What kind of chest pains are there? Aching chest pain - should you worry?

Pain in the chest (chest), under the shoulder blade and in the heart area can occur with a variety of diseases, some of which are life-threatening. For this reason, it is very important to be able to recognize when chest pain should promptly seek medical attention. Chest pain may be accompanied by a feeling of shortness of breath, increased breathing, numbness in the hands, cough, increased body temperature, etc. Based on the accompanying symptoms, the doctor can suggest a possible cause of chest pain and prescribe tests that will help determine the problem.

Causes of chest pain

The most common causes of chest pain are:

1. Diseases of the heart and large vessels: angina pectoris, acute myocardial infarction, aortic aneurysm dissection, pericarditis, mitral valve prolapse, etc.
2. Lung diseases: pneumonia, pulmonary embolism, spontaneous pneumothorax, pleurisy, etc.
3. Diseases of the esophagus: GERD (gastroesophageal reflux disease), esophagitis, esophageal spasm, esophageal cancer, etc.
4. Diseases of the spine and chest: inflammation of the costal cartilages in the area of ​​connection with the sternum (Tietze's disease), osteochondrosis of the cervical and thoracic spine.
5. Nerve diseases: herpes zoster, intercostal neuralgia, etc.
6. Women's diseases: various diseases of the breast.

For each of the above diseases, chest pain has its own characteristics, which can help determine the cause of the pain. The most common types of chest pain and their causes are described below:

Chest pain associated with heart disease

The main symptom of acute myocardial infarction is intense pain in the sternum. The pain may last from an hour to several hours. However, the individual factor plays a significant role. Sometimes the symptoms of a heart attack become atypical. For example, with the abdominal form of a heart attack, pain is felt not in the chest, but in the abdomen; symptoms of the abdominal form resemble those of pancreatitis. In some atypical cases, patients feel pain in the shoulder and arm.

Angina is a condition in which the heart muscle lacks oxygen. In this case, the person feels severe pain in the chest, often accompanied by a feeling of pressure. Angina occurs when physical stress on the heart and muscles has increased, but there is no access to additional oxygen because the blood vessels are in spasm. The first aid in this condition is nitroglycerin, and the person will immediately feel better.

Mitral valve prolapse is a common cardiac dysfunction in which the mitral valve leaflets bend inward into the atrium. In some cases, this condition is painless; in other cases, patients complain of chest pain, decreased performance, weakness, and fainting. This cardiac disorder is more common in women.

An aortic aneurysm is a protrusion of the walls of the aorta, resulting in decreased blood flow. Manifested by chest pain, severe shortness of breath and other symptoms. The pain is of high intensity, sometimes radiating to the epigastric region, to the back. The condition is acute and requires urgent medical attention.

Pulmonary embolism occurs when the pulmonary artery stops blood flow due to a blockage from a blood clot. If the blockage is massive, then acute heart failure occurs, with a fatal outcome. If the blockage is minor, you may experience chest pain, shortness of breath, sweating, and changes in blood pressure.

Chest pain radiating to the back, between the shoulder blades

Esophageal rupture is a serious condition in which the integrity of the esophageal wall is disrupted and its contents enter the chest cavity. As a rule, rupture of the esophagus occurs during profuse vomiting. Chest pain due to a rupture of the esophagus is strong, sharp, felt in the middle of the chest and radiates to the back. The pain intensifies when coughing, inhaling or changing body position. If you suspect a rupture of the esophagus, you should immediately call a doctor, as delay in treatment can lead to serious consequences and even death.

When an aortic aneurysm ruptures, the pain occurs suddenly and feels like a “tear” inside the chest. Chest pain with this disease can radiate to the area between the shoulder blades and is combined with a pronounced fear of death, shortness of breath, abdominal pain, weakness (even loss of consciousness).

Pain in the center of the chest

Pain in the midline of the chest can occur with various diseases of the esophagus, trachea and other organs.

Esophagitis is an inflammation of the mucous membrane of the esophagus, which usually occurs as a result of prolonged reflux of acidic gastric contents into the esophagus. The pain associated with esophagitis is burning (heartburn), lasts from several minutes to several hours, intensifies during or after eating, and can radiate to the neck. See GERD symptoms and treatment.

Tracheitis is an inflammation of the mucous membrane of the trachea, which, as a rule, occurs with various colds (flu, etc.). Chest pain with tracheitis is burning, felt behind the sternum (in the middle of the chest), combined with a feeling of dry throat, hoarseness, sometimes accompanied by a cough (dry or with sputum). Often with tracheitis, body temperature rises.

A hiatal hernia is a disease characterized by the entry of the upper part of the stomach (rarely the entire stomach or other abdominal organs) into the chest cavity. Chest pain with a hiatal hernia is usually associated with food intake, appears or worsens in a lying position, is accompanied by heartburn, a feeling of heaviness in the chest, and can radiate to the left half of the chest, to the neck, simulating the pain of angina pectoris. See All About Diaphragmatic Hernia and Its Treatment.

Chest pain in women

Many women at one time or another in their lives have encountered the problem of chest pain. The appearance of these symptoms should not cause panic or fear, but they should not be taken lightly either. In order for every woman to have peace of mind about her health, and, if necessary, to be able to undergo the necessary course of treatment in a timely manner, she needs to become familiar with the symptoms and causes of pain in the mammary glands.

Pain localized in the mammary glands has a medical name - mastalgia. Mastalgia is divided into two groups - cyclic and non-cyclic.

