Chest pain - causes, symptoms, diagnosis and treatment

Thoracic pain is one of the most common complaints with which patients turn to a cardiologist. But they do not even suspect that cardiology can be anything at all. Chest pain can cause very different reasons. For example, diseases of the esophagus or respiratory system. More details about the causes, symptoms, diagnosis and treatment of chest pain.

[1], [2], [3], [4], [5], [6]

Causes of chest pain

Pain in the chest usually depends on one of the organs of the chest (heart, lungs, esophagus) or the constituent walls of the chest (skin, muscles or bones). Sometimes the internal organs are located close to the chest, for example, such as the gallbladder or stomach, and when their work fails, it causes chest pain. Pain in the chest can also be the result of pain in the neck, this is the so-called reflected pain.

[7], [8]

Ischemia and angina pectoris

All organs and tissues of the body need oxygen and nutrients, which they saturate blood. Blood passes through a huge network of arteries throughout the body, including blood vessels that supply blood to the heart muscle. These vessels, called coronary arteries, are located directly on the surface of the heart muscle.

In people with coronary artery disease (IHD), coronary arteries are clogged with fatty deposits - they are also called plaques. They can be the causes of the narrowing of the coronary arteries, and then the blood does not receive enough oxygen, and the blood itself does not pass well through the blood vessels. The heart loses it and begins to work with interruptions. This is called ischemic heart disease.

Angina pectoris is also one of the types of chest pain, quite dangerous. This type of heart disease is especially often manifested during physical activity, when the heart rate increases, and the pressure rises because the heart needs more oxygen. Angina develops when the need for oxygen exceeds the amount of oxygen that delivers blood to the heart muscle.

Heart attack (myocardial infarction)

A heart attack or myocardial infarction (MI) happens when the blood vessels do not flow because of the plaques formed in them. Blood clots (thrombi) can partially or completely block the artery. This bloody cork slows or completely blocks the flow of blood to the area of the heart muscle. And then a person has a sore chest. If the pain lasts more than 15 minutes, the muscles can be damaged and tissue death occurs - a heart attack. During a heart attack, the patient may feel discomfort and pain, which is similar to pain in ischemia. A heart attack can happen after a long period of angina.

Other cardiovascular diseases

Some cardiovascular diseases that are not related to the blood flow in the coronary arteries can cause chest pain.

Some people suffer from classic pain with angina pectoris. This is called variant angina pectoris, which can be caused by a temporary spasm of the coronary arteries. These arteries, as a rule, are not affected by cholesterol plaques, so they are not narrowed, doctors also do not diagnose arterial obstruction. But with variant angina, partial blockage of the artery may occur due to a spasm in one of its areas.

Pericarditis, or inflammation of the membrane around the heart, can also cause chest pain, which worsens with deep breathing. Pain can weaken when a person sits or leans forward. When listening to the heart, the doctor hears unusual, uncharacteristic sounds of heartbeat. This rustling leaves of the pericardium. Problems with the heart (pericardium) are confirmed by an electrocardiogram (ECG).

Inflammation of the heart muscle, which is called myocarditis, can also cause chest pains that are similar to ischemic pain. Myocarditis is often caused by a viral infection.

Another reason for classic pain in angina in people with normal coronary arteries is "syndrome X", which is more common in women. People with this disease may not even know the cause of their chest pain.

Problems associated with heart valves or cardiac muscle (the so-called hypertrophic cardiomyopathy) can also sometimes cause typical chest pains, such as with angina pectoris. People with the diagnosis of "mitral valve prolapse" and "aortic stenosis", for example, can often complain of chest pains.

Quite a rare, but serious cause of chest pain is the aortic dissection (rupture). The aorta is the main artery in the body. It consists of several layers of muscle cells, similar to the layers that surround the bulb. Sometimes these layers break, and the person bleeds outside the circulatory system, that is, blood spreads throughout the body. This is a very serious disease that can be treated only by vascular surgery. Pectoral pains due to aortic dissection, as a rule, are very severe, they arise very unexpectedly, they are given in the back or between the shoulder blades.

