My chest hurts a lot, which could be the case. Why does pain occur in the middle of the chest?

The heart, lungs, esophagus, and great vessels receive afferent innervation from the same thoracic ganglion. Pain impulses from these organs are most often perceived as pain in the chest, but since there is a crossover of afferent nerve fibers in dorsal ganglia, chest pain can be felt anywhere between the epigastric region and the jugular fossa, including the arms and shoulders (as referred pain).

Pain impulses from the chest organs can cause discomfort described as pressure, fullness, burning, aching and sometimes sharp pain. Since these sensations have a visceral basis, many patients describe them as pain, although they are more accurately interpreted as discomfort.

Causes of chest pain

Many diseases are accompanied by discomfort or pain in the chest. Some (eg, myocardial infarction, unstable angina, thoracic aortic dissection, tension pneumothorax, esophageal rupture, embolism pulmonary artery) pose an immediate threat to life. Some diseases (stable angina, pericarditis, myocarditis, pneumothorax, pneumonia, pancreatitis, various tumors chest) pose a potential threat to the patient's life. Other conditions [such as gastroesophageal reflux disease (GERD), peptic ulcers, dysphagia, osteochondrosis, chest trauma, biliary tract disease, herpes zoster] cause discomfort but are usually harmless.

Chest pain in children and young adults (under 30 years of age) is rarely due to myocardial ischemia, but myocardial infarction can develop in the 20s. More often in this age group There are lesions of the muscles, skeleton or lung diseases.

Chest pain is the most common reason for calling an emergency doctor. Major diseases of cardio-vascular system, in which pronounced painful sensations in the chest are:

• angina pectoris
• myocardial infarction,
• aortic dissection,
• pulmonary embolism,
• pericarditis.

A classic example of pain or discomfort in the chest is angina pectoris. With “classic” exertional angina, pain or unpleasant sensations of pressing or squeezing nature occur behind the sternum during physical activity. Pain during angina pectoris quickly disappears after stopping the exercise (after stopping), usually within 2-3 minutes. Less often within 5 minutes. If you immediately take nitroglycerin under the tongue, the pain will disappear in 1.5-2 minutes. Angina pain is caused by myocardial ischemia. With spontaneous angina, pain occurs at rest (“angina at rest”), but the nature of the pain during typical attacks is the same as with angina pectoris. In addition, most patients with spontaneous angina have concomitant exertional angina. Isolated (“pure”) spontaneous angina is extremely rare. With spontaneous angina, in most cases there is a clear effect from taking nitroglycerin. For chest pain that occurs at rest, the effect of nitroglycerin is very significant. diagnostic value, indicating an ischemic origin of pain.

Symptoms of chest pain

Symptoms that appear when serious illnesses organs of the chest cavity are often very similar, but sometimes they can be differentiated.

• Unbearable pain radiating to the neck or arm indicates acute ischemia or myocardial infarction. Patients often compare myocardial ischemic pain with dyspepsia.
• Exercise-related pain that disappears with rest is characteristic of exertional angina.
• Excruciating pain radiating to the back indicates dissection thoracic aorta.
• Burning pain spreading from the epigastric region to the throat, increasing when lying down and decreasing when taking antacids, is a sign of GERD.
• High body temperature, chills and cough indicate pneumonia.
• Severe shortness of breath occurs with pulmonary embolism and pneumonia.
• Pain may be triggered by breathing, movement, or both in both severe and mild illnesses; these precipitating factors are not specific.
• Brief (less than 5 seconds), sharp, intermittent pain is rarely a sign of serious pathology.

Objective examination

Symptoms such as tachycardia, bradycardia, tachypnea, hypotension, or signs of circulatory compromise (eg, confusion, cyanosis, diaphoresis) are nonspecific, but their presence increases the likelihood that the patient has a serious illness.

Lack of breath sounds on one side is a sign of pneumothorax; a resonating percussion sound and swelling of the jugular veins indicate tension pneumothorax. Fever and wheezing are symptoms of pneumonia. Fever is possible with pulmonary embolism, pericarditis, acute myocardial infarction or esophageal rupture. A pericardial friction rub is evidence of pericarditis. The appearance of a fourth heart sound (S 4), a late systolic murmur of papillary muscle dysfunction, or both of these signs appear with myocardial infarction. Local lesions of the central nervous system, the sound of aortic regurgitation, asymmetry of the pulse or blood pressure in the arms are symptoms of thoracic aortic dissection. Swelling and soreness lower limb indicate deep vein thrombosis and thus a possible pulmonary embolism. Chest pain on palpation occurs in 15% of patients with acute heart attack myocardium, this symptom is nonspecific for diseases of the chest wall.