Cyclic chest pain

Cyclic mastalgia or mastodynia is pain in a woman’s mammary glands that occurs on certain days of the menstrual cycle, namely two to seven days before the start of the next menstruation. For most women, this pain does not cause discomfort - it is not very strong, more like a feeling of fullness of the mammary glands, a burning sensation inside them. Within a couple of days, these sensations disappear without a trace.

A woman's breasts change throughout life. In one menstrual cycle, the influence of various hormones that are produced in the female body stimulate the tone or relaxation of the walls of the excretory ducts in the mammary glands and affect the tissue of the lobules. About a week before the onset of menstrual bleeding, a large number of epithelial cells and lobular secretions accumulate in the ducts of the mammary glands. The mammary glands swell, more blood flows to them, they become larger in volume and dense, painful to the touch. Cyclic breast pain in women always manifests itself simultaneously in both mammary glands.

In some women, cyclic mastodynia manifests itself pathologically strongly. The pain sometimes becomes simply unbearable, and the woman cannot lead a normal life, do her usual activities, and feels very bad on such days. As a rule, increased pain in the mammary glands is a sign that some pathological process is beginning in the body, and the woman needs to see a doctor for examination and subsequent treatment, if necessary.

Non-cyclical pain in the mammary glands

Non-cyclical pain in the mammary glands is not associated with a woman’s menstrual cycle; they are always provoked by some other factors, in some cases pathological.

When pregnancy occurs, a woman’s body undergoes changes associated with hormonal changes - the level of female sex hormones increases. Under the influence of estrogen and human chorionic gonadotropin, the lobules of the mammary glands begin to swell, secretion is formed in the ducts, and at the end of pregnancy - colostrum. From the first days of pregnancy, a woman’s breasts acquire increased sensitivity, even soreness.

As you know, tenderness and engorgement of a woman’s mammary glands are likely signs of pregnancy. This soreness of the breasts in the first weeks of pregnancy can also be different - from a slight burning sensation, tingling of the nipples, to severe tension in the mammary glands and dull pain radiating to the shoulder blades, lower back, and arms. Such phenomena usually disappear completely by the end of the first trimester of pregnancy, that is, by the 10th – 12th weeks.

From the 20th week of pregnancy, a woman’s breasts intensively prepare for the upcoming feeding of the baby and lactation. Women note a significant enlargement of the mammary glands, various tingling sensations in them, feelings of tension, engorgement. But these phenomena are not painful; normally they should not be accompanied by severe pain. If a woman notices pain that does not go away, and even more so if the pain is localized only in one mammary gland, she should seek advice from her gynecologist in order to timely rule out various diseases and pathological processes not related to pregnancy.

What diseases are accompanied by pain in the mammary glands?

Mastopathy– these are fibrocystic growths in the mammary glands of a woman, an imbalance between connective and epithelial tissues. Mastopathy causes non-cyclical pain in the mammary glands. Mastopathy appears in women in case of hormonal instability, under the influence of various unfavorable factors that change the normal hormonal background of the female body. These factors include abortion, neuroses, chronic inflammatory and infectious diseases of the female genital area, thyroid diseases, pathological conditions of the pituitary gland, liver diseases, cessation of breastfeeding during increased lactation, and irregular sex life.

Infectious and inflammatory processes in the mammary glands– diseases that can cause both chest pain and an increase in general body temperature, deteriorating a woman’s well-being. Pain in infectious and inflammatory diseases of the mammary glands can be of various types, but most often it is shooting, aching, radiating to the shoulder blades, armpits, and abdomen. Most often, mastitis is observed in women who have recently given birth, during the period of breastfeeding the baby. These diseases require urgent treatment from a doctor.

Breast cancer– a malignant neoplasm in the mammary gland, which is characterized by the formation of large accumulations of atypical cells in it, which form a tumor over time. In some cases, breast cancer develops asymptomatically until a certain stage, so a woman should be especially attentive to any changes in her body. The most common changes in the mammary gland during cancer are “orange peel” in a certain area of ​​the skin, severe peeling of the mammary gland and nipple.

An aching chest is usually not something to worry about. Pain can occur for many reasons, from sports training to medications. Here's what you need to know before seeing a doctor, writes Health.

What causes chest pain?

As soon as a woman feels pain in her chest, the thought immediately arises - “CANCER!” However, breast pain is very rarely associated with breast cancer.

“Chest pain is very rare, rarely associated with cancer,” says Monique Swain, MD, an obstetrician and gynecologist at Henry Ford Medical Center in Detroit.

There are two types of breast pain: Cyclic pain, which is associated with the menstrual cycle, most often affects both breasts. Non-cyclical pain occurs for any other reason and does not follow a monthly pattern. It may cover one or both breasts, the entire breast, or just part of it.

Most often, chest pain goes away on its own. However, talk to your doctor if the pain does not go away after a week or two, or if it interferes with your normal activities. You should also see your doctor if you have other symptoms, including those related to your menstrual cycle, nipple discharge, or signs of infection such as redness, swelling and burning.

Here are several causes of chest pain.

1 A certain period of the menstrual cycle.

Two-thirds of breast pain is caused by the release of estrogen and progesterone throughout the menstrual cycle.

“Hormonal breast pain can happen to any woman who is approaching her period,” says Dr. Swain. "It doesn't matter whether you're 14 or 44, if you're menstruating, you're at risk for periodic breast pain."

