Pain in the chest on the left: aching, stitching, sharp, pulling, dull

The pain in the chest on the left can often be caused by a heart attack. But in 80% of cases this is far from the case. The causes of chest pain on the left can be diseases of the respiratory system, digestive organs, as well as muscles, skin and bones. How to understand the causes of pain in the chest on the left? What are the symptoms of chest pain on the left, as well as the diagnosis and treatment?

[1], [2], [3]

Cardiovascular diseases

Let's start with the most dangerous causes that cause pain in the chest on the left. These are cardiovascular diseases. Their list is rather long, but it is important to know all these points in time to call the doctor for pain in the chest on the left. Diseases associated with pain in the chest due to malfunctions in the heart, are coronary and non-coronary.

Coronary heart disease includes myocardial ischemia and acute myocardial infarction. These are formidable diseases of the heart and blood vessels, which can cause a lethal outcome if the person does not provide medical assistance on time.

[4], [5], [6], [7]

Heart attack (acute myocardial infarction and ischemia)

A heart attack due to acute myocardial infarction or ischemia occurs when blood flow is blocked in the arteries that supply the blood to the heart (coronary arteries). Because of this, the heart muscles do not get enough oxygen. This can cause damage, deterioration and atrophy of the heart muscle.

Causes of a heart attack

A heart attack is caused by coronary heart disease, or ischemic heart disease. Cardiovascular diseases can be caused by the accumulation of cholesterol in the coronary arteries (atherosclerosis), blood clots that can damage the blood flow, or spasm of blood vessels that supply the heart.

[8], [9], [10], [11]

Risk Factors for a Heart Attack

• high blood pressure
• diabetes
• smoking
• high cholesterol
• heredity - cardiovascular diseases in close relatives, occurring at the age of under 60,
• obesity

After menopause, women have a higher risk of heart attack than premenopausal women. It is believed that this is due to the loss of the protective effect of the hormone estrogen in menopause. Therefore, women before the menopause need hormone replacement therapy to balance the hormonal balance in the body.

Symptoms of a heart attack

Typical pain during a heart attack occurs in the middle and left side of the chest, and can also extend to the left shoulder, left arm, jaw, stomach or back. Be careful: different people may have different symptoms during a heart attack.

Associated with chest pain symptoms - shortness of breath, excessive sweating, nausea and vomiting.

Symptoms of pain in the chest on the left side of a heart attack in women can not be different from men's. And yet in women, the symptoms can be atypical (uncharacteristic). With pain in the chest on the left, women may experience such signs of a heart attack:

• discomfort in the abdomen,
• heartburn,
• dizziness,
• unexplained fatigue.

Diagnostics

1. Examination by palpation of the chest
2. Electrocardiogram (ECG), for the diagnosis of heart function. After an electrocardiogram, you can already tell which cardiac vessels are blocked or narrowed.
3. Study the enzymes that produce the cells of the heart muscle when it does not get enough oxygen. These enzymes can be detected by a blood test.

Treatment

First of all, with a heart attack, you need to call an ambulance. While the patient is waiting for an ambulance, they must take nitroglycerin to reduce chest pain.

The inpatient treatment of infarction or ischemia, which caused a heart attack, is aimed primarily at increasing blood flow through the arteries. It is important to unlock the blood flow and the arteries themselves, as well as to eliminate the risk of passing blood clots to the heart. Medicines that are used for this purpose include aspirin, heparin, thrombolytic drugs.

The second goal in stopping a heart attack is to slow down the heart rate, this reduces the burden on the heart and reduces the chest pain on the left.

Angioplasty is a way to unblock the artery.

Angiography - it is done first to find narrowing or blockages in the arteries. A very thin plastic tube, a catheter, is inserted into the artery. This expands it, providing a wider passageway for the blood. Sometimes a stent (metal flexible construction) is used to expand the arteries and allow blood flow to flow freely.

Surgery for pain in the chest on the left is used if the treatment failed. This can be angioplasty or bypassing the heart.