Additional research methods

The minimum scope of examination of a patient with chest pain includes pulse oximetry, ECG and chest x-ray. Adults are often tested for markers of myocardial damage. The results of these tests, together with data from the anamnesis and objective examination, allow us to make a presumptive diagnosis. Blood tests are often not available when initial examination. Separate normal indicators markers of myocardial damage cannot be a basis for excluding cardiac damage. In the event that myocardial ischemia is likely, the studies must be repeated several times, just like an ECG; it is also possible to perform a stress ECG and stress EchoCG.

Diagnostic administration of a nitroglycerin tablet under the tongue or a liquid antacid does not reliably differentiate between myocardial ischemia and GERD or gastritis. Any of these medicines can reduce the symptoms of each disease.

Cardiovascular diseases today occupy a leading position among dangerous and common diseases in the world.

The basis of such diseases is most often identified genetic predisposition, as well as the wrong lifestyle.

There are many cardiovascular diseases and they occur differently: they can arise as a result of inflammatory processes in the body, intoxication, injuries, birth defects, metabolic disorders, etc.

However, the diversity of causes for the development of these diseases is connected by the fact that their symptoms may be common.

Chest pain as a precursor to heart disease

A symptom such as an unpleasant feeling of discomfort and pain in the chest area may portend a disruption in the functioning of the heart and blood vessels.

If the pain is burning in nature, then this condition indicates a spasm coronary vessels leading to poor nutrition of the heart. This kind of pain in medicine is called angina pectoris.

Such pain occurs as a result of:

• physical activity,
• at low temperature,
• often in stressful situations.

The phenomenon of angina occurs when blood flow stops meeting the needs of the heart. muscle mass in oxygen nutrition. People call angina pectoris "angina pectoris." The doctor recognizes this disease literally at the patient’s first visit.

Diagnosing abnormalities in this case is difficult, because to make a correct diagnosis it is necessary to monitor the development of angina pectoris and additional examinations(For example, daily monitoring ECG). Differentiate between angina pectoris and angina pectoris calm state(rest).

1. Angina at rest. Usually not associated with physical activity, It has General characteristics with severe attacks of angina pectoris, may be accompanied by a feeling of lack of air. Often occurs at night.
2. Angina pectoris. Attacks of such angina pectoris occur with almost a certain frequency, which is provoked by exercise. When the load is reduced, the attacks stop.

However, there is also unstable angina, which is dangerous for the development of myocardial infarction. Patients with unstable angina in mandatory are hospitalized.

Heart disease that causes chest pain

According to the patient's description of pain in the chest area experienced doctor draws a conclusion about the nature of the disease. In such cases, the cardiovisor device helps determine whether this deviation is associated with a disease of the cardiovascular system.

Diagnosis of chest pain

Clarifying the duration, localization, intensity and nature of chest pain, as well as reducing and provoking factors, is very important.

Previous abnormalities in the heart, taking strong drugs that can cause spasms coronary arteries(for example, cocaine or phosphodiesterase inhibitors), as well as the presence of pulmonary embolism or a risk factor for coronary heart disease (travel, pregnancy, etc.) are of considerable importance.

A family history increases the likelihood of developing coronary artery disease, but there is no point in clarifying the causes of acute pain.

Additional research methods

The minimum evaluation of a patient with chest pain may include:

• pulse oximetry,
• chest x-ray.

For adults, screening for markers of myocardial tissue damage can be performed. The effectiveness of such tests with medical history data, as well as an objective examination, allows us to formulate a preliminary diagnosis.

Blood tests may not be available during the initial examination. If the markers indicate myocardial damage, then they cannot state that the heart is damaged.

Diagnostic administration of nitroglycerin tablets or liquid antacid under the tongue cannot reliably differentiate gastritis, GERD or myocardial ischemia. Each of the specified medical medicines able to reduce signs of disease.

Treatment of chest pain

Drug and therapeutic treatment of chest pain is carried out in accordance with the diagnosis.

If the causes of chest pain are not fully understood, the patient is taken to the hospital for an in-depth examination to monitor heart conditions. Until a correct diagnosis is made, only opiates can be prescribed.