Usually you feel pain in the chest, which is associated with the arrival of menstruation, which can be either external or internal. Most people describe the pain as pulling rather than sharp.

For some women, simply knowing that the pain will go away, usually within a week or 10 days, is enough. Other women seek relief from over-the-counter pain medications. There is one FDA-approved prescription drug for chest pain called danazol, but it (like other prescription pain medications) can have serious side effects.

Diet also plays a role in reducing menstrual breast pain: Eating more flaxseed may reduce the pain, as can eating a low-fat diet rich in complex carbohydrates, Dr. Swain points out.

2 You are pregnant

The first trimester of pregnancy brings a whirlwind of hormones that can cause not only mood changes, food cravings, fatigue, nausea and vomiting, but also chest pain.

Pain is associated with “acute hormonal changes,” including human chorionic gonadotropin, according to Jennifer Wu, MD, an OB/GYN at Lenox Hill Hospital in New York City.

The pain is usually temporary. In the second and third trimester, there will be less pain or no pain at all.

3 You are breastfeeding

Breastfeeding your baby is completely natural, but it can also cause discomfort and pain. You may feel pain when your baby starts to suckle or if his or her mouth is not positioned correctly on the nipple. The first pain gradually goes away, and the second can be removed by changing the position of the child.

Your baby's wet lips may also cause nipple soreness due to microcracks. Talk to your doctor or lactation consultant about how to manage these symptoms, as they can lead to infections.

Your breasts can also be damaged while breastfeeding if you have an infection in your milk ducts. In this case “the milk ducts are very swollen”, says Dr. Wu. "They can get clogged". Contact your doctor if breast pain with feeding lasts more than a couple of days.

4 You are taking certain medications

Any type of medication that contains hormones - birth control, hormonal, fertility treatments - can also cause breast pain, as when natural hormones surge during the menstrual period.

But other types of medications can also have an effect. For example, antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can cause chest pain, and chlorpromazine, an antipsychotic, can cause severe pain. The reasons for this are not entirely clear today. Some heart medications may also cause chest pain.

Talk to your doctor if your medication causes pain and you may be offered an alternative treatment.

5 You have a cyst

Cysts are common in women 35 years of age and older. “A cyst is a clogged breast gland with fluid accumulation,” says Teresa Bevers, MD, director of the Cancer Prevention Center at the University of Texas at Houston.

Cysts are usually harmless, but they can be painful. “If [the fluid] stretches the walls of that canal, the tissue, it can become sensitive and very painful.”, says Dr. Bevers.

Treatment depends on your age, how large the cysts are, and how painful they are. You may decide to do nothing, or your doctor may remove the fluid to relieve the pain.

6 You had surgery

Any injury to the chest can cause pain. This could be surgery, a biopsy, a seat belt injury, or even a simple blow.

Immediately after the injury, sometimes up to two years, tissue necrosis may occur, which manifests itself as thickening or lumps in the chest. By this time, you may not always remember the original injury, but fortunately it is not dangerous and does not require treatment.

7 You have shingles

Shingles is a later manifestation of the varicella zoster virus. Anyone who had chickenpox as a child may develop shingles as an adult, but the chest is only considered damaged by the infection if a rash appears on it.

This rash can be very painful, with itchy blisters that may burst. You may also have a fever, headaches, and sensitivity to light.

Shingles usually lasts two to six weeks. There is no drug treatment for it. Antiviral drugs can speed up treatment. Your doctor may also prescribe pain relievers, antidepressants, and birth control, which may help relieve pain.

8 You overextended your muscles

An injury to your muscles after a tough workout may feel like chest pain, although the injury is actually located elsewhere. Heat and over-the-counter pain relievers are usually sufficient to relieve muscle pain; your doctor may recommend something stronger if the pain is more severe.

Muscle problems are just one type of pain that originates outside but is felt in the chest. Other causes include pneumonia, heartburn, spinal problems, gallbladder disease, heart disease and neck arthritis.

Of course, be aware of any chest pain, which could be a sign of a heart attack. Other heart attack symptoms in women may include pressure, heaviness in the middle of the chest; shortness of breath; pain in the arms, back, neck, jaw or stomach. Call 911 right away if you think you are having a heart attack.

9 You have large breast size

Large breast size can cause enough stress to stretch the pectoral ligaments and tissues. This can cause pain not only in the chest, but also possibly in the back, neck and shoulders.

“Women with larger breasts have breast pain, but usually these women also have other problems such as back pain and shoulder pain.”, says Dr. Swain.

Finding the right, supportive bra can go a long way in relieving this type of pain. You can also try over-the-counter pain relievers. For severe pain, you may consider prescription treatments such as tamoxifen or danazol, but the side effects of using them can be serious.

In extreme cases, some women choose breast reduction surgery.

10 You're Wearing the Wrong Bra

The wrong bra can cause pain, even if you have small breasts. “Most of the time, women wear bras that are too big.”, says Dr. Swain, and a bra that is too large will not support your breasts.

A bra that is too small is not much better as it compresses the breasts. Dr. Swain says if your bra is causing breast pain, you should choose a larger size.

11 You're approaching menopause

Women approaching menopause may experience painful fullness in the breasts, called ductal ectasia. This causes fluid to accumulate. “This process can cause pain in the nipples and areolas,” says Dr. Swain.

Other symptoms may include nipple discharge.

This condition can be reduced with warm compresses. However, if the pain does not go away, your doctor may recommend surgery or medication.