Pectoral pain can also spread to the skin, muscles, bones, tendons, soft tissues and cartilage of the chest, so even when palpated, a person feels severe pain. Trauma, including a recent surgery, can lead to severe chest pain (it is more felt in the chest wall).

Pains of the breast due to diseases of the esophagus

The esophagus is a tube that connects the mouth, throat and stomach. Since the esophagus and heart serve the same nerves, in some cases, the chest pain due to the esophagus can be confused with cardiac ischemia. In some patients, chest pain due to diseases of the esophagus causes its spasm and becomes weaker after taking nitroglycerin.

A number of medical circumstances can cause pain in the esophagus, including its cause can be gastroesophageal reflux disease, also known as heartburn, is caused by an acid that flows from the stomach back into the esophagus. Feelings with this pain can be uncomfortable for a person or very painful.

Pectoral pain can cause esophageal spasms due to a disorder in its motor function - the muscles around the esophagus do not move properly, causing chest pain. The causes of chest pain may be esophagitis, an inflammation of the esophagus, sometimes it is caused by medications.

Gastrointestinal tract

Diseases of the gastrointestinal tract increase the number of problems associated with chest pain, which begins, and then spreads throughout the thorax. The number of diseases that cause chest pain includes ulcers, gallbladder disease, pancreatitis, irritable bowel syndrome.

Pains of the breast due to diseases of the respiratory system

The lungs provoke a number of problems that cause chest pain. Many diseases of the respiratory system cause pain, which becomes stronger with deep breathing.

Pulmonary embolism - a thrombus in the vessels of the lungs. It almost always worries people with a high risk of disorders due to a recent operation, those who have long complied with bed rest, pulmonary embolism may occur in pregnant women or patients after recent pelvic surgery. Pectoral pain with pulmonary embolism occurs suddenly, it is accompanied by shortness of breath and can worsen with deep breaths.

Pneumonia - infections in the lungs and their inflammation can cause chest pain, cough and fever.

Pleurisy is an inflammation of the tissues surrounding the lungs. Pleurisy can occur due to a viral disease or as a complication after trauma. Pleurisy can provoke a disease such as pneumonia, pulmonary embolism. The pleurisy pain is chest pain.

Pneumothorax is a collapse of the lung, because of which an air cushion forms in the space between the chest wall and the lungs. Pneumothorax causes chest pain, sometimes very severe and intolerable.

Psychological causes of chest pain

Panic disorder or depression can cause a person to feel chest pain. Severe chest pain associated with panic attacks of fear or anxiety can occur in a person with impaired system. These changes can be diagnosed on an electrocardiogram (ECG).

Pectoral pain can occur when the nerves in the chest wall become inflamed. Pain can be given to tissues around the lungs, diaphragm or mucosa of the abdominal cavity. Herniated disc or arthritis of the cervical spine can lead to permanent complex chest pains.

Symptoms of chest pain in heart disease

Pain in the chest, which is caused by angina or pain caused by myocardial infarction, may be similar. They differ in duration and severity. If the pain lasts no more than 15 minutes, it is angina, and if more than half an hour - a heart attack. With a heart attack, pain is stronger and sharper. Depending on the cause, the chest pains can be sharp, blunt, burning, they can be localized in one or more areas (in the middle of the chest, upper chest, back, hands, jaw, neck or entire chest area). Heart pain may become weaker or worse after physical activity or even during rest. There may be other concomitant symptoms (sweating, nausea, palpitations, dyspnea).

Ischemic pain in the chest, as a rule, is not localized in a specific place, but it is felt throughout the thorax. Heart pain is often localized in the center of the chest or upper abdomen.

If the pain is felt only in the right or left side, and not in the center of the chest, it can hardly be caused by ischemic heart disease.

Radiation chest pain is a heartache that spreads to other areas of the upper body, not just to the chest. These areas - the neck, throat, lower jaw, teeth (chest pain can give in the teeth), and also shoulders and hands. Sometimes the chest pain can be felt in the wrists, fingers or between the shoulder blades.