Prevention of heart disease

To prevent the occurrence of heart disease, doctors have developed several recommendations:

1. Walk more, regularly do feasible and simple physical exercises. It is not recommended to start classes physical exercise with the greatest loads, and before starting such training, it is imperative to consult with doctors so that the chosen program only brings benefits to the body.
2. Try to maintain an optimal body weight.
3. Must be kept under control possible factors development of atherosclerosis, - for example, increased arterial pressure, amount of cholesterol, etc.
4. Meals should always be regular and nutritious; the diet should contain more protein foods and vitamins and minerals.
5. It is recommended to visit your doctor regularly and carry out the necessary laboratory research.
6. Remember Golden Rule health: it is always easier to prevent a disease than to treat it.

Prediction of chest pain symptom

Predicting a symptom that subsequently develops into cardiovascular disease, very difficult. The fact is that everything depends on providing first aid to the patient.

Chest pain may indicate various diseases. In order to find out the cause, the doctor checks its nature, how long it lasts, the patient must take all necessary tests and only then can we say what caused the pain. You cannot tolerate pain in the chest, because, no matter what the reason, the appearance of unpleasant sensations in this area is quite dangerous. Therefore, it is important to diagnose the cause in time and begin effective treatment. Why does pain occur in the chest area?

Chest pain after exercise

Unpleasant sensations most often occur after a person has overworked himself physically, also after injuries, sprains, or damage. In cases of intense physical activity, pain may occur in the chest area and be localized between the ribs. This kind of pain is called sore throat, it can most often appear after active exercise or physical work. It does not pose a danger to humans, because it is associated with the fact that muscle connective tissues secrete lactic acid, which causes slight damage to the muscle and ligamentous structures of tense muscles. It has a pulling character, and with sudden movement it begins to increase greatly. Such pain can be avoided if you train correctly, calculate the load and your strength.

Post-traumatic chest pain

Pain in the chest appears due to the fact that an injury has been caused, as well as if internal organs are damaged due to it. When the pain is stabbing, especially when you put pressure on the chest. It can intensify when a person coughs heavily and goes away after relaxation. Bruises are immediately noticeable; bruises and bruises begin to appear. If the lungs are bruised, it is not dangerous, but if it is severe, it can end in death, because it can cause rupture of the lungs and hemorrhage.

Chest pain due to viral and infectious disease

This pain occurs when a person takes a deep breath, sneezes or coughs. In this case, it appears in the place affected by the infection. In cases of colds, the pain goes away after it is cured, also when the patient adheres to bed rest. In cases of deterioration of the patient's condition, it can be said that serious complications have arisen in vital respiratory organs, such as:

Chest pain due to cardiovascular disease

1. When pain in the chest is sudden, it can occur on one side or radiate to both sides at once. In this case, a person suffers from pressing pain, it occurs at any time of the day - after physical exertion, at night, etc.

2. With myocardial infarction, acute pain appears in the chest area, this is caused by the fact that one part of the heart muscle has died, and because of this, he lacks oxygen. The pain is sudden, sharp, and can radiate left hand or shoulder. Here you need to act quickly, call urgently ambulance.

3. Pain in the chest due to, which occurs when the pericardial sac becomes inflamed. This disease can be independent, or accompany infectious, oncological and autoimmune diseases. The pain resembles angina pectoris, but at the same time it becomes difficult for the person to breathe, he is tormented by shortness of breath, and the esophageal system begins to be compressed. In this case, a feverish state appears, the face and neck swell, and veins are noticeable.

Thus, the chest may hurt with various reasons and all of them are quite serious, so you shouldn’t hesitate, you need to urgently contact a specialist who will definitely help diagnose pain in the chest area.

The chest is a part of the body, consisting of the chest cavity, the organs of the respiratory and cardiovascular systems located in it, muscle fibers and bone tissue(ribs, sternum and spine). Women have a flatter chest shape, so their volume is slightly smaller compared to men of the same age. The thoracic cavity contains the bronchopulmonary system, thoracic vertebrae, heart, arteries through which blood enters the heart muscle, esophagus and top part diaphragm tube.

If a person experiences pain in the sternum area, the cause may be a pathology of any of the listed organs, so such a symptom cannot be associated only with heart disease. Treatment chest pain should be handled by a doctor: self-administration of medications and untimely appeal behind medical care may cause deterioration of health and progression of the underlying disease.