12 You May Have Inflammatory Breast Cancer

This is one of the few cases where breast cancer can actually involve pain. Inflammatory breast cancer is a rare and aggressive form of the disease that accounts for 1 to 5% of all breast cancer cases.

In people with inflammatory breast cancer, cancer cells obstruct the lymphatic vessels in the skin of the breast, causing redness, swelling and inflammation in about a third of the breast. The skin may also appear ulcerated due to the accumulation of lymph fluid. Sometimes you may feel a lump, but this is usually not the case.

Inflammatory breast cancer is more common in younger women, African-American women, and obese women—and is usually treated with surgery, chemotherapy, and/or radiation. Targeted treatments are also sometimes used.

Many of these symptoms may also be due to infection or injury. Don't panic, but you need to see a doctor right away!

Aching pain can be no less dangerous than violent manifestations of problems in the body. What and how should those with a similar situation behave? There may be several causes of pain: problems of the chest organs, mammary glands, depression.

Diseases of the chest organs

When the cause of aching pain is heart disease, it may be:

1. Heart attack. The pain that occurs with this disease manifests itself regardless of the load and time of day. In addition to the chest area, they can spread to other parts of the body. If they occur, immediate contact with a medical facility is required.
2. Myocarditis. The cause of pain is an infectious disease, after which an inflammatory process occurs. Accompanied by heart rhythm disturbances. This kind of aching pain can last.
3. Pericarditis. The cause of pain is inflammation. Additional symptoms include palpitations, cough, shortness of breath, and irregular pulse rhythm.
4. Angina. Aching pain and discomfort may spread to the abdomen, arm, jaw, or throughout the chest. Most often, the symptom occurs after physical activity and lasts several minutes. To eliminate it.
5. Intercostal neuralgia. Movement in this disease increases pain. After a few minutes the pain goes away until the next attack. Without assistance, the frequency of pain increases. To alleviate the condition, take anti-inflammatory, painkillers and vitamin preparations. Spinal diseases, which are a provoking factor, should be treated.

Diseases of the chest organs require qualified assistance. Therefore, you should not self-medicate.

Pain in the mammary glands

Hormonal changes in the female body can be accompanied by pain in the chest area. The reason for this may be:

1. Mastopathy. It is a consequence of an increase in connective tissue. Aching pain most often occurs before and goes away after. A tincture of 30 walnuts in 100 grams of alcohol helps in the treatment of mastopathy.
2. Fibroadenoma. Having felt the place where discomfort is felt, under your fingers you can find a compaction with clear contours. Education is good quality. It is treated surgically.
3. Cancer is a tumor in the mammary gland, which is a malignant formation. It is treated only in medical institutions.

Other causes of aching pain

Sometimes aching pain occurs in women during menopause. Most often they are provoked by worries and worries. In this case, soothing drinks and procedures will be the best assistant. Depression can also lead to aching pain. In this case, the cause of depression should be eliminated and the unpleasant sensations will pass.

Aching pain is not always a symptom of a serious illness. Therefore, you do not need to diagnose yourself. It's better to get tested to know for sure. This must be done immediately after discomfort occurs. The sooner treatment begins, the better the outcome.

A woman's breasts are the most tender part of the body. It reacts to any changes in the functioning of the body and the negative influence of the environment. Chest pain is a fairly common pathology in women of all ages. Discomfort and painful sensations and tingling sensations have different etiologies and are not always a sign of pathological disorders and diseases in the chest.

Causes of chest pain

Often, a painful symptom appears when there are changes in the body's hormonal system, increased production or increased sensitivity to hormonal surges, before menstruation and postmenopause, and tingling in the chest occurs with temporary changes in the body.

A more rare cause of breast pain is sclerotic seals in the vessels or inflammatory processes, previous operations and injuries, and neoplasms.

Types of chest pain

To find out the reason why your chest hurts, you need to consult a specialist. Painful sensations in the mammary glands are divided into several types.

According to the location of the outbreak:

• on one or both sides;
• in the lower segments of the gland;
• in the upper lobes;
• encircling, pulling total.

According to the nature of the pain:

• dull;
• pulsating;
• aching;
• piercing;
• baking;
• cutting;
• shooting (starts shooting).

By saturation:

• discomfort in the mammary gland;
• medium brightness;
• very spicy.

From the period of appearance:

• cyclical pain syndrome - depends on monthly bleeding or hormonal imbalance;
• acyclic mastalgia - pain occurs from the appearance of pathological changes in the breast or nearby organs and appears regardless of the woman’s menstrual cycle.

Causes of cyclic soreness

Chest pain occurs 7 or 10 days before the start of monthly discharge, more often in the second half of the monthly cycle, after ovulation. The main causes of cyclic pain:

An aching and dull pain appears in the upper segments of the chest or around the mammary gland (total shingles), aching in the armpits. Always appears in both female breasts. The glands increase in size and swell, sometimes small nodules can be felt, which disappear after menstruation.

Chest pain is accompanied by migraines, pulling sensations in the lower abdomen, irritability and emotional outbursts.

Cyclic pain occurs in young girls, women of childbearing age and before menopause.

Constant pain

Pains of a constant nature have no connection with a woman’s monthly cycle, and then special attention needs to be paid to them. The reasons are related:

Hereditary anomalies in the structure of the lacteal segments are possible; this causes pinched vessels and nerves, inflamed lesions appear, and adhesions and cysts form.