Non-coronary heart disease

This group of heart diseases also can cause pain in the chest on the left. But these diseases are very difficult to diagnose, because they have not been sufficiently studied by doctors. In addition, many of these diseases have very blurred, fuzzy symptoms. The most common non-carinogenic cardiovascular diseases are pericarditis, arterial hypertension, also associated with pericardium, myocarditis, cardiomyopathy, heart defects, congenital and acquired, mitral valve prolapse, neurocirculatory dystonia (including 4 types of cardialgia), angina. Consider the most life-threatening diseases that cause heart pain in the chest on the left.

Acute pericarditis

This is the inflammation of the pericardium, the sac covering the heart. It is called a heart bag or connective heart. The role of the pericardium is to isolate the heart from all other organs that are located in the chest. The pericardium allows the heart to fill with blood better, and during physical overloads our "motor" keeps from stretching and displacement from its anatomical place.

Pericardium is a cavity between two leaves of connective tissue. Inside, between the walls of the heart and the pericardium is a liquid that protects these leaves from friction. Liquids are not so little - 25 ml. When the pericardium becomes inflamed, there is a pain in the chest on the left.

[12], [13], [14]

Causes of pericarditis

Pericarditis can be caused by a viral infection, a bacterial infection, a cancer, an uncontrolled drug intake, radiation therapy, and chronic kidney failure.

An acute attack due to inflammation of the pericardium can be aggravated by an even more life-threatening condition - cardiac tamponade. This is the accumulation of fluid around the heart, which prevents him from effectively pumping blood through the body. Cardiac tamponade can be characterized by an unexpected loss of consciousness, severe pain in the chest, shortness of breath.

[15], [16], [17], [18], [19], [20]

Symptoms of acute pericarditis

The pain in the chest on the left with pericarditis is usually described as acute or stitching. It also occurs in the middle of the chest, aggravated by a deep breath.

This pain is easily confused with pain due to a heart attack, because it can irradiate to the left side of the back or shoulder.

A distinctive feature of acute pericarditis in comparison with infarction or ischemia is that the pain is aggravated in the horizontal position and subsides when the person leans forward. This is because when a person lies, the inflamed skin of the pericardium touches the heart, causing pain. When a person leans forward, a space is formed between the pericardium and the heart, and the pain in the chest on the left and in the middle subsides.

Concomitant symptoms - a person throws something in the cold, then in a fever, he has difficulty breathing or sore throat when swallowing.

Treatment of pericarditis

Viral pericarditis usually passes through 7-21 days of therapy with non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen. If there is a threat of tamponade, the doctor will puncture the fluid from the pericardium through the skin. Also, drainage along with ultrasound is performed, and excess fluid from the pericardium is pumped out.

Mitral valve prolapse

The prolapse of the mitral valve is an anomaly of one of the heart valves. This disease is accompanied by a violation of the valve, which is located between the ventricle of the heart and its left atrium. This disease, life-threatening, can cause severe chest pain on the left.

Symptoms of mitral valve prolapse

Mitral valve prolapse usually passes without symptoms, but some people may experience rapid heartbeats and chest pains on the left. These pains can also be accompanied by fatigue, dizziness and shortness of breath.

The chest pain associated with mitral valve prolapse differs from the pain with angina in that it is sharp, does not give up anywhere and is not associated with physical exertion.

There may also be complications that cause infection of the heart valves, regurgitation of the mitral valve (abnormal blood flow into the heart chambers) and abnormal heart rhythms, sometimes resulting in sudden death.

Angina pectoris

Angina is chest pain due to the lack of oxygen entering the heart with blood flow. Insufficiency of blood supply to the heart is caused by blockage or constriction of blood vessels. Angina differs from a heart attack in that arteries with angina are not completely blocked, and this does not cause cardiac damage incompatible with life.

Small angina (the so-called stable angina) can occur during physical exertion, chest pain stops after rest. "Unstable" angina leads to severe and unpredictable pain, which does not go completely even at rest.