Injury to bone or muscle tissue– a fairly common cause of pain in the sternum. The nature of the pain depends on the conditions in which the injuries were sustained and the influence of additional factors. For example, when falling, the pain is most often dull, aching, of moderate or high intensity and intensifies when bending forward or turning the body to the side. Injuries received in a fight can lead to rupture of internal organs - such a pathology will be accompanied by sharp or cutting pain, which weakens if the patient takes a certain position of the body (most often on the side), but does not go away completely.

The most dangerous chest injuries are those resulting from road traffic accidents and other emergency situations. Often patients develop pain shock, blood pressure decreases, lips and skin turn blue. With fractures, pain may be absent for 6-10 hours. Some patients at this time continue to do their usual activities and maintain their normal level of activity, but after a few hours the effect of natural pain relief ends, and severe pain appears. pain syndrome, often requiring emergency hospitalization of the patient using special means.

Common symptoms indicating chest injury of various origins, are:

• strong pain(blunt, sharp, dagger-shaped, cutting) in the central part of the chest and at the site of injury;
• decreased or fluctuating blood pressure;
• headache and dizziness;
• vomit;
• increased pain during movement, breathing and palpation of the injured area.

If the respiratory organs are damaged, the patient may develop acute respiratory failure, which can lead to loss of consciousness and even death if the person is not taken to the trauma department on time. Treatment of injuries and pathologies depends on the type of injury, the patient's condition, existing symptoms and other factors. If the patient has damaged thoracic vertebrae, surgery may be required.

Note! If the person at the time of injury was in a state of alcohol intoxication, pain may appear only after a few hours, since wine alcohol blocks pain receptors and acts as a synthetic analgesic.

Relationship between pain in the sternum and pathologies of the digestive system

Some people think that with diseases of the stomach and intestines, pain occurs only in various departments stomach, but this is not so. Pathologies digestive system- another one common reason pain in the center of the sternum, so people with chronic disorders at work gastrointestinal tract it is necessary to know the features of the clinical course of this group of diseases.

Diseases of the esophagus

In the central part of the chest is the esophagus - a muscular hollow organ in the form of a tube through which crushed food enters the stomach. The esophagus is located in the middle of the thoracic cavity, so if there is a disturbance in the functioning of this organ, the pain syndrome will appear along the midline of the sternum. The most common pathology of the esophagus is its inflammation - esophagitis. The disease manifests itself with symptoms typical of diseases of the digestive tract, and it is pain in the middle of the chest that allows it to be differentiated from other digestive disorders even before hardware and laboratory diagnostics.

Common signs of esophagitis include:

• stitching sensation in the throat when swallowing;
• “lump” in the larynx;
• pain during eating when food passes through the esophagus, occurring in the middle of the chest cavity;
• bad breath;
• painful sensations in the epigastrium and abdominal area, intensifying after eating;
• foul belching;
• heartburn.

In rare cases, similar symptoms with localization of the main pain syndrome in the sternum can be observed during exacerbation of cholecystitis, pancreatitis or gastritis with increased secretion of hydrochloric acid. For staging accurate diagnosis the patient is given a series of diagnostic studies: blood and urine tests, FGDS, ultrasound of the abdominal organs. Based on their results, the doctor will prescribe treatment and give recommendations on nutrition and regimen.

Treatment regimen for esophagitis in adult patients (can be adjusted depending on individual indicators)

Group of drugs	What medications should I take?	Image
Histamine receptor inhibitors	"Famotidine"
Means for symptomatic treatment heartburn, neutralizing excess hydrochloric acid in the stomach	"Maalox"
Proton pump blockers	"Pantoprazole" "Omeprazole"
Medicines to eliminate vomiting and nausea and facilitate the passage of food through the esophagus	"Ganaton"

If the esophagus is infected, the doctor may prescribe antibacterial or antiviral therapy.

Video: Pain in the esophagus when swallowing and passing food

Subphrenic abscess

This is a pathology in which, under the lower border of the diaphragm - the muscular tube separating the chest and abdominal cavity and necessary for the expansion of the lungs, a cavity is formed filled with purulent exudate. In most cases, the disease requires surgical treatment, since when the abscess ruptures, pus will enter the peritoneum, which will lead to the rapid development of a life-threatening condition - acute peritonitis. After opening the abscess and drainage, the patient is prescribed conservative supportive therapy using anti-inflammatory, painkillers and antimicrobial agents. For elimination painful sensations and relieve inflammation, drugs from the NSAID group can be used ( “Ibufen”, “Ibuklin”, “Ketorol”, “Ketanov”). To prevent tissue infection, use "Metronidazole" and "Tsiprolet".