In addition to painful manifestations, other symptoms appear, such as:

• deformation of the nipple and breast shape;
• red spots on the skin indicate a focus of inflammation;
• changes in the structure of the dermis;
• abnormal nipple discharge;
• inflammation of the lymph nodes;
• general malaise, increased body temperature, lethargy, nausea, loss of appetite;
• pain haunts women from the age of 30 and after menopause.

Inflammatory process

Mastitis is a common disease with inflammation of the mammary glands. It often appears during breastfeeding and is caused (in 10% of women the problem is not related to lactation).

Mastitis causes the glandular tissue of the breast to grow, tearing pains appear, swelling is added, and fever begins. If the problem is not dealt with, it will develop into purulent mastitis, an abscess will appear, and surgery will be required.

Chest pain can appear not only from pathology, but also from inflammatory processes in the abdominal cavity (left side - pancreas, spleen, small intestine) or in the lungs. Then the pain is stabbing in nature and the symptoms are similar to an intestinal disorder or a cold. Pain in the right chest occurs with liver problems.

Neurological pathology

Neurological diseases include disorders of the sensitivity of nerve endings. The pain syndrome is paroxysmal and quite strong, intensifies when coughing, walking, or bending the body. It is felt not only in the sternum, but also in the lower back, back and shoulder blade. Painful symptoms recede after treatment with warming ointments, anti-inflammatory medications, muscle relaxants and multivitamins.

The symptoms of neuralgia are similar to heart attack, coronary heart disease and other heart diseases, and pain appears in the left mammary gland in women.

Hormonal surges

80% of women are familiar with the situation when they begin to ache, ache, and pull in the mammary glands 10 days before monthly bleeding. In addition to unpleasant discomfort, the breasts swell, the woman becomes irritable and drowsy. The cause of these surges is hormonal fluctuations. They occur in a woman’s body regularly in various phases of menstruation (the balance of progesterone and estrogen is disrupted due to excessive secretion of progesterone), this is not a deviation, the norm for adolescence and before menopause, does not require medical attention.

Changes during pregnancy

The beginning of pregnancy is signaled by pain in the mammary glands. Such symptoms also depend on hormonal changes, on excess progesterone. This hormone activates the growth of the alveolar lobes and breast enlargement, all of which causes pain.

From the second trimester of pregnancy, the body produces prolactin, and the woman’s breasts prepare to feed the baby. The milk ducts become stretched, causing pain and a feeling of heaviness.

Problems of a nursing mother

The most well-known cause of pathology in lactating women is milk stagnation. The pathology appears in the first month of feeding and is associated with an irregular rhythm and incorrect feeding technique, and large glands. Most often, pain in the mammary glands in nursing mothers occurs due to problems such as:

• lactostasis;
• lactation mastitis;
• lactation abscess;
• lactocele.

These factors cause stagnation of human milk in the milk segments and canals, their excessive filling and stretching. In this case, it will hurt both in two and in one gland.

In this case, lactostasis is accompanied by:

If you ignore treatment of the causes of the pathology, this will lead to lactation mastitis or breast abscess.

Lactation mastitis is an inflammation of the milk segment caused by stagnation of breast milk and the ingress of pathogenic microflora.

Mastitis manifests itself as acute pain in one point, spreading throughout the chest and into the armpit, with swelling and a sharp increase in temperature, redness of the skin, and headaches. Massage and expressing milk do not alleviate the situation.

If one of these symptoms occurs, you should urgently consult a surgeon or gynecologist. An untreated problem will become more complicated and develop into an abscess (purulent inflammation).

Signs of transformation of mastitis into an abscess are: acute point pain, bluish skin color, fever up to 40 degrees, severe migraine, weakness in the limbs, dizziness, drowsiness, fatigue.

The only way to treat an abscess is surgery. The purulent focus is opened, a drain is inserted, and antibacterial and disinfectant solutions are injected into the chest cavity.

Lactocele is traumatic after a bruise or from a congenital anomaly of the milky segments and canals, scars after surgery. These signs interfere with normal lactation and a cyst filled with milk appears in a separate segment of the breast, which grows as the milk arrives, bringing a feeling of discomfort and tearing.

During self-examination, when pressed, a soft, moving formation is felt, which does not disappear after pumping. If you find similar symptoms and there are stimulating factors, you should consult a doctor. The diagnosis is made after puncture of the cyst and its removal is prescribed.

Mastopathy includes everything in which there are:

• pain in all segments of the gland;
• compaction and volumetric neoplasm;
• any discharge from the nipples.

The most common mastopathy is diffuse fibrocystic. In gynecology, it is considered not a disease, but a condition of the mammary gland against the background of dishormonal changes (temporary and permanent) in a woman’s body. The pain appears in the form of aching discomfort in the upper chest on the right or left and depends on the menstrual cycle.

Occurs with increased milk secretion, infrequent feeding of the baby, and sluggish sucking.

Breast tumor

Cysts and tumors are the most dangerous cause of breast pain. The danger is that benign formations can degenerate into malignant ones. In addition to painful sensations, the following are added:

When palpated, lumps and nodules are felt, both painful and painless. If, during a self-examination, a woman discovers similar symptoms, she should urgently consult a mammologist or oncologist. Early diagnosis of tumors makes treatment more effective.

With tumors and cysts in the glands, sharp piercing pains appear that are not associated with the monthly cycle. The pain can last up to 2 weeks and does not go away after menstruation; it appears locally in one area.