Unlike non-cardiac pain, pain in the heart can start suddenly and worsen at the very beginning. This is often associated with physical stress. Non-cardiac pain, unlike cardiac pain, can last only a few seconds or persist for several hours. Pain can become weaker when a person takes nitroglycerin or does not pass even after it is taken. Then this is a very serious symptom. Pain that persists for several days or weeks is likely to indicate angina or a heart attack.

Muscle spasms or spasm of the esophagus, which provoke chest pain, may become weaker after taking nitroglycerin. If eating food or antacids can relieve chest pain, then it is most likely caused by problems with the esophagus or stomach.

Pain with ischemia usually does not increase with a deep sigh or pressing on the site where it hurts and where the person feels uncomfortable. Ischemic pain, as a rule, does not depend on the position of the body, although some patients with ischemia feel relief when they sit down, especially when they lean forward.

Concomitant symptoms of cardiovascular diseases that cause chest pain

• Dyspnea
• Nausea, vomiting, eructation
• Sweating
• Cold, sticky "goose" skin
• Frequent and rapid heart rate
• Cardiopalmus
• Fatigue
• Dizziness
• Fainting
• Indigestion
• Discomfort in the abdomen
• Tingling in the arm or shoulder (more often left)

[9], [10], [11], [12], [13], [14], [15], [16], [17]

Diagnosis of chest pain

Many circumstances and diseases can cause pain in the chest. And they are diagnosed differently.

Basically, during diagnosis, the method of palpation and a doctor's consultation are first used. With certain diseases that cause chest pain, palpation can clearly show the cause. For example, with angina pectoris during the pressing of the thorax, the chest hurts even more.

An electrocardiogram, or ECG, shows how electrical waves pass through different parts of the heart muscle. People with ischemic pain in the chest can clearly see changes in the cardiac muscle on the ECG.

Blood tests - can be used to analyze the enzymes of the heart muscle. During a heart attack, these enzymes can move from the heart to the blood. Analyzes of cardiac enzymes found in the blood can indicate the possibility of myocardial infarction.

Stress test - the patient is watched when he walks or runs along the treadmill. This method is very indicative in the diagnosis of ischemia. During active running or walking, heart activity is monitored on the ECG. So the doctor can recognize the symptoms of ischemia. Echocardiography can also be used to diagnose cardiovascular diseases.

Cardiac catheterization - this method, also known as coronary angiography, uses a small catheter inserted into the coronary arteries, and a special dye is also used to show the contours of the heart. Arteriography is recommended for people at high risk of developing coronary artery disease and blocking the arteries. The results of arteriography will help to prescribe the best treatment.

Interpretation of data - with this method of diagnosis, the physician will be able to synthesize all the factors described above to determine the cause of chest pain. Even if there is evidence of coronary heart disease, the cause of the pain can also be other diseases. Many of them can mimic ischemic pain in the chest. Statistics show that in most cases, chest pain, in which a person calls an ambulance, is not caused by angina or myocardial infarction.

[18], [19], [20], [21], [22], [23], [24]

Treatment of chest pain

Use of nitroglycerin. If you have ischemic heart disease, your doctor may prescribe nitroglycerin. Nitroglycerin is placed under the tongue as soon as there is pain in the chest. If the mouth is dry at this time, you can drink water. This will help the tablet to dissolve under the tongue. You should sit down (nitroglycerin can cause dizziness, you do not need to swallow nitroglycerin - it will be wrong.) After drinking one nitroglycerin pill, wait five minutes (check this time on the clock) .If chest pain does not go away after five minutes, immediately call an ambulance and take the second pill while the doctors arrive.

If the chest pain is caused by diseases of the respiratory system, antibiotics are used - for example, in the treatment of pneumonia.

If the pain in the chest is caused by diseases of the gastrointestinal tract, alternative means are used, for example, fresh potato juice with ulcers or pain medications.

One way to treat chest pain may also be changing the regimen of the day: strengthening or, conversely, weakening physical activity.

Pectoral pain is a serious symptom, so you need to see a doctor if this pain does not last long.