Heart problems

This is the main cause of pain in the sternum, so it is important to know the signs and characteristics of diseases that can provoke such symptoms.

Disease	Image	What is it characterized by and how does it manifest itself?
Angina (type of tension)		The patient experiences squeezing and bursting pain in the center of the sternum, the attack of which can last from 2 to 15 minutes. Painful sensations may remain even at rest, and the pain may radiate to the area of ​​the shoulder blades, collarbone and left forearm
Myocardial infarction (necrosis)		Deadly dangerous pathology. Pain may occur in the left side of the chest, moving to the central zone. Added to the pain syndrome are breathing disorders, shortness of breath, feelings of anxiety and fear, and a drop in blood pressure.
Pulmonary artery blockage (thromboembolism)		The pain intensifies with inspiration, but is well relieved with analgesics. The symptoms resemble an attack of “angina pectoris”, hallmark is the absence of irradiation to other parts of the body

Important! For any symptoms that may indicate heart disease, you should immediately call an ambulance. The patient should be seated on a chair or placed in bed with his head elevated, air flow should be ensured, and a tablet should be given “ Nitroglycerin"under the tongue (analogous to " Nitrospray", to alleviate the condition, take one injection into the sublingual area). If there is no effect, the reception can be repeated after 5-7 minutes.

Neurological diseases and pathologies of the musculoskeletal system

Spinal diseases can be congenital, but about 80% are acquired in childhood or adolescence, therefore, the task of parents is to ensure the prevention of disorders of the musculoskeletal system and the correct formation spinal column with help physical activities, gymnastics and massage. The most common diseases of the spine include scoliosis (curvature of the spine) and osteochondrosis. A painful attack in the central part of the chest cavity can occur with chest or cervical osteochondrosis. The pain is pressing, intense, and intensifies when lying down.

Treatment of osteochondrosis includes therapeutic exercises, properly formulated diet and normalization psycho-emotional state, since most attacks are provoked nervous breakdowns or overvoltage. Anti-inflammatory drugs can be used to relieve pain ( "Nimesulide", "Diclofenac", "Capsicam"), but only after consulting a doctor, since many of them have a large list of contraindications and can cause blood diseases.

Important! Similar symptoms are also characteristic of intercostal neuralgia - compression or pinching of the intercostal nerves. The pain can be sharp, shooting, pulsating, stabbing in nature and very high intensity. The pain syndrome occurs against the background of a disorder respiratory function, may have a constant course or appear in short attacks. With chronic neuralgia, painful sensations can take on a burning or dull character.

Chest pain is a dangerous symptom, common mainly in people over 30 years of age who have chronic diseases. If such pain appears in a child, it is necessary to urgently go to the hospital to eliminate the possibility of hidden injuries and damage to internal organs. In rare cases, pain in the central part of the sternum may indicate a tuberculosis infection; such symptoms should never be ignored. read on our website.

Video - Why does my chest hurt?

Video - How to find out what hurts behind the sternum?

Pain in the chest or chest can be a symptom of many diseases, including those that pose a serious threat to human life. It can be difficult to recognize which organ is hurting; for example, sometimes pain in the heart area can indicate problems with the spine or stomach. That is why it is important to be able to recognize life-threatening symptoms and provide first aid in a timely manner.

Causes and symptoms of chest pain

Diseases of the lungs, cardiovascular system, chest, digestive organs, spine, malfunctions nervous system– all these factors can cause pain in the chest area. It may be accompanied by rapid breathing, elevated temperature, numbness of hands and cough.

Some chest pains may be harmless to a person's health, while others may lead to fatal outcome. This is why if you have chest pain, you should consult a doctor. He will appoint necessary research and based on their results, make a diagnosis and prescribe treatment.

