What can chest pain mean? What can be indicated by pain in the chest, in the upper part

If there is pain in chest in the middle, you need to find out its cause. More often, such a symptom indicates damage to the respiratory organs or other system.

Constant chest pain occurs with organ damage abdominal cavity and the pelvis.

To select the optimal therapy, the sick person must be examined.

Etiology and clinic

Dull or sharp pain in the chest - important sign that cannot be ignored. With the help of such a clinic, the body signals the development of problems or disorders.

Sharp or dull pain in the chest, why does it occur?

Often this symptom front or back appears when the heart is affected. It can be angina pectoris, ischemia, or heart attack.

In each case, the patient feels acute manifestations. Sometimes it radiates to different areas of the body (back, ribs, shoulder).

The soreness is strong, has a stabbing character, and is concentrated in the middle. Such signs are quite dangerous, since in severe cases can be fatal.

If you suspect a serious injury, it is important to see a surgeon immediately. In such cases, only an x-ray will reveal the true cause. unpleasant symptoms.

If there is sharp pain in the chest, before the medical examination, the patient is prohibited from doing any work. He needs to be at rest so as not to worsen his condition.

Aching pain in the chest area can occur against the background or after sports. This is often due to the inexperience of beginners who do the exercises without adhering to safety techniques.

The symptoms in question may be associated with excessive stress on the thoracic spine.

Soreness between the ribs occurs in athletes doing push-ups on the uneven bars, especially with significant weights.

Soreness from overload is considered the safest. Manifestations with coughing, deep breaths disappear on their own within a few days.

But if the pain does not stop, the clinic intensifies, causing a lot of inconvenience - a doctor's consultation is inevitable.

Respiratory, Digestive, and Spinal Disorders

Pain in the middle of the chest occurs against the background of pulmonary ailments. This is a fairly common cause of front chest discomfort.

A cough with sputum production occurs with sudden or deep breaths.

Often there is fever, soreness of the head, muscles, joints.

General malaise may occur. In this case, shortness of breath increases.

With the accumulation of pleural fluid, the integuments turn blue.

Severe, complicated ailments lead to damage to the intercostal muscles, diaphragm.

The relationship of defeat is great digestive tract with soreness in the chest. Often, the slightest stomach upset radiates to the sternum. Usually this manifestation is accompanied by:

heartburn;
belching sour or bitter;
nausea;
vomiting after eating food;
irritability;
bad sleep;
soreness in the stomach or in the hypochondrium.

The discomfort in the chest after eating is greatly increased. Despite its remoteness, defeat thyroid gland cause pain in the upper chest.

This phenomenon occurs with oncological ailments of the gland and the appearance of a goiter. In this case, the pain is joined by:

general malaise;
a sharp change in behavior;
slowness;
constant fatigue;
a sharp increase or decrease in weight;
hypotension;
hypothermia;
decrease in physical and mental activity.

The condition of any part of the chest directly depends on the stability of the spine. His slightest lesions provoke soreness in the chest.

Most often there is osteochondrosis spinal column... At the same time, its cartilaginous zones become inflamed. The ailment occurs due to improper posture, prolonged stay in an uncomfortable position, inactivity.

Soreness is permanent, intensifying with inhalation. It changes from a change in body position.

It has been proven that the discomfort is significantly increased when the back is bent (pricks or bakes), subsides - in a supine position or sitting with a straight back.

Often, signs of spinal damage do not appear immediately. At first, a little discomfort occurs only with sudden movements.

Therefore, many patients do not pay attention to pain in the middle of the chest. With the progression, the thoracic region becomes inactive, and neurological symptoms often join.

Patients complain of intercostal neuralgia. Such a specific provokes unpleasant sensations above solar plexus, which are given under the left shoulder blade.

In terms of intensity, they are often confused with a heart attack. To find out the true etiology of pain in the center of the chest, it is recommended to take a Nitroglycerin tablet, which will always relieve a heart attack.

Other causes of the disease

Other etiological factors thoracalgia:

Aortic aneurysm - A bulge, enlargement of the walls of the aorta. Violation of the blood supply provokes a severe pain attack at night. It is difficult to stop it. In many patients, against this background, a strong productive cough develops, shortness of breath is possible.

Prolapse mitral valve- Deflection of the mitral valve leaflets inside the atrium. After sleep, there is a sharp cardialgia, spread throughout the chest, feeling general malaise, a tendency to frequent fainting.

Hypertension or hypertension - Causes discomfort on the left, in the projection of the heart. Patients complain that they have pressure in the chest.

Thromboembolism - Blockage pulmonary artery or its branches. Depending on the size of the thrombus and the caliber of the blocked vessel, pain on top and shortness of breath may be more or less pronounced. Malaise manifests itself, death is possible.

Cardioneurosis or neurosis - In this case, discomfort on the left arises against the background of excessive emotionality, abuse of coffee, unhealthy food, alcohol, tobacco. Such a wrong life provokes pressing pain on exhalation, tachycardia, difficulty in breathing.

VSD - Violations of the autonomic regulation of the body. Such violations of homeostasis are the causes of pain in the head, chest, stomach, heart. Failures cause pressure drops, gastrointestinal disorders, panic attacks, fear of death.

Biliary dyskinesia - Spasms of the bladder and ducts cause chest pain. Attacks are similar to angina pectoris, therefore, to verify the diagnosis, additional research.

Tuberculosis - Against the background of severe thoracalgia, they note above bloody issues when coughing up. There is subfebrile condition, malaise, increased sweating, weight loss. A similar clinic is observed with lung neoplasms. It becomes difficult for the patient to breathe, severe emaciation, refusal to eat comes to the fore.