Help with painful discomfort

Having discovered unpleasant symptoms, it is strictly forbidden to self-medicate. You need to consult a specialist for a diagnosis.

Often the pain goes away once the cause is eliminated. If examinations show that the discomfort is not associated with serious disorders and pathologies, the patient is prescribed symptomatic treatment. Therapy consists of taking medications:

• medications to normalize the production of sex hormones;
• for severe premenstrual pain - sedatives and anti-stress drugs;
• multivitamins to normalize metabolism in the body.

Prevention of pain syndrome

To prevent pathology of the mammary glands, a woman should adhere to the following recommendations:

• promptly seek treatment for infectious and inflammatory diseases;
• avoid injury to the chest and mammary glands;
• have a regular sex life;
• use contraception against unwanted pregnancy (medicines are prescribed only by a doctor);
• wear natural, comfortable underwear;
• give up alcohol and smoking;
• During breastfeeding, feed the baby for at least 6 months and follow the rules of personal hygiene.

Women with intact reproductive function need to visit a mammologist and gynecologist every six months for a preventive examination and diagnosis of diseases in the early stages.

Many patients know that it is a possible sign of life-threatening conditions and seek help when minimal symptoms appear. Other patients, incl. if they have serious illnesses, they minimize or ignore the occurrence of pain. The perception of pain varies significantly between individuals. Whatever the description, chest pain should never be ignored without finding out its cause.

Pathophysiology of chest pain

The heart, lungs, esophagus and large vessels are the source of afferent innervation with the participation of the same autonomic ganglia. Painful stimuli originating in these organs are usually perceived as “chest pain,” but because the afferent nerve fibers cross in the dorsal ganglia, pain originating from the chest organs can be perceived in any area between the umbilical region and the line of the ears. , including the upper limbs.

Painful stimuli, the source of which are the chest organs, can cause pressure, tearing, gas formation with belching, dyspepsia, burning, aching or stabbing pain, and sometimes a sharp “needle-like” pain. When complaints are visceral in nature, many patients deny that they have pain, they say that it is just “discomfort.”

Causes of chest pain, why does pain occur?

Cardiovascular diseases

Cause	Possible signs	Diagnostic approach
Myocardial ischemia (myocardial infarction/unstable angina/angina pectoris)	Acute pressing pain radiating to the jaw or arm. S4 gallop rhythm. Sometimes - a systolic murmur of mitral regurgitation. Signs that require special attention are often identified.	ECG dynamics and markers of myocardial damage; hospitalization for observation. Stress imaging tests or CT angiography for patients with no evidence of ischemia on the ECG and normal levels of markers of myocardial injury. Catheterization and coronary angiography are often indicated if test results are positive.
Thoracic aortic dissection	Sudden “tearing” pain radiating to the back. Sometimes - syncope, stroke or signs of ischemia of the lower extremities. There may be asymmetry of pulse or blood pressure in the extremities. Age over 55 years. Hypertension. Signs that require special attention.	Signs of the disease on a chest x-ray. CT of the aorta to confirm the diagnosis, Transesophageal echocardiography
Pericarditis	Constant or intermittent sharp pain, often worsening when breathing, swallowing, lying on your back and decreasing when bending forward. Pericardial friction rub. Swelling of the neck veins.	The ECG is usually informative. Markers of myocardial damage (increased troponin levels with normal CPK values). Transthoracic echocardiography
Myocarditis	Fever, shortness of breath, fatigue, chest pain (if myopericarditis is present), recent viral or other infection. Sometimes signs of heart failure, pericardial disease, or both	ECG. Markers of myocardial damage. ESR. C-reactive protein. Usually - echocardiography

Cause	Possible signs	Diagnostic approach
Esophageal rupture	Sudden severe pain after vomiting or instrumental interventions (for example, esophagogastroscopy or transesophageal echocardiography). Subcutaneous crepitus during auscultation. Multiple signs requiring special attention	Chest X-ray. Esophagography with water-soluble contrast for confirmation
Pancreatitis	Pain in the epigastrium of the chest. Vomit. Upper abdominal muscle tension. Shock. Often - anamnestic indications of alcohol abuse or biliary tract diseases	Serum lipase. Sometimes - CT scan of the abdomen
Peptic ulcer	Recurrent pain of uncertain localization in the epigastrium or upper quadrant of the abdomen, a history of smoking or excessive alcohol consumption, pain relieved by food, antacids, or both. There are no signs requiring special attention	Clinical assessment. Sometimes endoscopy. Sometimes - testing to detect Helicobacter pylori
Reflux esophagitis (GERD)	Recurrent burning pain from epigastrium to neck.	Clinical assessment. Sometimes endoscopy. Sometimes motor examination.
Diseases of the biliary tract	Recurrent discomfort in the upper right quadrant of the abdomen or epigrastrium after eating	Ultrasound examination of the gallbladder
Esophageal motility disorder	Long-lasting pain with a sudden onset, which can sometimes accompany the act of swallowing. Usually also difficulty swallowing	Barium X-ray