[21], [22], [23], [24]

Causes of angina pectoris

Angina can be caused by spasm, constriction or partial blockage of the artery, which delivers blood to the heart.

The most common cause of angina pectoris is ischemic heart disease, in which a blood clot or the accumulation of cholesterol inside blood vessels (atherosclerosis) delays blood flow, but does not completely block blood vessels.

Angina may be caused by physical exertion, emotional stress or arrhythmia, in which the heart beats very quickly.

[25], [26], [27], [28], [29]

Symptoms of stenocardia

Angina is sometimes similar to an attack of a heart attack, but it occurs during physical exertion and passes after rest, which is never the case with an infarct or an ischemic attack. Angina pectoris becomes life-threatening when the pain in the chest on the left arises at rest, the heart rate or intensity increases.

Pain with angina does not go away after taking one tablet of nitroglycerin, as it happens with a heart attack. It is necessary, at least, three tablets of nitroglycerin with intervals in five minutes that the attack became not so intensive.

Diagnostics

Angina is diagnosed by the same methods that doctors use to diagnose heart attacks.

The diagnosis of "angina" is made only after the possibility of a heart attack has been ruled out. This is done by analyzing the heart enzymes, which we wrote about above.

Although the ECG can show abnormalities in the heart, these changes are often treated.

Stress test: ECG monitoring during exercise and at rest. The results of the tests are then compared to determine how the load acts on the heart. With this test, a blockage or congestion in the blood vessels leading to the heart is detected.

Cardiac catheterization (catheter insertion) is used to identify blockages of the arteries.

A special type of diagnosis (angiography or arteriography) is used to detect blockage or other abnormalities of blood vessels.

[30], [31]

Treatment of angina pectoris

Tablets nitroglycerin under the tongue - the very first aid for angina before the arrival of an ambulance. Nitroglycerin can help increase blood flow to blocked or narrowed arteries.

If the pain in the chest continues for the next five minutes, you need to take another nitroglycerin pill under your tongue. If there are no improvements, repeat the same action in five minutes before the ambulance arrives.

When stationary treatment of angina, β-blockers are used to stop an attack of chest pain in the left and in the middle. Representatives of these blockers are atenolol, metoprolol and bisoprolol.

Aneurysm of the aorta (other names - aortic dissection, aortic rupture)

The aorta is the main artery that supplies blood to vital organs, such as the brain, heart, kidneys, lungs and intestines. Aortic dissection means a rupture of the inner aorta. It can lead to severe internal bleeding and stop the flow of blood to vital organs. However, only 20-30 percent of people survive. An aneurysm (rupture) can occur in the aorta of the breast or abdominal cavity. Men are at higher risk of aortic rupture than women.

[32], [33], [34], [35], [36], [37], [38]

Causes of aortic dissection

Aortic dissection can be caused by causes that cause the inner aortic membrane to collapse. This uncontrolled high blood pressure, rupture of connective tissue, diseases, the use of strong drugs without a doctor's prescription, old age, pregnancy, congenital heart defects and cardiac catheterization in diagnosis.

[39], [40]

Symptoms of aortic rupture

The pain in the chest on the left, associated with aortic dissection, occurs suddenly and is characterized as "tearing up, powerful." Pain can be given in the back or between the shoulder blades. Since the aorta supplies blood to the entire body, the symptoms of its rupture may include:

• pain as in angina with intermittent breathing
• dyspnea
• fainting
• abdominal pain
• symptoms of stroke (numbness of limbs and tongue, loss of motor function of one part of the body)

Diagnostics

The diagnosis of aortic dissection based on the patient's symptoms includes

• Chest X-ray (X-ray images show irregular contours of the ruptured aorta or its enlargement).
• Echocardiography (with a specialized ultrasound of the heart, when the probe is inserted into the esophagus under local or general anesthesia).
• The aortic dissection of a doctor can be very accurately determined with CT (computed tomography) of the chest or angiography.