Schmorl's hernia - Provokes pinching of the nerve roots. Against this background, pulling back pains, thoracalgia, and muscle fatigue appear in the morning.

Kyphosis - Accompanied by discomfort in the pectoral muscles. In the lower back, when pressed, the discomfort increases.

Ankylosing spondylitis - Rear part spondyloarthrosis in advanced stages leads to severe ossification (ankylosis) of the spine. Patients are worried about limited movement, discomfort with deep breathing.

Pinching chest pain is a clear sign of many problems in the body. To identify true reason of such a condition, it is important to comprehensively examine the entire body.

Patients with continuous pain are referred for x-rays, ultrasounds, and MRIs. It is important to seek help from a specialist in a timely manner.

Chest pain- extremely common symptom... As a rule, it is associated with heart damage. However, the causes of chest pain are very diverse, including many diseases that are not associated with damage of cardio-vascular system.

Pain behind the sternum can indicate both fatal conditions, when the patient needs emergency medical care (myocardial infarction, pulmonary embolism), and predominantly functional disorders that do not require immediate hospitalization (neurocirculatory dystonia).

Therefore, it is advisable to know the basics of differential diagnosis for chest pain not only for doctors, but also for people without medical education to navigate, how urgently and to which doctor to seek help.

First of all, it is necessary to detail the signs of pain syndrome.
The type of pain (acute or dull), its nature (pressing pain behind the sternum, burning, stabbing, etc.), additional localization (behind the sternum on the right, behind the sternum on the left), irradiation (radiating between the shoulder blades, under the left shoulder blade, v left hand, in the left little finger, etc.).

It is necessary to pay attention to the time of onset of pain (morning, afternoon, evening, night), the relationship with food intake or physical activity. It is advisable to know the factors that alleviate pain (rest, forced position of the body, a sip of water, taking nitroglycerin), as well as factors that increase it (breathing, swallowing, coughing, certain movements).

In some cases, passport data (gender, age), family history data (what diseases the patient's relatives suffered from), information about occupational hazards and addictions can help in making a diagnosis.

It is necessary to collect an anamnesis of the medical history, that is, to pay attention to previous events (infectious disease, trauma, inaccuracies in the diet, overwork), and also to find out if there were such attacks before, and how they could be caused.

The detailing of the pain syndrome and other complaints of the patient, the registration of passport data and a thorough collection of anamnesis in many cases make it possible to accurately make a preliminary diagnosis, which will then be clarified during a medical examination and various kinds of studies.

Angina pectoris as a typical cause of pressing chest pain

Typical angina attack

Chest pain is so common in angina that some diagnostic guidelines internal diseases an attack of angina pectoris is called a typical chest pain.

Angina pectoris (angina pectoris) and myocardial infarction are manifestations of coronary heart disease (CHD). IHD is an acute or chronic insufficiency of blood supply to the heart muscle caused by the deposition of atherosclerotic plaques on the walls of the coronary vessels that feed the myocardium.

The main symptom of angina pectoris is pressing pain behind the sternum on the left, radiating under the left shoulder blade, to the left arm, left shoulder, left little finger. The pain is intense enough, and makes the patient freeze in place with his hand pressed to his chest.

Additional symptoms of an attack of angina pectoris: a feeling of fear of death, pallor, cold extremities, increased heart rate, possible arrhythmias and increased blood pressure.

An attack of angina pectoris occurs, as a rule, after physical activity, during which the heart's need for oxygen increases. Sometimes an attack of typical chest pain can provoke cold or food intake (especially in debilitated patients). A typical attack of angina pectoris lasts two to four minutes, up to a maximum of 10 minutes. The pain subsides at rest, the attack is well relieved by nitroglycerin.

It should be borne in mind that due to the peculiarities of the blood supply to the female heart and the antiatherosclerotic action of female sex hormones, angina pectoris is rare in women of childbearing age (under 35 years of age, it is practically not diagnosed).

If you suspect angina pectoris, you should contact a therapist or cardiologist who will prescribe a standard examination (general and biochemical blood tests, general urinalysis, ECG).

Basic treatment when confirming the diagnosis of angina pectoris: diet, healthy lifestyle, taking nitroglycerin during attacks.

In the presence of such concomitant diseases as hypertonic disease, diabetes mellitus, obesity, the treatment of these diseases will simultaneously treat angina pectoris and prevent further development Ischemic heart disease.

Pain behind the sternum with Prinzmetal's angina

Prinzmetal's angina (atypical, special, spontaneous angina) is one of the variants of coronary heart disease.

Unlike typical angina pectoris, Prinzmetal's angina attacks occur at night or in the early morning hours. The cause of attacks of insufficiency of coronary circulation is acute vasospasm.

Patients with atypical angina, as a rule, tolerate physical and psycho-emotional stress well. If overstrain causes them to have seizures, then this happens in the morning.

Pain behind the sternum with Prinzmetal's angina pectoris is similar in nature, localization and irradiation to typical angina pectoris, and is well relieved by nitroglycerin.

A characteristic feature is the cyclical nature of attacks. They often come at the same time. In addition, anginal attacks in atypical angina often follow one another, combining in a series of 2-5 attacks with a total duration of about 15-45 minutes.

With spontaneous angina pectoris, heart rhythm disturbances are more common.

Mostly women under 50 are ill. The prognosis for Prinzmetal's angina largely depends on the presence of comorbidities such as hypertension and diabetes mellitus. Sometimes special angina pectoris is combined with attacks of typical angina pectoris - this also worsens the prognosis.