Lung diseases

Cause	Possible signs	Diagnostic approach
Pulmonary embolism	Often - pleural pain, shortness of breath, tachycardia. Sometimes - minor situations: fever, hemoptysis, shock. Highest probability - in the presence of risk factors	Varies depending on the clinical situation
Tension pneumothorax	Severe shortness of breath, hypotension, tension of the jugular veins, unilateral weakening of respiratory sounds and increased percussion tone. Sometimes - signs of air under the skin	Usually - clinically. Detected by chest x-ray
Pneumonia	Fever, chills, cough and purulent sputum. Often - shortness of breath, tachycardia.
Pneumothorax	Sometimes - unilateral weakening of respiratory sounds, air in the subcutaneous tissue	Chest X-ray
Pleurisy	May occur after pneumonia, embolism Usually - clinical assessment of pulmonary artery or viral respiratory infection. Pain when breathing, coughing. Physical data - no features	Usually - clinical assessment

Other reasons

Cause	Possible signs	Diagnostic approach
Pathology of the musculoskeletal system as a cause of chest wall pain (for example, due to injury, overexertion or costochondritis)	The diagnosis is often assumed based on clinical assessment of the history. The pain is usually long-lasting (several days or longer) and worsens with active or passive movement. Diffuse or local muscle tension	Clinical assessment
Chest tumors	Various. Sometimes - chronic cough, history of smoking, signs of chronic disease (weight loss, fever), cervical lymphadenopathy	Chest X-ray. Bone scan for long-term local rib pain
Herpes zoSTer infection	Acute girdling pain in the middle part. Clinical assessment of the chest on one side. Classic vesicular rash. Pain may precede the appearance of the rash by several days	Clinical assessment
Idiopathic pain syndrome	Various signs. There are no signs requiring special attention	Diagnosis is made by exclusion

Examination for chest pain

Anamnesis

The history of the present disease should reflect the location, duration and nature of the pain. The patient should be questioned about events that may have led to the pain (eg, tension or excessive use of the chest muscles), as well as the presence of any precipitating factors and factors that help reduce pain. Particular attention should be paid to the appearance of pain during physical activity or at rest, its connection with breathing or coughing, the presence of swallowing disorders, connection with meals, body positions that lead to the appearance or disappearance of pain (for example, horizontal position, bending forward). It is necessary to identify the presence of similar episodes in the anamnesis and assess whether the circumstances of their occurrence were similar. Particular attention should be paid to the presence of associated symptoms, incl. shortness of breath, palpitations, syncope, sweating, nausea or vomiting, cough, fever and chills.

Assessment of symptoms should be aimed at searching for possible causes, incl. the presence of pain in the legs and swelling and, consequently, the development of pulmonary embolism, as well as weakness, malaise, weight loss (cancer).

History of other medical conditions should reveal known causes, especially the presence of cardiovascular or gastrointestinal disease, as well as any investigations or interventions.

It is necessary to pay attention to the use of drugs that can cause spasm of the coronary arteries (for example, cocaquin, triptans, phosphodiesterase inhibitors) or damage to the gastrointestinal tract (primarily alcohol, NSAIDs).

For family history, data on the presence of MI (especially at a young age) and hyperlipidemia are important.

Physical examination

The main parameters of vital functions are assessed and the body mass index (BMI) is calculated.

Appearance (eg, pallor, sweating, cyanosis, anxiety) is assessed.

The neck is examined to identify swelling of the jugular veins, the presence of hepatojugular reflux, and determine the shape of the venous pulse wave. The pulse in the carotid arteries is assessed, and the neck is palpated to identify lymphadenopathy or thyroid pathology. Auscultation of the carotid arteries is performed to detect murmurs.

Percussion and auscultation of the lungs is performed to assess the symmetry of respiratory sounds, signs of congestion (dry, moist or wheezing), compaction of the lung tissue (bronchophonia), pleural friction noise or effusion into the pleural cavity.

A cardiac examination involves assessing the intensity and time of appearance of the first (Si) and second (S2) heart sounds, the connection of the pulmonary component of the second sound with breathing, the presence of additional tones and clicks on the mitral valve, pericardial friction noise, murmurs and gallop rhythms. When identifying noises, one should evaluate the time of their appearance, duration, tone, shape, intensity, as well as their dynamics against the background of changes in body position, isometric load and Valsalva maneuver. When identifying gallop rhythms, it is necessary to make a differential diagnosis between the fourth heart sound (S4). which is often detected in the presence of diastolic dysfunction or myocardial ischemia, and the third heart sound (S3), which is a sign of systolic dysfunction.

The chest should be examined to identify skin lesions as a result of injury or herpes zoSTer infection, and palpation should be performed to determine crepitus (a sign of the presence of air in the subcutaneous tissue) and muscle tension. The abdomen should be palpated to identify areas of tension, enlarged internal organs, and the presence of tumors.

When examining the lower extremities, it is necessary to determine the arterial pulse, the pattern of perfusion, the presence of edema, varicose veins, and signs of deep vein thrombosis (eg, swelling, redness, tension).

Signs that require special attention

A number of signs indicate the presence of serious causes of chest pain:

• Changes in vital signs (tachycardia, bradycardia, tachypnea, hypotension).
• Signs of hypoperfusion (eg, confusion, ashen skin, sweating).
• Dyspnea.
• Asymmetry of breath sounds or pulse.
• The appearance of new heart murmurs.
• Paradoxical pulse more than 10 mm Hg.

Interpretation of identified changes

Symptoms and signs of chest disease vary widely, and it is not always easy to distinguish serious problems from less significant ones. Although the presence of signs that require special attention indicates a high probability of serious pathology, and many diseases are characterized by the presence of “classical” manifestations, a large number of patients with severe pathology do not have these classic symptoms and signs. For example, patients with myocardial ischemia may complain of only mild dyspepsia or have a very tense chest wall to palpation.