Gastrointestinal diseases

Sometimes a person may mistakenly perceive stomach pain as chest pain. Typically, such pain is caused by spasm of the muscles of the organ. But the main difference is that they are longer lasting than pain due to heart disease and have significant differences. The main diseases of the digestive system that can cause chest pain:

• Stomach ulcer. In this case, pain depends on food intake. Usually the pain occurs on an empty stomach, and as soon as the person eats, it goes away. The disease may be accompanied by the following symptoms: heartburn, nausea, vomiting, indigestion. Stomach pain cannot be relieved with nitroglycerin; in this case, antispasmodics usually help.
• Diaphragmatic hernia. Through a defect in the diaphragm, internal organs penetrate from one cavity to another. The diaphragm contracts and organs are pinched. A hernia appears suddenly, mainly at night, and is characterized by severe pain that is similar to angina pectoris. The attack cannot be relieved with nitroglycerin, but the patient feels better when he is in an upright position.
• Esophageal rupture. A serious pathology in which its integrity is disrupted and its contents enter the chest area. Most often, rupture occurs during vomiting. The pain syndrome, in this case pronounced, can radiate to the back. The pain usually intensifies when coughing and changing body position. This condition is very serious and requires immediate surgical intervention, any delay can lead to death.
• Biliary colic. The pain radiates to the left chest. Typically, a pronounced pain syndrome occurs, which is relieved with the help of antispasmodics.
• Acute pancreatitis. It can also be confused with heart pain; such pain syndrome is difficult to relieve on your own. It is usually accompanied by nausea and vomiting; the patient in this case requires immediate hospitalization.
• Gastroesophageal reflux disease

Respiratory system diseases

The lungs occupy most of the chest, so pain can occur due to diseases of the lungs, bronchi, trachea and pleura. Often pain occurs due to tumors, injuries and inflammatory diseases, namely:

• Inflammation of the pleura. This is the most common reason why chest pain may occur. The pleura is a serous sac that covers the lungs, consists of two layers, and between them is the pleural cavity. If the cause of pain is inflammation of the pleura, then the person will have following symptoms: cough and fever. The pain usually worsens with deep breathing and coughing. At genetic disease, which is manifested by periodic inflammation of the pleura, pain in the chest may also be felt. The disease is most often unilateral, much less often the lesion is bilateral. All symptoms of this disease usually go away on their own within 5-7 days.
• Pulmonary tuberculosis can also cause chest pain. It is usually aching in nature and worsens when coughing. In addition to pain, the patient will have the following symptoms: prolonged cough, blood-streaked sputum, weight loss, fever and night sweats. For tuberculosis and abscess lung fluid or air may get into pleural cavity, severe pain appears, which is accompanied by shortness of breath, the person’s blood pressure decreases, the skin turns blue, it is difficult for him to breathe and move. The pain can radiate to the arm, neck and abdomen, while the chest increases in volume and the intercostal spaces widen. The person needs urgent hospitalization; he can only be treated in a hospital.
• Pneumonia. This disease can also be accompanied by chest pain. Usually, an area of ​​the lung becomes inflamed, a cough with sputum appears, and the body temperature rises. As a rule, pain in this disease is one-sided, can be felt under the shoulder blade, intensifies with movement and coughing, and the pain decreases in the lying position.
• Lungs' cancer. Chest pain occurs on late stages lung cancer, when the tumor has already grown into the surrounding tissue. The pain can be constant, sometimes intensifying to unbearable pain, which can radiate to the back, neck and shoulder. In addition, the patient may suffer from a dry cough, loss of appetite, weakness, and it will seem to him that there is not enough air.
• Tracheitis.
• Bronchitis.

Heart diseases

• Obstruction of the coronary artery. Acute piercing pain in the chest area can be caused by obstruction of the coronary artery, which stops blood access to the heart muscle and causes myocardial infarction. The pain syndrome is very strong and can radiate to the left arm and left shoulder blade. Due to the unbearable pain syndrome, the patient tries not to breathe, as breathing movements only strengthen it. Blood pressure rises, the person begins to turn pale or red. There is no need to endure such pain; you should take nitroglycerin and immediately call an ambulance, otherwise everything could end in death.
• Myocarditis. Sometimes chest pain can be caused inflammatory process occurring in the area of ​​the myocardium (heart muscle), myocarditis is a complication of the previous purulent sore throat or rheumatism. The disease usually occurs approximately two weeks after past illness. Painful sensations may resemble angina attacks, but they are not relieved by nitroglycerin. The pain intensifies with physical activity and is usually stabbing or aching in nature.
• Pericarditis. Another complication of various infectious diseases is an inflammation of the serous membrane of the heart muscle. Pericarditis is manifested by dull moderate pain, but sometimes the pain can intensify and resemble an angina attack. As a rule, the pain becomes stronger with movement, so the person tries to breathe shallowly and make as few unnecessary movements as possible. In addition to pain, the patient’s temperature rises, general malaise appears, and an increase in the level of leukocytes is observed in the blood test.
• Aortic aneurysm. Chest pain may occur due to an aortic aneurysm when a large blood vessel the area expands due to atherosclerosis, inflammatory lesions or injury. The person is usually tormented constant pain in the upper half of the chest, which does not radiate to other parts of the body and is not relieved by nitroglycerin. If the aorta ruptures, it will begin heavy bleeding, which usually ends in death.
• Thromboembolism. Blockage of a pulmonary artery by a blood clot is also a cause of severe chest pain. The pain is similar to an angina attack, but does not radiate to other parts of the body and is not relieved by nitroglycerin. Painkillers do not help, pain is accompanied by strong heartbeat, shortness of breath and decreased blood pressure. A person needs emergency surgery, otherwise he will die.
• Angina pectoris.
• Mitral valve prolapse;
• Aortic aneurysm;
• Myocardial infarction.