If you suspect spontaneous angina pectoris, you should immediately consult a doctor, since this kind of anginal attacks can be observed with small focal myocardial infarctions.

Attending physician: therapist, cardiologist. Examination and treatment: if there are no special indications - the same as for typical angina pectoris. Atypical angina belongs to the class unstable angina, and requires constant supervision.

Sternum pain requiring emergency medical attention

Myocardial infarction symptoms

Myocardial infarction is the death of a portion of the heart muscle due to the cessation of blood flow. The cause of a heart attack, as a rule, becomes a thrombosis or, less often, a spasm of the coronary artery damaged by atherosclerotic plaques.

In mild cases, pressing pain behind the sternum with myocardial infarction is similar in nature, localization and irradiation to angina pectoris, but significantly exceeds it in intensity and duration (30 minutes or longer), is not relieved by nitroglycerin and does not decrease at rest (patients often rush about the room, trying to find a comfortable position).

With extensive heart attacks, chest pain is diffuse; the maximum pain is almost always concentrated behind the sternum on the left, from here the pain spreads to the entire left, and sometimes right side breasts; gives in upper limbs, lower jaw, interscapular space.

Most often, the pain increases and decreases in waves with short interruptions, so the pain syndrome can last about a day. Sometimes the pain reaches such intensity that it cannot be relieved even with the help of morphine, phentalin and droperidol. In such cases, the heart attack is complicated by shock.

Myocardial infarction can occur at any time of the day, but more often in the night before morning hours. As provoking factors, one can single out increased nervous or physical stress, alcohol intake, and a change in weather.

The pain is accompanied by such signs as a variety of cardiac arrhythmias (increased or decreased heart rate, palpitations, interruptions), shortness of breath, cyanosis (cyanosis), cold sweat.

If you suspect a myocardial infarction, you should seek emergency medical help. The prognosis depends both on the extent of the lesion of the heart muscle and on the timeliness adequate treatment.

Aortic dissecting aneurysm

Aortic dissecting aneurysm is a critical condition caused by a threatening rupture of the largest blood vessel the human body.

The aorta consists of three membranes - inner, middle and outer. Aortic dissecting aneurysm develops when blood enters between pathologically altered vessel membranes and stratifies them in the longitudinal direction. it rare disease therefore it is often misdiagnosed as myocardial infarction.

Pain behind the sternum with dissecting aortic aneurysm occurs suddenly, and is described by patients as unbearable. Unlike myocardial infarction, which is characterized by a gradual increase in pain, pain behind the sternum with dissecting aortic aneurysm is most intense at the very beginning, when the primary dissection of the vessel occurs. Also, a very significant difference is irradiation along the aorta (first, the pain radiates between the shoulder blades, then along the spinal column to the lower back, sacrum, inner thighs).

Aortic dissecting aneurysm has symptoms acute blood loss(pallor, drop in blood pressure). In case of damage to the ascending aorta with overlapping of the departing from it great vessels there is an asymmetry of the pulse on the hands, puffiness of the face, visual impairment.

Distinguish between acute (from several hours to 1-2 days), subacute (up to 4 weeks) and chronic course process.

If a dissecting aortic aneurysm is suspected, emergency hospitalization is required. To stabilize the process, patients are prescribed drugs that reduce cardiac output and blood pressure; in the following, the operation is shown.

The prognosis depends on the severity and localization of the process, as well as on the general condition of the patient (the absence of severe concomitant diseases). Mortality in surgical treatment acute aneurysms - 25%, chronic - 17%.

After surgery for dissecting aortic aneurysm, most patients remain functional. Much depends on correct diagnosis and the availability of adequate treatment.

Pulmonary embolism

Pulmonary embolism (PE) - blockage of the pulmonary trunk from the right heart to the lungs, thrombus or embolus - a particle that moves freely through the blood stream (amniotic fluid in amniotic fluid embolism, inert fat in embolism after fractures, tumor particles in oncopathologies) ...

Most often (about 90% of cases) pulmonary embolism complicates the course of thrombotic processes in the veins of the lower extremities and pelvis (thrombophlebitis of the leg veins, inflammatory processes in the small pelvis, complicated by thrombophlebitis).

Often, the cause of PE is severe heart damage, occurring with congestion and atrial fibrillation (rheumatic heart disease, infective endocarditis, heart failure in ischemic heart disease and hypertension, cardiomyopathy, severe forms myocarditis).

PE is a formidable complication of traumatic processes and postoperative conditions, about 10-20% of victims with a hip fracture die from it. More rare reasons: amniotic fluid embolism, cancer, some blood diseases.

Pain behind the breastbone occurs suddenly, most often has an acute dagger character, and is often the first symptom of pulmonary embolism. In about a quarter of patients, due to circulatory disorders, acute coronary insufficiency so some clinical manifestations are similar to the symptoms of myocardial infarction.

When making a diagnosis, anamnesis (severe diseases that can be complicated by PE, surgery or injury) and symptoms characteristic of pulmonary embolism are taken into account: severe inspiratory dyspnea (the patient cannot breathe air), cyanosis, swelling of the cervical veins, painful enlargement of the liver. With severe damage, there are signs of a lung infarction: a sharp pain in the chest, aggravated by breathing and coughing, hemoptysis.

If pulmonary embolism is suspected, emergency hospitalization is indicated. Treatment includes surgical removal or lysis (dissolution) of a thrombus, anti-shock therapy, prevention of complications.

Spontaneous pneumothorax

Spontaneous pneumothorax occurs when the lung tissue ruptures, causing air to enter pleural cavity and constricts the lung. The causes of pneumothorax are degenerative changes in the lung tissue, leading to the formation of cavities filled with air, much less often - severe bronchopulmonary diseases (bronchiectasis, abscess, lung infarction, pneumonia, tuberculosis, oncopathology).

