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Doctor Leonid STERNIK
Cardiologist, heart surgeon

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Cardialgia

 
, medical expert
Last reviewed: 23.11.2021
 
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When pains are felt that are localized on the left side of the chest - where the heart is located, then when contacting a doctor, cardialgia will be indicated in the medical report.

The symptom of a wide variety of diseases in the form of cardialgia (pain in the region of the heart) has the ICD-10 code R07.2.

Epidemiology

As a rule, there are no medical statistics on the frequency of symptoms. However, cardialgia syndrome is in the area of increased attention of physicians of various specializations.

According to some reports, in at least 80-85% of cases, the development of pain in the region of the heart is not associated with impaired coronary circulation. The share of cardialgia due to osteochondrosis of the spine (cervicothoracic region) accounts, on average, up to 18-20% of cases.

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

Causes of the cardialgia

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

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

An idea of the origin of these pains is given by the classification of cardialgia, which distinguishes coronary and non-coronary pain. By the way, there is no single classification of this pain syndrome because of the terminological options for its systematization.

Coronary cardialgias are associated with impaired blood circulation in the vessels of the heart muscle - insufficiency of the coronary (coronary) blood circulation, and these include:

As the name implies, non-coronary cardialgias have nothing to do with the vessels of the heart; their other definition is functional cardialgia. In particular, these are:

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

Reflex cardialgia is also non-coronary, including such types as:

Associated with dysfunctions of the autonomic nervous system and is one of the  symptoms of vegetative-vascular dystonia,  vegetative cardialgia, cardialgia with VSD, with neurocirculatory dystonia (cardioneurosis). Read more in the publication -  Autonomic Dysfunction Syndrome

Psychogenic or neurotic cardialgia accompanies depressive and obsessive states, psycho-emotional overload, hypochondriac syndrome and neurasthenia, anxiety and panic disorders. 

In postmenopausal women, the level of sex hormones (estrogens) in the blood decreases sharply, and in some women, at the same time, there is a high level of the male hormone (testosterone) in the blood. This negatively affects the cardiovascular system of women over 50 and can manifest itself as dyshormonal cardialgia - with an increased risk of coronary heart disease. [4]

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

Many of the listed reasons can be caused by cardialgia in a child, for more details in the materials:

Risk factors

The risk of pain in the heart area is increased by factors such as high blood cholesterol levels and vascular atherosclerosis; arterial hypertension; diabetes and overweight; degenerative diseases of the spine (cervicothoracic 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 the cardialgic syndrome is also considered.

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

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

Cardialgia associated with osteochondrosis is caused by the compressive effect of the osteophytes reaching 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, as well as  neurogenic pain of  other localization.

Complications and consequences

Possible negative consequences and complications relate to diseases in which the pain syndrome of this localization develops.

For example, with ischemic 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 violation of the cardiac conduction system. With aortic aneurysm, breathing becomes difficult, and patients with myocardial infarction develop cardiosclerosis and cardiogenic shock may occur. See 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 of the cardialgia

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

Differential diagnosis

Differential diagnosis is described in detail in the publication -  Retrosternal pain .

Differential diagnosis of pain in coronary artery disease and cardialgia, which is not associated with impaired coronary circulation, is especially important - in case of problems with the digestive system, respiratory system, spine, etc.

In addition, an anxiety disorder called neurocirculatory asthenia, cardiophobia syndrome or Da Costa syndrome should be differentiated. What is the difference between cardiophobia and cardialgia? People with cardiophobia periodically complain of chest pain and palpitations - against the background of fear of a heart attack, cardiac arrest and death. They are convinced they have heart disease, although repeated medical examinations have confirmed that they are not. [7]

Who to contact?

Cardiologist

Treatment of the cardialgia

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

If the pain syndrome is of cardivascular origin (with angina pectoris, coronary artery disease, heart attack), then the drugs used include:

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

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

  • anti-ischemic agents, for example,  Advocaat ;
  • 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 relieve seizures.

More information in the materials:

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

Therapy of psychogenic cardialgia is carried out with the help of neuroleptic drugs and antidepressants.

Read also:

Physiotherapy is carried out, in particular:

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

In cardiology, surgical treatment is carried out - depending on the diagnosis - by stenting the coronary vessels, bypass grafting, replacing heart valves, installing a pacemaker, and correcting heart defects. Aortic aneurysm rupture requires urgent surgical intervention.

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

Prevention

Measures to prevent problems with the cardiovascular system are 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 a different prognosis, but in most cases it is favorable. However, frequent and severe pain in the heart area can be a serious problem.

In addition, one should be aware of the possibility of death in case of myocardial infarction or ruptured aortic aneurysm.

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