalamus, which activates the corresponding areas of the cerebral cortex. [ 6 ]

Cardialgia associated with osteochondrosis is caused by the compressive effect of osteophytes that have extended beyond the vertebrae on the roots of the sympathetic ganglia of the spinal nerves.

And psychogenic cardialgia is a pathologically altered humoral and vegetative-visceral reaction of the limbic-reticular complex of the autonomic nervous system, like neurogenic pain of other localizations.

Complications and consequences

Possible negative consequences and complications concern diseases in which pain syndrome develops in this localization.

For example, with coronary heart disease, coronary circulation worsens and oxygen starvation of myocardial cells increases, aggravating its weakening and heart failure. Myocarditis is complicated by a disorder of the contractile function of the heart muscle and a disorder of the cardiac conduction system. With an aortic aneurysm, breathing becomes difficult, and in patients with myocardial infarction, cardiosclerosis develops and cardiogenic shock may occur. Read also - Myocardial infarction: complications.

Osteochondrosis of the spine can lead to its deformation, compression of the vertebral artery and the development of neurological complications.

Diagnostics cardialgia

All details, including the necessary tests and instrumental diagnostics, are given in the article: Diagnosis of pain in the heart area.

Differential diagnosis

Differential diagnosis is described in detail in the publication – Chest pain.

Particularly important is the differential diagnosis of pain in coronary heart disease and cardialgia not associated with coronary circulation disorders - in case of problems with the digestive organs, respiratory system, spine, etc.

In addition, it is necessary to differentiate the anxiety disorder called neurocirculatory asthenia, cardiophobia syndrome or Da Costa syndrome. What is the difference between cardiophobia and cardialgia? People with cardiophobia periodically complain of chest pain and rapid heartbeat - against the background of fear of a heart attack, cardiac arrest and death. They are convinced that they have heart disease, although repeated medical examinations confirm the absence of such. [ 7 ]

Who to contact?

Cardiologist

Treatment cardialgia

In case of coronary and non-coronary cardialgia, the etiological treatment, as well as the symptomatic treatment, cannot be the same.

If the pain syndrome is of cardiovascular origin (angina, coronary heart disease, infarction), then the medications used include:

  • nitrates – Nitroglycerin (Sustak);
  • drugs from the group of calcium channel blockers, such as Verapamil ( Finoptin, Veratard), Seplopin, Diacordin, etc.;

Agents that block beta-adrenergic receptors - Metoprolol, Medocardil (Carvedilol), Propranolol (Anaprilin);

  • anti-ischemic drugs, for example, Advocard;
  • antihypertensive drugs (Captopril, Lisinopril, Ramipril, etc.);
  • fibrinolytics (Streptokinase, etc.);

Valocordin (Corvalol), as well as Validol for cardialgia associated with angina pectoris, is used to relieve spasm of the coronary vessels and stop attacks.

More information in the materials:

Myocarditis and pericarditis of infectious etiology are treated with antibiotics, and inflammation is relieved with nonsteroidal anti-inflammatory drugs. NSAIDs are also prescribed for intercostal neuralgia, see - Tablets for neuralgia. [ 8 ]

Therapy for psychogenic cardialgia is carried out using neuroleptic drugs and antidepressants.

Read also:

Physiotherapeutic treatment is carried out, in particular:

Herbal treatment is also possible - using valerian root, motherwort herb, oregano, creeping thyme, sweet clover, carrot seeds, and hawthorn berries.

In cardiology, surgical treatment is performed - depending on the diagnosis - by stenting of coronary vessels, aortic bypass, heart valve replacement, pacemaker installation, and correction of heart defects. Rupture of an aortic aneurysm requires urgent surgical intervention.

Surgery may be required for a hiatal hernia. [ 9 ]

Prevention

Measures to prevent problems with the cardiovascular system include the prevention of arterial hypertension and proper nutrition aimed at reducing body weight and blood cholesterol levels.

Forecast

Diseases and pathologies, the symptom of which is cardialgia, have different prognosis, but in most cases – favorable. However, frequent and severe pain in the heart area can become a serious problem.

In addition, one should be aware of the possibility of a fatal outcome in case of myocardial infarction or rupture of an aortic aneurysm.

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