Most often occurs in men 20-40 years old. Usually, spontaneous pneumothorax develops in the midst of complete health. Pain behind the sternum occurs suddenly, localized most often in the anterior and middle sections of the chest on the side of the lesion. Can give to the neck, shoulder girdle, arms.

Such patients are often misdiagnosed as having myocardial infarction. A symptom of increased chest pain during breathing can help in the diagnosis, as well as the fact that the position on the sore side brings significant relief to the patient. In addition, attention should be paid to the asymmetry of the chest, the expansion of the intercostal spaces on the side of the lesion.

Forecast for timely diagnosis- favorable. Shows emergency hospitalization and aspiration (pumping out) of air from the pleural cavity.

Spontaneous rupture of the esophagus

A typical cause of spontaneous rupture of the esophagus is trying to stop vomiting (has diagnostic value). Predisposing factors: excessive absorption of food and alcohol, as well as chronic diseases of the esophagus (inflammation caused by gastric emptying, esophageal ulcer, etc.).

The clinical picture is very vivid, and resembles the symptoms of myocardial infarction: sudden sharp pain behind the sternum and in the left lower side of the chest, pallor, tachycardia, pressure drop, perspiration.

For differential diagnosis, a symptom of increased pain when swallowing, breathing and coughing is important. In 15% of cases, subcutaneous emphysema (swelling) occurs in the cervical region.

It should be borne in mind that this pathology occurs mainly in men 40-60 years old, often with a history of alcoholism.

Treatment: emergency surgery, anti-shock and antibacterial therapy.

The prognosis with timely diagnosis is favorable, however, according to some reports, about a third of patients die as a result of late and inadequate treatment.

Chest pain requiring a home call

Myocarditis

Myocarditis - a group of inflammatory diseases of the heart muscle, unrelated to rheumatism and other diffuse diseases connective tissue.

The causes of myocardial inflammation are most often viral diseases, less often other infectious agents. Allergic and transplant myocarditis are also distinguished. In some cases, a causal relationship is not traced, therefore there is such a nosological unit as idiopathic myocarditis.

Often, chest pain is the first symptom of myocarditis. The pain is usually localized behind the sternum and on the left side of the chest. It is often quite intense.

The main difference between pain in myocarditis and angina attacks is duration. With myocarditis, the pain lasts for hours or even days without weakening.
The age of the patient matters. Angina pectoris affects middle-aged and elderly people, myocarditis is more common in young people.

In typical cases with myocarditis, it is possible to trace the connection with acute viral disease, after which there was a light interval, and then pain syndrome appeared. Often, chest pain with myocarditis is accompanied by an elevated temperature, with angina pectoris, the temperature remains normal.

In severe and moderate myocarditis, symptoms such as shortness of breath and cough with little physical exertion, swelling in the legs, heaviness in the right hypochondrium, indicating an enlarged liver, rapidly increase.

If myocarditis is suspected, bed rest, thorough examination and treatment taking into account the form of the disease.

In the absence of adequate treatment, myocarditis often turns into cardiomyopathy.

Rheumatic heart disease

Rheumatic heart disease is one of the manifestations of rheumatism, systemic inflammatory disease connective tissue, which is based on disorders of the immune system (aggression against the proteins of one's own body) caused by infection with group A beta-hemolytic streptococcus. It occurs in genetically predisposed individuals, mainly at a young age.

Pain behind the sternum and in the chest on the left with rheumatic heart disease, as a rule, is not intense, accompanied by a feeling of interruption.

With focal lesions of the heart muscle, pain in the region of the heart of weak intensity and unexpressed nature may be the only symptom of rheumatic heart disease.

With diffuse rheumatic heart disease, shortness of breath, cough during exercise, swelling in the legs are expressed. The general condition is severe, the pulse is frequent, arrhythmic.

At rheumatic lesion coronary vessels symptoms of rheumatic heart disease are supplemented by typical anginal attacks characteristic of angina pectoris.

For differential diagnosis, the relationship of the disease with a recent sore throat, scarlet fever or exacerbation of chronic ENT pathology (tonsillitis, pharyngitis) is important.

Often, patients have polyarthritis characteristic of rheumatism.

In controversial cases, attention is paid to age (the peak incidence of esophageal cancer occurs at the age of 70-80 years, while angina pectoris develops, as a rule, earlier) and gender (mostly men are sick).

Attention should be paid to predisposing factors such as alcoholism, smoking, occupational hazards (for example, dry cleaning workers have an increased risk of this disease).

There is evidence that people who poisoned with alkali in childhood are more likely to develop esophageal cancer, and the time interval between chemical injury and the development of the tumor reaches 40 years.

Some diseases of the esophagus are considered as a predisposing factor, in particular, achalasia of the cardia (chronic disturbance of the motility of the esophagus with a tendency to spasm of the sphincter passing food from the esophagus into the stomach) and gastroesophageal reflux (chronic reflux of acidic contents from the stomach into the esophagus).

The emaciation of the patient often attracts attention. Rapid unexplained weight loss should always be alarming in relation to oncological pathology.

The prognosis for esophageal cancer diagnosed at this stage is usually poor. However, a correct diagnosis can correct palliative care aimed at alleviating the suffering of the patient.

Chest pain caused by the throwing of acidic stomach contents into the esophagus
Gastroesophageal reflux disease (reflux esophagitis) is the second most common disease of the esophagus, which is a tendency to retrograde gastric emptying into the esophagus.