Psychogenic factors

• Cardioneurosis. It is the most common cause of long-term chest pain. Arises due to functional disorder nervous system. The cause is all kinds of mental shocks, they can be both long-term and short-term. In this case, the person feels constant aching pain in the heart area, pain can sometimes be sharp, they can be confused with attacks of angina pectoris. But taking nitroglycerin does not make a person feel better. In addition, other symptoms may be present, for example, the patient’s face turns red and blood pressure rises. Almost always there are signs of neurosis such as increased anxiety, weakness, irritability, sleep disorder. Sometimes it can be very difficult to distinguish cardioneurosis from coronary disease hearts. In this case, monitoring of the patient is necessary. If a diagnosis of “cardioneurosis” is made, then the person is prescribed sedatives, sleeping pills, for sleep disturbances, and correct mode day.
• Climax. Sometimes heart pain may occur during menopause. They are caused by hormonal imbalance and are usually accompanied by flushing of the face, loss of sensitivity in some areas of the skin, chills and sweating. Anti-anxiety medications and hormone replacement therapy usually help.
• Hysterical syndrome.
• Vegetative-vascular dystonia.

Diseases of the circulatory system

• Acute leukemia.

Chest injuries

Chest injuries are usually divided into open and closed. The first type is rare, as it is more typical for wartime. The second type of damage is much more common.

• Fractured ribs. A fairly common injury, if it is serious, then fragments of the ribs can damage lung tissue, pleura, vessels. A patient with such an injury experiences pain in the area of ​​injury, which intensifies with movement, breathing becomes short and shallow.
• Injury. With chest bruises, pain is also felt, and a hematoma forms at the site of the bruise. If the injury is minor and there are no fractures, no treatment is usually required. When severe bruises Extensive hemorrhage may occur, as well as rupture of tissues and organs, which can lead to death.
• Chest compression. When compressed, its volume decreases sharply, which leads to compression of the organs. In this case, the skin on the chest turns blue, and pinpoint hemorrhages appear on the neck and head; they can be extensive. Naturally, this condition is also accompanied by severe chest pain.
• Vertebral displacement.

If there is pain in the right chest

Painful sensations in the mammary glands often appear a few days before the onset of menstruation; this is a normal phenomenon associated with changes in hormonal status. But sometimes pain can be a symptom of certain diseases:

• Mastopathy is the proliferation of glandular tissue, which is characterized by the presence of cysts and fibrous compactions.
• Tumors. If it hurts only in right breast, then the cause of this may be benign tumors. It is necessary to visit a doctor and do the necessary examinations.
• Oncology. Breast cancer usually affects only one breast; pain appears in the final stages, when the tumor begins to grow into the surrounding tissue.
• Renal and hepatic colic. The entire right half of the chest can also hurt with renal and hepatic colic. The pain syndrome is usually severe, with renal colic The lower back often hurts, but sometimes the pain radiates to the right side of the chest. In this case, the patient needs to be shown to a doctor; antispasmodic drugs are usually given as first aid.
• Pancreatitis.
• Hepatitis.

If there is pain in the left chest

Chest pain can be caused by injuries, hormonal changes, malignant and benign tumors. It often happens that it is difficult to determine exactly where it hurts; for example, it seems that the pain is localized in the left breast, but in fact it is a little lower.