The duration of pain can help determine the severity of the disease. Prolonged pain (i.e., for weeks or months) is not a consequence of a life-threatening pathology. Such pain is usually associated with pathology of the musculoskeletal system, although gastrointestinal diseases or cancer should also be considered, especially in older patients. Also, a short (less than 5 s) episode of acute, intermittent pain is rarely the result of severe pathology. Serious illnesses typically involve pain lasting minutes to hours, although these episodes may be repeated (for example, unstable angina may involve multiple episodes of pain).

The patient's age can help in assessing chest pain.

The onset and reduction of symptoms can also help in assessing pain. Although the pain associated with angina pectoris can appear anywhere between the umbilical line and the line of the ears (and very often not in the chest), in typical cases it is constantly associated with physical or emotional stress, i.e. the patient cannot describe angina pectoris while climbing one flight of stairs on one day, and on another day - while climbing three flights. Angina at night is a sign of acute coronary syndrome or coronary artery spasm.

Increased pain not caused by breathing, movement or palpation of the chest can be due to various reasons, both serious and less significant. This sign is not specific to chest wall lesions; in approximately 15% of patients with MI, chest wall tension is detected upon palpation.

Taking nitroglycerin can help reduce pain both during myocardial ischemia and in the presence of smooth muscle spasm in other organs (for example, in diseases of the esophagus or biliary tract); therefore, the effect of nitroglycerin should not be used to make a diagnosis.

Associated signs may also help identify the cause of pain. Fever is not a specific symptom, but, when combined with a cough, indicates lung damage. In patients with Raynaud's syndrome or migraines, spasm of the coronary arteries may be detected.

The presence or absence of risk factors for coronary artery disease (eg, hypertension, hypercholesterolemia, smoking, obesity, diabetes, family history) indicates the likelihood of a patient having coronary artery disease, but does not help identify the cause of a specific episode of acute chest pain. Patients with these risk factors may have another cause for chest pain, and patients without risk factors may experience acute coronary syndrome. However, the presence of a confirmed diagnosis of coronary artery disease in a patient with chest pain increases the likelihood of this particular cause of the pain syndrome (especially if the patient describes the symptoms as “my usual angina” or “like I had during a heart attack”). The presence of peripheral artery disease in a patient also increases the likelihood of angina as a cause of pain.

Survey

In adult patients with acute chest pain, it is first necessary to exclude diseases that pose an immediate threat to life. In most patients, pulse oximetry, ECG, and chest x-ray should be performed immediately. If PE is possible, D-dimer determination is performed. It is extremely important to quickly diagnose, since in the presence of MI, a decision must be made on emergency invasive intervention (if available).

Changes detected by these tests may confirm the diagnosis (eg, MI, pneumothorax, pneumonia). Other abnormalities suggest suspicion of disease or at least indicate the need for further examination (for example, a change in the contour of the aorta suggests the presence of dissection). Thus, if the findings are normal, diagnoses of thoracic aortic dissection, tension pneumothorax, or esophageal rupture are unlikely. However, it must be taken into account that in acute coronary syndrome the ECG may remain normal for several hours, and sometimes no changes appear at all, and in PE oxygenation may also be normal. In this regard, other examination methods may be required, the decision to perform which is made on the basis of anamnesis and objective examination.

Because a single determination of markers of myocardial damage does not rule out cardiac causes, patients should have multiple troponin measurements as well as ECG evaluations at least 6 hours apart if the clinical picture is appropriate. Some practitioners perform these tests in combination with an exercise ECG or carry out visualization tests with physical activity. Drug therapy should be started after repeated blood sampling to determine troponin levels, unless contraindicated. Sublingual nitroglycerin or oral administration of liquid antacids does not reliably distinguish myocardial ischemia from gastroesophageal reflux disease or gastritis. Both drugs can reduce the severity of symptoms in both diseases. Troponin levels will be elevated in all forms of acute coronary syndrome, as well as in other diseases that lead to myocardial damage (eg, myocarditis, pericarditis, aortic dissection with coronary artery involvement, pulmonary embolism, heart failure, severe sepsis). An increase in CPK can be a consequence of damage to any muscle tissue, but the MB fraction of CPK is specific to myocardial damage. At the same time, troponin is currently a standard marker for diagnosing damage to the heart muscle. ST segment changes on the ECG may be nonspecific or associated with preexisting conditions, so it is important to compare the ECG with earlier recordings.

The likelihood of developing pulmonary embolism is determined by a large number of factors that can be used in the algorithm that determines the approach to diagnostic studies.

In patients with chronic chest pain, the presence of a disease that poses an immediate threat to life is unlikely. Most specialists will first perform a chest x-ray and other tests based on symptoms and signs.

Treatment for chest pain

Specific therapy for identified diseases is carried out. If the etiology remains unclear, patients are usually hospitalized for observation and more thorough examination. Symptomatic treatment is carried out with acetaminophen or opiates as indicated until a definitive diagnosis is established.

Features of diseases in the elderly

The likelihood of having serious and life-threatening diseases increases with age. Most older patients recover more slowly than younger patients, but with early diagnosis and proper treatment, good survival rates can be achieved. Drug doses are usually lower and the rate of dose titration is slower. The frequent presence of concomitant pathology (for example, renal dysfunction) can complicate diagnosis and treatment.