Pain behind the sternum with reflux esophagitis - strong, burning, increases when bending forward and in a horizontal position. It is removed with milk and antacids.

In addition to pain, reflux esophagitis is characterized by symptoms such as belching, heartburn, pain when food passes through the esophagus.

The causes of reflux esophagitis are varied: from inaccuracies in the diet (abuse of foods rich in caffeine, spices, mint, etc.) and bad habits (smoking, alcohol) to various diseases (cholelithiasis, stomach ulcer, systemic diseases connective tissue, etc.). Reflux esophagitis often accompanies pregnancy.

Since reflux esophagitis is often the result of many serious illnesses, a thorough evaluation is necessary if symptoms are detected.

Spastic chest pain caused by impaired esophageal motility
Pain in the chest of a spastic nature often occurs when there is an obstacle to the movement of food through the esophagus. Such an obstacle may be functional (for example, spasm of the sphincter, through which food from the esophagus enters the stomach), or there may be an organic obstruction of the esophagus (swelling, cicatricial deformity). In such cases, the attack of pain is associated with food intake.

However, esophageal spasm can be caused by gastroesophageal reflux (as a reflex response to irritation of the esophageal mucosa by acid from gastric contents). In addition, there are many functional disorders esophageal motility, flowing with spasm (esophagospasm, esophageal dyskinesia, achalasia of the cardia). With such pathologies, a clear connection between a pain attack and food intake is not traced.

Meanwhile, the pain caused by esophageal spasm is very similar to an anginal attack with angina pectoris. The pain is localized behind the sternum or to the left of it, has a pressing character, radiates to the back, as well as to the jaw and left arm. Often, the pain syndrome is well removed by nitroglycerin.

Attacks vary in length from several minutes to several hours or even days, which can be of diagnostic value. In addition, the fact that seizures are often relieved with a sip of water or analgesics can help with the diagnosis.

Sometimes a painful attack with spasms of the esophagus is accompanied by pronounced vegetative manifestations, such as a feeling of heat, sweating, tremors throughout the body.

With attacks of pain behind the sternum caused by spasms in the esophagus, a combined examination of the cardiovascular system and the gastrointestinal tract is indicated.
Attending physician: therapist, gastroenterologist, cardiologist. Treatment is prescribed according to the results of the examination.

Hernia of the esophageal opening of the diaphragm

Hernia esophageal opening diaphragm (diaphragmatic hernia) - a disease based on the displacement of the abdominal part of the esophagus and the cardiac part of the stomach through the diaphragmatic opening. In severe cases, the entire stomach can be displaced, and even the intestinal loops.

The causes of a hiatal hernia can be congenital features the structure of the diaphragm and / or diseases of the abdominal organs, contributing to the development of pathology.

Pain behind the sternum with a diaphragmatic hernia is most often moderate, without pronounced irradiation. The pain is provoked by food intake and physical activity, disappears after belching or vomiting. Leaning forward increases pain, and standing up eases.
In addition, diaphragmatic hernia is characterized by such symptoms as: belching of air and food eaten, fast satiety, repeated regurgitation at night (symptom of a wet pillow). Later, vomiting joins, often mixed with blood.

Hernia of the esophageal opening of the diaphragm, as a rule, is complicated by reflux esophagitis, disorders of esophageal motility with a pronounced spasmodic component are often observed, therefore the clinical picture often requires differential diagnosis with attacks of angina pectoris.

Thus, if you suspect diaphragmatic hernia also shows a joint examination of the cardiovascular system and the gastrointestinal tract.
Attending physician: therapist, gastroenterologist, cardiologist.

If you suspect a hiatal hernia, it is recommended to sleep in a semi-sitting position, placing 2-3 pillows under the head end. Gastroenterologists advise in this case to avoid overstrain of the abdominal press and the forced position of the body with an inclination of the trunk forward. Fractional nutrition is shown.

Diseases of the cardiovascular system associated with impaired neuroendocrine regulation

Neurocirculatory (vegetative-vascular) dystonia
Neurocirculatory (vegetative-vascular) dystonia - functional disease cardiovascular system, which is based on violations of neuroendocrine regulation.

Pain in the region of the heart (with the epicenter in the apex of the heart or behind the sternum) is one of the leading symptoms of the disease. The intensity of the pain syndrome, along with the severity of other symptoms of neurocirculatory dystonia, plays a role in the classification of this pathology according to its severity.

With severe neurocirculatory dystonia, the pain syndrome strongly resembles acute heart attack myocardium. Characterized by pain in the region of the heart of a pressing or constricting nature, increasing and decreasing in waves, which can last for hours and days. Pain syndrome is accompanied by severe palpitations, fear of death, feeling of lack of air; resistant to nitroglycerin intake.

Often, patients with neurocirculatory dystonia testify that pain in the heart area is relieved by various sedatives (validol, valerian root, etc.).

Conduct differential diagnostics with ischemic disease the presence of other symptoms of neurocirculatory dystonia also helps.

A characteristic feature of this disease: a multiplicity of subjective symptoms with a paucity of objective data (most indicators are within normal limits). Very often, patients complain of dysfunction of many organs and systems: respiratory disorders with attacks resembling bronchial asthma; lability blood pressure with a tendency to hypertension, less often to hypotension; spontaneous fluctuations in body temperature (from 35 to 38); disorders of the gastrointestinal tract (nausea, vomiting, constipation, alternating with diarrhea, etc.); rich neuropsychiatric symptoms (dizziness, headache attacks, insomnia, weakness, lethargy, cardiophobia (fear of dying from heart disease), depression).