At the following diseases The left breast may hurt:

• Muscle spasms. The reason for this may be spasms of the sternum muscles; they may appear after physical exertion.
• Osteochondrosis. Unilateral nagging pain occur due to diseases of the spine, for example, osteochondrosis.
• Diseases of the cardiovascular system (angina pectoris).
• Breast cancer. It turns out that in most cases breast cancer affects the left breast, so if a woman has the following dangerous symptoms such as: tightness in the breast, severe pain, inverted nipple or other area of ​​skin on the chest, discharge not related to breastfeeding, then you need to consult a doctor immediately.

What to do and when to call an ambulance

From all of the above, it becomes clear that chest pain can occur due to various diseases, some of them do not pose a serious danger, while others can be fatal. That is why, if pain occurs in the chest area, you should consult a doctor for a diagnosis.

In what cases should you not delay calling an ambulance?

• If severe pain occurs suddenly, the person cannot breathe, shortness of breath and rapid heartbeat appear.
• The pain is not relieved by nitroglycerin and does not go away within five minutes.
• A person coughs and has sputum mixed with blood.
• Loss of consciousness, increased sweating, nausea and vomiting, pain radiating to the left arm, shoulder and neck.

The symptoms described above are a serious reason to consult a doctor; any delay can cost the patient his life.

Heart Attack Symptoms

During a heart attack, there is a lack of blood supply to the heart muscle, resulting in tissue necrosis. In most cases, death from a heart attack occurs within the first two hours. This is due to the fact that the heart cannot maintain normal blood circulation in the body. This is why it is important to be able to recognize the symptoms of a heart attack:

• pain and burning in the chest;
• dyspnea;
• dizziness;
• fear and panic;
• pale skin;
• nausea and vomiting;
• cold sweat;
• cough;
• sometimes fainting occurs.

All of the above symptoms are a serious reason to be wary, you need to call an ambulance as quickly as possible, every minute counts. When a person has a heart attack, they first feel pain in the chest. It can radiate to the arm, shoulder, neck, back and even to the stomach. The pain syndrome usually lasts from several minutes to several hours. When changing position, the patient may feel better.

Occasionally, a so-called “silent heart attack” may occur in some patients; it is usually diagnosed in people over 70 years of age who suffer from diabetes mellitus. In this case, the symptoms of a heart attack may not be pronounced or not appear at all, so it is difficult to suspect a heart attack, the disease progresses, and the person dies without treatment.

Symptoms such as anxiety, insomnia and discomfort may precede a heart attack. Sometimes you may experience increased heart rate and an irregular pulse. The symptoms of a heart attack can be confused with shingles, but there is one important difference. For herpes zoster skin Bubbles will be visible in the area of ​​the intercostal nerve.

Diagnosis and differential diagnosis

Chest pain can be caused by many diseases, so it is difficult for doctors to make a diagnosis based only on the symptoms of the disease; differential diagnosis. Basically, doctors prescribe the following studies:

• First, the patient is interviewed to find out the nature of the chest pain, whether there is any connection with physical activity or eating, whether the pain syndrome radiates to other parts of the body, and the like.
• Then the patient is examined: blood pressure and temperature are measured, pulse, heart, and lungs are listened to.
• A chest x-ray is ordered. This diagnostic method is very informative. It helps identify diseases of the lungs, heart, as well as fractures and other diseases of organs located in the chest.
• Using an ECG, the work of the heart is determined. This test can detect heart attack and angina, as well as pulmonary embolism.
• Computed tomography is the most exact method diagnostics, which allows us to identify changes that have occurred in the body that were not visible on x-rays.
• Fibroesophagogastroduodenoscopy (FEGDS) - this diagnostic method is carried out to exclude diseases of the digestive system, which can also cause pain in the chest area.
• A general blood test is carried out in order to understand whether there is inflammation in the body.

Since pain in the chest can indicate many diseases, there are no actions that could alleviate a person’s condition. If the symptoms are similar to a heart attack, then you need to give him nitroglycerin and call an ambulance as quickly as possible. In other cases, you should also go to the doctor to accurately identify the causes of chest pain.

Which doctor treats

If you experience chest pain that does not require immediate hospitalization and does not resemble a heart attack, then it is recommended to first consult a therapist. He will examine the patient, conduct the necessary studies and refer the patient to other doctors. If your heart hurts, then see a cardiologist, if you suspect intercostal neuralgia, see a neurologist, and if your stomach hurts, then see a gastroenterologist; in case of breast disease, you need to see a mammologist. In any case, the referral should be made by a therapist.