[41],

Treatment of aortic rupture

• Painkillers such as morphine, dopamine, mezatonum
• Drugs that reduce blood pressure - diuretics, berlipril, anaprilin, diroton and others.
• Medications that slow the heart rate and expand the arteries
• Surgical treatment is required for aortic dissection (rupture), which damages the ascending (bottom-up) part of the aorta.

Esophageal diseases that cause chest pain in the left

Often the pain in the chest on the left occurs due to diseases of the gastrointestinal tract. In particular, because of the reflux disease, which in common people is called heartburn. On symptoms, this pain may be similar to a heart attack, but it is not.

[42], [43]

Causes of acid reflux

• Diseases of the gastrointestinal tract
• Binge eating
• High acidity
• Disruption of the gastric sphincter
• diabetes
• scleroderma

Heartburn can be caused by any factor that reduces pressure on the lower part of the esophagus, causes the esophagus to stop activity or prolonged emptying of the stomach. This condition can be caused by:

• eating high-fat foods
• using nicotine
• use of alcohol
• ingestion of caffeine during pregnancy
• certain drugs or hormones (for example, nitrates, calcium channel blockers, anticholinergics, estrogens, progesterone)
• Acid reflux and chest pain on the left can also be caused by yeasts, fungi, viruses, bacteria or irritation due to allergens.

[44], [45],

Symptoms

• acute pain that disturbs the person in the left side of the chest
• pain giving in the sternum, back, neck and shoulder
• pain during swallowing
• bleeding in the esophagus
• heartburn
• salivation
• chest discomfort
• chest pressure
• heavy sweating
• pallor
• nausea and vomiting
• a sore throat
• sour or bitter taste in the mouth or throat
• hoarseness
• constant dry cough.

Diagnostics

1. Examination of symptoms and palpation in the chest
2. X-ray examination
3. Bernstein's tests (when injecting acid into the esophagus to study the reaction to it)
4. Esophagoscopy (examination of the esophagus with a flexible hose connected to the monitor, where the doctor can see the results)

[46]

Treatment

You can reduce chest pain on the left with acid reflux in a simple way - raise the head of the bed 15 cm higher or simply place a higher pillow under your head. So caustic liquid from the stomach - acid - will not flow into the esophagus.

It is important to take drugs that reduce the acidity of the stomach - rannisan, for example, cimetidine

No need to smoke, and to eat, on the contrary, it is necessary, but only useful foods: oatmeal, vegetables, fruits, it is necessary to exclude fried and fatty foods, to limit chocolate and coffee.

Sometimes the doctor prescribes antacids, antibiotics, antiviral or antifungal drugs, drugs to relax the muscles of the esophagus or a combination of them.

Pain in the chest on the left caused by diseases of the respiratory system

Such most common diseases include pulmonary embolism (arterial thrombosis), spontaneous pneumothorax, pneumonia.

Pulmonary embolism

Pulmonary embolism is a thrombus in one of the large blood vessels that provides blood to the lungs. This is a potentially life-threatening condition that is not associated with heart and vascular disease.

Causes of pulmonary embolism

Risk factors for pulmonary embolism include:

• sedentary lifestyle,
• obesity,
• prolonged immobility,
• fracture of the tibia of the legs,
• pregnancy,
• cancer,
• hereditary predisposition to pulmonary embolism,
• disturbance of the heart rhythm (arrhythmia),
• heart attack
• congestive heart failure.

Women who use birth control pills and often smoke are at a higher risk of pulmonary embolism than women who do not smoke (especially over 35).

[47], [48], [49], [50], [51], [52]

Pulmonary embolism - symptoms

Symptoms of pulmonary embolism include

1. sudden shortness of breath
2. rapid breathing
3. sharp pain in the middle of the chest, which increases with deep breaths

Diagnosis of pulmonary embolism

• Description of the patient's symptoms when a doctor is questioned
• ECG results
• Chest X-ray
• The doctor can perform a blood test from the patient's arteries to check the oxygen level in it. Blood flow disorders indicate lung disease, which does not allow the patient to get enough oxygen.
• Ventilation-perfusion scanning (V / Q scanning) - makes it possible to compare the flow of blood and the flow of oxygen into various parts of the lungs. Problems in only one segment may indicate embolism.
• CT scan of lungs (computed tomography)

Treatment

Anyone diagnosed with pulmonary embolism needs urgent hospitalization.