Pain in the middle of the sternum often indicates that a person has problems with internal organs respiratory system or abdomen.
When diagnosing a problem, doctors work out all the options, so they prescribe a whole range of studies. In the process of diagnostics, the functionality and structure are investigated:

esophagus;
hearts;
the aorta;
trachea.

Aching pain can be accompanied by other unpleasant sensations. Other areas of the body are also being examined, because the underlying diseases can provoke the development of side problems. Location pain is likely to indicate another ailment.

Self-diagnosis can be done by determining the type of pain sensation. The conclusions drawn after this should not be taken as an official diagnosis, because only a qualified physician can make the right decisions. Blunt pain in the middle of the sternum is most often a sign:

ailments of the respiratory system and lungs;
diseases of the digestive tract or stomach;
chronic or acquired disease of the heart and blood vessels;
deviations in the structure or work of the spine in the thoracic region;
endocrinological diseases indicating problems in the functioning of the thyroid gland.

The pain that occurs in the center of the sternum can be systematic or episodic. Seeking the help of doctors is necessary in any case. It often becomes impossible to get rid of unpleasant sensations without detailed diagnostics and prescription. necessary treatment... Doctors will be able to determine the course of treatment only after all the studies, analyzes and an accurate diagnosis have been made.

How to help a person with a sudden attack?

Systematic pain always indicates a serious illness, therefore this case the help of qualified specialists is the only way out. A strong sudden pain sensation can be fatal to a person, therefore, if it occurs, measures should be taken immediately. Calling an ambulance urgently will be the first step to getting rid of suffering.
There is a certain algorithm of actions that will help to delay the peak of the attack and buy valuable time. Before arrival emergency care you need to do the following:

put a mustard plaster, a special plaster or pepper lotion in the place of the location of unpleasant sensations;
make a compress based on camphor oil or ethyl alcohol;
apply an anesthetic (topical preparations are most often used);
take inside any of the modern analgesics;
take a certain dose of nitroglycerin (recommended only for people with chronic heart disease and heart failure).

The above actions will help to reduce pain as much as possible.

Practice shows that pain in the middle is most often clear signs of diseases of the cardiovascular system.

Less Common Causes of Center Chest Pain

Unpleasant sensations in the chest area may not be chronic or pathological in nature. Injury is a common cause of the problem. The danger in this case is that the patient may not immediately feel a serious injury or even a fracture. A pain attack begins at any time, so help must be provided immediately.
Breast bone can be damaged in a variety of situations:

accidents;
fights;
falling;
the consequences of work.

The cause of the problem may lie not only in bone damage. Falls and accidents can damage the diaphragm, which is the muscle organ that separates the chest cavity from the peritoneum. Serious ruptures are fraught with internal hemorrhage, which are potentially life-threatening. Having established the symptoms of internal hemorrhage, it is necessary to urgently call emergency help.
Pain in the middle of the sternum often worries athletes who are accustomed to constantly increasing the level of physical activity. The unpleasant sensations that arise after two hours of intensive training are not a reason to call an ambulance. Despite this, it is necessary to consult a doctor in order to exclude the likelihood of pathological or exacerbation of chronic ailments.

Pain when inhaling

Doctors distinguish six groups of diseases, a symptom of which may be pain in the sternum in the middle when exhaling, inhaling or pressing:

chronic infectious diseases respiratory tract(pneumonia, tracheitis, bronchitis, laryngitis);
disorders of the heart and blood vessels (aneurysms, heart attacks, pericarditis, coronary syndrome);
disorders in the pulmonary system (benign and malignant tumors, metastases, trauma);
violation of the structure of the ribs and the spinal trunk;
ailments provoked by a malfunction of the nervous system.

How to determine the stage of the disease?

A burning pain in the middle of the sternum may indicate an actively developing disease. Unpleasant sensations in the chest area must be quickly diagnosed by establishing the degree of pain in order to protect a person from possible consequences... Signs of a serious illness can include:

unbearable pain in the center of the chest;
severe loud cough;
blood and mucous discharge;
Dyspnea;
uneven breathing.

All of the above symptoms indicate the presence of a dangerous progressive disease. In this situation, a person needs to be helped immediately.

Pain in osteochondrosis of the thoracic spine

Unpleasant sensations in the middle of the sternum can also be a symptom of a disease of the musculoskeletal system. Compression in the chest area may be accompanied in this case by the following:

pain in the center of the back (especially noticeable when the body bends and the arms are raised);
decreased sensitivity of the upper and lower extremities;
problems in the digestive tract;
deviations in the work of the male reproductive system (in exceptional cases);
pressure in the area of the heart muscle.

Diseases of the spine are fraught with serious consequences. Inaction can lead to impaired functioning of the kidneys, liver and pancreas. The main rule for the prevention of ailment is to maintain an active lifestyle.
People who lead an inactive lifestyle are at risk, as a result of which, the vertebral discs lose their functionality, cartilage tissue collapses. Proper nutrition also plays a large role in spinal health.

Prevention of chest pain

Quitting bad habits can be the first step in dealing with discomfort. Smoking and alcohol abuse have a detrimental effect on the cardiovascular system:

heart rhythm disturbance;
loss of vascular elasticity;
narrowing of the arterial lumen;
failure of the normal heart rate;
increased blood pressure.

No one is immune from injuries, which often lead to deformation of the bones of the chest and diaphragm. When playing sports, follow a normal training regime, alternate work with rest, and provide your body with a high level of protection.

