Chest pain – Pain in the chest or in the area of the heart is in the first place among all reasons for seeking medical help. However, these painful sensations are not always a sign of heart disease.
There are many conditions in which unpleasant sensations in the chest are possible.
By origin, all chest pains can be divided into two large groups: “heart” and “non-cardiac”. This classification is very important, as it allows you to differentiate life-threatening conditions (for example, myocardial infarction) from cases that are not associated with any risk to the patient’s life (for example, intercostal neuralgia).
Heart pains include:
- Pain in coronary heart disease (angina pectoris). The reason for these pains is oxygen starvation of the heart cells with an increase in the load on it.
The lack of oxygen supply is caused by the narrowing of the vessels supplying the heart, due to the deposition of fat-like accumulations (atherosclerotic plaques) on their walls, as a result of which they lose the ability to expand and provide blood flow adequate to the needs of the heart.
Such pain, as a rule, occurs during physical exertion or psychoemotional stress, has a pressing or compressive character, is more often localized behind the sternum, less often in the left half of the chest, is relieved (stopped) by taking nitro drugs or when the load stops, is short-term (several minutes).
- Pain in myocardial infarction. Their nature is similar to pain in angina pectoris, but they, as a rule, are more prolonged, may be accompanied by shortness of breath, cold sweat, and are not stopped by taking nitroglycerin.
The cause of this pain is a blockage by a blood clot (thrombus) of one or more of the arteries that supply blood to the heart.
- Pain like angina cal, can occur at a number of other conditions characterized by an increase in the load on the heart muscle: for example for hypertensive crisis, heart diseases (aortic stenosis), hypertrophic cardiomyopathy.
In such cases, the pain is caused by overloading the heart with sufficient blood supply.
- Cardialgia – pain in the heart that is not associated with ischemia or myocardial overload, but arising in the presence of minimal structural changes in the heart, more often congenital (additional chords of the left ventricle, mitral valve prolapse), or in case of dysregulation of its activity by the nervous system (vegetative-vascular dystonia).
Causes of chest pain
A large group of causes of chest pains are not related to the heart in any way. In this types of cases, pain is give rise to by damage to other organs. Let’s list some of them:
- Osteochondrosis of the cervical and thoracic spine is the cause of the so-called “vertebral cardialgia”, which also has similarities with angina pectoris.
The pain is intense and prolonged, can be localized behind the sternum and in the left half of the chest, radiating to the left arm. However, unlike angina pectoris, pain in chest osteochondrosis is associated with changes in body position, increases with head turns, hand movements.
- Gastroesophageal reflux disease (GERD). It is accompanied by heartburn – a burning sensation in the chest that occurs when acidic gastric juice from the stomach enters the esophagus.
May be accompanied by a sour taste in the mouth and belching, more often occurs when bending or lying down, is stopped by taking antacids (almagel, maalox).
- Pleurisy. With various diseases, but more often with pneumonia, inflammation of the membrane lining the inside of the chest cavity and covering the lungs occurs. Such pain is acute, localized in one place, aggravated by breathing and coughing.
- Tietze’s syndrome. Pain in this condition occurs due to inflammation of the cartilage, most often, in the places of their attachment to the sternum, and thus simulate an attack of angina pectoris.
Differentiation of one condition from another in such cases helps palpation of the site of pain – with Tietze’s syndrome, the inflamed cartilage is sharply painful, with angina pectoris – palpation does not affect the intensity of pain.
- Chest pain can be caused by muscle problems. Such pains, as a rule, are provoked by turns of the body, hand movements.
- Rib bruises and fractures can also cause pain, sometimes very intense
- Diseases of the esophagus. Pain can also occur with spasm of the esophagus, achalasia (a disease of the lower esophageal valve that interferes with the passage of food), moreover,
Such pains disappear after the patient takes nitroglycerin, which relaxes the muscles of the esophagus, which makes it difficult to diagnose the condition.
- Shingles. It is a herpes infection that affects the nerve endings and causes severe pain in the chest.
- Diseases of the gallbladder and pancreas. Gallstones or inflammation of the gallbladder (cholecystitis) and pancreas (pancreatitis) can cause epigastric pain radiating to the heart.
- Pulmonary embolism. This formidable condition develops when a blood clot enters the pulmonary artery, through which blood flows to the lungs, blocking the flow of blood through the lungs to the heart.
As a result, there is a severe dull pain in the chest, shortness of breath, blood pressure drops sharply, and loss of consciousness is possible.
Pains of any nature and localization in the chest, especially those that have arisen for the first time, should alert the person and cause immediate medical attention. After that, it is necessary to go through all the examinations prescribed by the doctor to establish the cause of the pain.
Diagnosis of chest pain
It is most important to diagnose cardiac pathology as early as possible, since it is this that is associated with the greatest risk to the patient’s life.
Currently, there are all the necessary techniques to determine the cause of chest pain, the need for a particular method is determined by the attending physician in each case. As a rule, the following studies are assigned:
- Electrocardiography. Mandatory for any suspicion of cardiac pathology, helps in the diagnosis of angina pectoris, myocardial infarction, cardiac arrhythmias and conduction disorders. Exercise ECG tests (ECG recording during exercise on a treadmill or bicycle ergometer) and daily ECG monitoring (ECG recording for a day or more during the patient’s free daily activity) are widely used.
- Echocardiography (ultrasound of the heart). It helps to identify significant structural changes in the myocardium, measure the speed of blood flow through the heart valves, and determine the pumping function of the heart. In difficult diagnostic cases, a modification of the echocardiographic method is used – stress echocardiography (ultrasound examination of the heart under stress).
- Finally, the “gold standard” in the diagnosis of coronary heart disease is coronary angiography, which allows visualization of the arterial system of the heart through the introduction of contrast and to confirm or refute the diagnosis of angina pectoris;
- To exclude other causes of pain in the heart, patients may be prescribed an examination of the spine (X-ray, computed tomography, MRI), consultation, a neurologist, gastroenterologist and even a psychotherapist.
What is important to the patient?
- pain in the chest and in the region of the heart can be the result of angina pectoris or myocardial infarction – conditions that directly threaten a person’s life.
- if pain in the chest occurs, it is necessary to seek medical help from qualified specialists as soon as possible, since delay in this situation can cost a person his life.
- only a cardiologist can decide on a cardiac or non-cardiac cause of chest pain after the necessary examination.
- treatment of patients with coronary heart disease should be carried out only in the cardiology department of the hospital, equipped with an intensive care unit.