Treatment usually involves additional oxygen that is injected into the bloodstream, and medications to prevent further blood clotting, usually heparin.

If the embolus is very large, in some situations, the patient takes drugs to dissolve the blood clot.

To some people, the doctor suggests surgery to prevent the formation of blood clots

[53], [54], [55], [56], [57]

Spontaneous pneumothorax

Collapse of the lung this condition occurs when air enters the space between the chest wall and lung tissue. As a rule, the negative pressure in the chest cavity makes it easy to expand. When spontaneous pneumothorax occurs, air enters the chest cavity. When the pressure balance is lost, the lungs are not able to re-expand. This cuts off the normal supply of oxygen in the body.

Spontaneous pneumothorax - causes

Spontaneous pneumothorax (lung collapse) occurs when a so-called air pillow appears around the lungs. The area into which air enters (and it should not get there) is called pleural.

Causes of pneumothorax

Breast trauma is the most common cause of this condition. Injuries can happen due to a stroke, a fall, an awkward turn, injury, a surgical operation.

Some very thin and tall people may suffer from spontaneous pneumothorax due to stretching of lung tissue and abnormal air sacs that form in the upper part of the lungs. It is possible that these air sacs can burst from simple actions - sneezing or coughing.

Other risk factors for pneumothorax are AIDS, pneumonia, emphysema, severe asthma, cystic fibrosis, cancer, antibiotic use

[58], [59], [60]

Symptoms of pneumothorax

• sudden difficulty breathing,
• sharp pains in the chest,
• increased heart rate,
• dizziness,
• weakness

Diagnosis of pneumothorax

1. Spontaneous pneumothorax is diagnosed, first of all, by medical examination and chest X-ray.
2. CT (computed tomography) can be useful for determining a small pneumothorax.
3. Radiography of the abdominal cavity in the supine position on the left side.

Treatment

Pneumothorax, which has appeared for no apparent reason, does not always require serious treatment. Sometimes it is enough for a person to spend six hours in a hospital under the supervision of a doctor and repeatedly examine the chest with an X-ray.

If during this time the amount of pneumothorax does not change, the patient is usually discharged with a recommendation to visit the doctor after two days.

If the patient develops new pain symptoms or the volume of pneumothorax increases, he will be placed for in-patient treatment.

Perforated internal organs: Perforated organ has an opening or rupture in the wall of any area of the gastrointestinal tract. This allows air to enter the abdominal cavity, which irritates the diaphragm, and can cause pain in the chest.

[61], [62]

Pneumonia and chest pains left

Pneumonia is an infectious disease of the lungs. Pain in the chest on the left with pneumonia occurs due to inflammation of the mucous membrane of the lungs.

Causes of pneumonia

Pneumonia can be caused by a viral, bacterial or fungal infection of the lungs.

[63], [64], [65]

Symptoms of pneumonia

The pain in the chest on the left due to pneumonia occurs and intensifies during prolonged coughing or deep breathing

Pain in pneumonia, usually one-sided

Other accompanying pain symptoms are chills, coughing with mucus (sputum), high fever, and shortness of breath.

Diagnostics

Pneumonia is diagnosed by physical examination, chest X-ray, listening to a patient with a stethoscope.

Treatment of pneumonia

Pneumonia is usually treated with antibiotics, and an anesthetic doctor prescribes to relieve pain in the chest on the left.

No matter what the cause of the pain in the chest on the left, you need mandatory examinations at the doctor. This will help in time and most importantly - to correctly determine the diagnosis and prescribe the optimal treatment. This will enable a person to recover and prevent pain in the chest on the left.