Timely treatment of infectious diseases of the upper respiratory tract will reduce the risk of pain to a minimum. Systematic physical education will increase the tone of not only external, but also internal muscles. Improving the work of the heart muscle will favorably affect general condition health.
For people who are forced to work at a computer, the health of the spine should come first. From chronic discomfort in the area of the shoulder blades and thoracic spine will help get rid of:

systematic physical education;
dousing;
comfortable and correct working conditions;
spa treatments, massages;
bath procedures;
healthy food.

In women, chest pains occur quite often, according to experts - an order of magnitude more often than in men. Some of them are signs chronic diseases others signal development acute pathologies... It is important to know the causes of pain of this nature - it is necessary to search for methods of treatment.

Heart pathologies are a dangerous cause of chest pain

In women after menopause diseases of the heart and blood vessels occur with the same frequency as in the stronger sex. Before climax female body the hormones estrogens protect against them. Heart disease usually causes pain on the left side of the body, but in the mid-chest area, it is also very common.

Angina pain is the most common. They appear when moving, after walking, physical activity: the more affected coronary vessels, the less stress can provoke discomfort. If pain appears at rest, this reflects an advanced stage of the disease. With an attack of angina pectoris, pain can be given to the back and shoulder blades, arm, shoulder, neck and even jaw. The symptoms of angina pectoris are complemented by:

A much more dangerous condition - myocardial infarction... Painful cider during a heart attack is very pronounced, it cannot be stopped by taking pills. The pain can spread to any area of the chest, abdomen and back, accompanied by burning, pressure on the chest, fear of death, fainting. With such an attack, an important task is to call an ambulance in time and start treatment. Also, in women, chest pain occurs with heart defects, thrombosis, pericarditis, but such causes are less common.

Gastrointestinal diseases and chest pain

If the chest hurts in the middle, the reasons for women may also relate to pathologies of the gastrointestinal tract. Most often, pain in the center of the chest is given chronic gastritis and reflux esophagitis in the acute stage. The causes are inflammation of the walls of the stomach and the reflux of gastric contents into the esophagus. Stress, alcohol intake, smoking, consumption of spicy and hot food, treatment with certain drugs can provoke such conditions. The symptoms are as follows:

Acute chest pain is often perceived as heart pain, but in fact it is a sign of gastric ulcer, duodenal ulcer. But it appears against the background of gastrointestinal tract pathologies in direct connection with food intake - on an empty stomach with an ulcer, immediately after eating - with gastritis, an hour after eating - from duodenal problems.

During pregnancy, pain from gastrointestinal problems is accompanied by heaviness in the stomach and is almost always combined with severe heartburn.

Chest pain - lung pathologies are to blame

Insofar as most of the chest is occupied by the lungs, their diseases may well give unpleasant sensations. In women, chronic lung pathologies are more common with a long smoking experience, with autoimmune and allergic diseases, as well as with an untreated inflammatory process. Lung pathologies, each of which can cause pain in the middle of the chest, are as follows:

Almost any pulmonary disease has a lot of other, more characteristic signs for it, and the pain syndrome only accompanies them. The main component clinical picture is an cough - dry, moist, with or without phlegm... Often there is an increase in body temperature, shortness of breath, wheezing in the lungs, symptoms of general intoxication - if we are talking about acute infectious disease... The pain in this case is associated with spasms that strain the intercostal muscles, the diaphragm.

Lung tumors cause pain inside the chest only for later stages and are often accompanied by hemoptysis.

Acute heart-type pain can be characteristic of pleurisy, aching - for pneumonia, pain during exertion and on inspiration - for tracheitis.

Diseases of the spine and nervous system as a cause of pain

Cervical and thoracic osteochondrosis is a very "popular" cause of pain in women, which is localized in the chest. Why, when the spine is affected, does discomfort appear in the chest area?

The fact is that pinched nerves leads to the development of intercostal neuralgia, which can give pain anywhere in the chest. Often, such sensations even resemble a heart attack, or pain syndrome with inflammation of the stomach.

Unpleasant signs may appear after sleep if a person with osteochondrosis sleeps in the wrong position and does not use orthopedic products. An increase in pain is possible when leaning forward, while inhaling. Osteochondrosis is accompanied by other symptoms:

Often scoliosis of the spine also leads to intercostal neuralgia - its curvature in the thoracic region.

For women, pathologies such as heart neurosis and vascular dystonia are very characteristic, and they also cause chest pain in the middle.

Other causes of chest pain in women

Having found pain in the chest, many women suspect that they have problems with the mammary glands, in particular, breast cancer. This disease, indeed, is often found, but it gives pain only in the later stages, when there are a number of other signs (formation noticeable when pressing and feeling, discharge from the nipples, etc.). Pain is more characteristic for mastopathy, although it is localized not in the center of the chest, but directly in the mammary gland.

Diseases of the thyroid gland are an order of magnitude more frequent in women. Hyperthyroidism, nodular goiter, diffuse goiter - all these diseases can give painful sensations in the chest, as well as the following symptoms:

With the abuse of training, with physical stress chest muscle pain is also possible. This symptom is characteristic in women and with stress, depression, nervous exhaustion, as well as bruise, impact, any injury to this area.

Diagnosis and treatment of chest pain

Algorithm diagnostic activities will depend on the nature of the discomfort, its severity and other symptoms. So, with acute heart pain or serious injuries diagnostics and treatment are carried out after hospitalization. At chronic pathologies with subacute symptoms, diagnostic methods can be as follows:

Treatment will depend on the problem encountered. So, with neuralgia, you need to do massage, physiotherapy, take painkillers. With angina pectoris - drink a number of heart medications, follow a diet. Antibiotics and cough suppressants help with lung diseases. With pathologies of the gastrointestinal tract, special medications and special nutrition are prescribed. It is not recommended to delay therapy - this is the only way to avoid complications.

Sternum pain can occur in people of different ages. She not only brings with it unpleasant sensations, but also a signal that it is necessary to undergo a thorough examination by a doctor in a medical institution.

As you know, the chest contains organs that are very important for vital activity and a failure in the work of one of them can lead to death. Consider all possible reasons the appearance of pain in the chest and methods of its elimination.

What characteristics should you pay attention to for pain:

The nature of the manifestation of pain: pulls, pricks, whines, burns.
Pain type: dull or sharp.
Localization location: right, left, in the center of the chest.
Where does it give: hand, shoulder blade.
When it occurs most often: day or night.
What can provoke the onset of pain: cough, physical activity, breathing, or something else. Read about that here.
What helps relieve pain: change in body position, medicines.

Pressing pain on the left

When pressing pain in the left side of the chest you need to see a doctor without delay.

The main reasons for its development:

Aortic aneurysm. A very serious illness. There is an accumulation of blood in the vessel as a result of the fact that their shells have exfoliated.
Myocardial infarction or angina attack... The condition requires immediate hospitalization. Pain in this condition indicates a problem with a large muscle.
Stomach ulcer. Pain comes on after eating. Often common antispasmodic drug(no-shpa) is able to alleviate a person's condition.
Inflammatory process in the pancreas (pancreatitis)... Pain in this organ is projected onto the left side of the chest and is pronounced. In most cases, food intake provokes discomfort.
Hernia in the diaphragm. This pathology occurs due to the loss of intestinal loops through the weakened places in the diaphragm into the chest cavity. As a result, it is very difficult for the patient to breathe.

Presses on the right

There are many reasons for the sensation of pain on the right, both easily removable and very serious:

Intercostal neuralgia or panic attack.
If, with pain on the right, the heart contracts very quickly, then this can become a signal of the development of cardiac pathologies.
A concomitant cough, phlegm, and fever may indicate lung problems.
and rapid breathing is indicative of tracheitis.
At pathological processes in the stomach and esophagus, the eaten food will cause unpleasant sensations.
If there is pain when swallowing and constriction of the chest in the upper right, then this may be a symptom of ordinary laryngitis. See an otolaryngologist to confirm the diagnosis.
A right-sided rib fracture also causes discomfort in the chest.

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Presses in the middle

The feeling of pain in the central part of the chest signals all of the above diseases.

These will be supplemented by:

Stress.

Nervous breakdowns and anxiety.

In the presence of these factors, muscle spasm may develop and unpleasant painful sensations may occur.

Also, the pinching of the nerves and the feeling of pain in the middle of the chest are affected by:

Scoliosis.
Osteochondrosis.
Hernia of small vertebrae.

Disease symptoms

When chest pain occurs, the symptoms are quite different. This is explained a wide range diseases that provoke unpleasant pain sensations.

Dangerous symptoms, in the event of which, it is necessary to urgently consult a doctor:

A sharp jump in body temperature.
Nausea and urge to vomit.
Increased sweating.
The appearance of shortness of breath and impaired breathing.
Loss of consciousness. It can become one of the main symptoms of myocardial infarction.
Increased or decreased heart rate.
During a change in body position, coughing or active movement, pain may increase.
Muscle weakness.
Body aches.

Symptoms are rarely lonely, they often combine and interfere with the correct provision of first aid.

When the appearance following symptoms you must immediately call an ambulance:

When the nature of the pain changes.
Painful sensations in the left side of the chest, then in the right.
Increased pain when lying down.
First aid drugs are not effective.

After all possible types diagnosis, the patient is referred to a narrow specialist for the appointment of treatment.

Treatment

Treatment begins only after the attending physician makes a diagnosis.

Depending on the causes of the pressure behind the breastbone, the following drugs are used:

Angina pectoris. It is possible to relieve an attack with the help of nitroglycerin.
Cerebral atherosclerosis. First aid for lowering high blood pressure - drops "Pharmadipin", and for normal blood circulation in the brain is prescribed "Glycine".
Myocardial infarction. Taking medications at home is prohibited. The patient must be urgently placed in a hospital environment. Often such patients are admitted to the intensive care unit.
Osteochondrosis. In this disease, non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen) are used, (). To improve blood circulation, Actovegin is prescribed. Also, a positive effect in the treatment of this ailment is produced by massage and acupuncture.
Intercostal neuralgia. This disease is often confused with a heart attack. To relieve pain, muscle relaxants (tizanidine), corticosteroids (dexamethasone) are used, a warming plaster is glued to the rib area or rubbed with an anesthetic ointment.
Acute gastritis. The first help will be antispasmodics (no-shpa, bellastezin), sorbents (smecta, enterosgel, phosphalugel).
Angina. When treating angina, it is important to provide the patient complex treatment: antibiotics (Flemoxin, Summamed), gargle (Givalex), use sprays (Bioparox, Septolete).
Pulmonary embolism. First aid is provided only by the ambulance team. In case of untimely treatment, it will not be possible to save the patient.
Depression, stress, hysteria. It is necessary to calm the person down with special medicines (persen, dormiplant), to provide psychological assistance.

Let's summarize all of the above and find out what needs to be done to provide first aid:

Call an ambulance.
While the team is traveling, give the patient a half-sitting position. Never place it on your back or stomach.
Help to breathe evenly and calmly.
For cardiac abnormalities, place a tablet of validol or nitroglycerin under the tongue.
If the patient faints, soak a cotton swab with ammonia and bring it to your nose.
Do not leave the person alone, wait for the doctors to arrive together.
Never self-repair fractures and dislocations.
If the cause of chest pain is unknown, then warming compresses cannot be used.