Sinusitis

Substernal pain, pain in the sternum: causes, symptoms and what it can be associated with, help, treatment. Chest pain is one of the symptoms of heart disease. What does it mean when the chest hurts?

Chest pain is a syndrome that can occur as with non-dangerous diseases, and with serious, sometimes life-threatening heart pathology. In this regard, any patient should know and be able to distinguish the main signs of “dangerous” pain, and also seek medical help in time.

Why does the sternum hurt?

Pain in the chest can be localized anywhere - in the region of the heart on the left, in the intercostal spaces on the right, in the interscapular space, under the scapula, but the most common pain is in the sternum. The sternum is the bone to which the collarbones and ribs are attached via cartilage. It is not difficult to feel it in yourself - it is located between the jugular notch above (the dimple between the inner ends of the clavicles) and the epigastric region (one of the areas of the abdomen between the ribs) below. The lower end of the sternum has a small protrusion - the xiphoid process.

Often the patient reasons like this: if the sternum “covers” the area of the heart, then it can only hurt because of cardiac pathology. But this is far from true. Due to the fact that the sternum is the anterior border of the mediastinum region, in which several organs are located, the pain syndrome can be caused by diseases of any of them.

So, the main reasons why the sternum hurts are the following:

1. Pathology of the cardiovascular system:

seizures,
development of acute
– the occurrence of thromboembolism in the pulmonary arteries,
and – inflammatory processes in the outer lining of the heart and the heart muscle itself.
or its rupture,

2. Intercostal neuralgia– “pinching” of the intercostal nerves by spasmed muscles between the ribs or located along the spinal column. In this case, chest pain is called thoracalgia of vertebrogenic origin, that is, chest pain caused by spinal pathology.

3. Pathology of the stomach or esophagus:

GERD (gastro-esophageal reflux disease),
esophagitis - inflammation of the inner wall of the esophagus,
tearing of the esophageal mucosa, for example, with Mallory-Weiss syndrome (bleeding from the veins of the esophagus with injury to its wall due to frequent vomiting, more common in people who abuse alcohol).

4. Traumatic injuries– bruises or fractures of the sternum.

5. Congenital or acquired deformities of the sternum– cobbler’s chest (funnel chest), keeled chest (chicken breast), cardiac hump.

6. Inflammatory processes in the respiratory organs– tracheitis (more often causes pain behind the sternum), pneumonia (rare, but can manifest itself as pain in the sternum).

7. Oncological diseases– metastases to the lymph nodes of the mediastinum, lymphoma.

How to distinguish pain in the sternum in various diseases?

Differential diagnosis is carried out on the basis of clarifying the nature of the patient’s complaints. The doctor needs to know many nuances regarding pain in the chest due to various pathologies.

Typical zone of irradiation of pain in angina pectoris

So, for angina pectoris Pain in the chest almost always occurs a few minutes after the start of physical activity, for example, when climbing to your floor, when walking down the street, when working out in the gym, after sexual intercourse, when running or taking an intense step, more often in men. This pain is localized in the middle of the sternum or under it and has the character of pressing, squeezing or burning. Often the patient himself may mistake it for an attack of heartburn. But with heartburn there is no connection with physical activity, but there is a connection with food intake or an error in diet. That is, chest pain after physical activity is an almost reliable sign of angina pectoris (angina pectoris). Often, pain from angina can radiate to the scapula, jaw or arm, and is relieved by taking it under the tongue.

If the patient develops acute myocardial infarction, then the chest pain becomes intense and is not relieved by taking nitroglycerin. If after 2-3 doses nitroglycerin under the tongue at intervals of every five minutes, pain in the sternum persists - the likelihood of a heart attack is very high. Often this pain is combined with shortness of breath, a general serious condition, bluish facial skin and a dry cough. Abdominal pain may occur. However, in some patients the pain may not be severe, but may be characterized as mild discomfort behind the sternum. However, even in this case, he needs to call an ambulance or go to a 24-hour hospital himself to perform an ECG. Thus, a sign of a heart attack is chest pain that is not relieved by taking nitroglycerin for more than 15-20 minutes.

variety of irradiation of pain during myocardial infarction

PE is a deadly condition accompanied by chest pain

At thromboembolism (PE) pain in the sternum area can take on a diffuse character, occurs sharply, suddenly, and is accompanied by severe shortness of breath, a dry or wet cough, a feeling of lack of air and blue discoloration of the skin of the face, neck and upper half of the chest (strictly up to the internipple line). The patient may wheeze, lose consciousness, and in particularly severe cases die at lightning speed. Aggravating data from the anamnesis is the presence of vein operations the day before or strict bed rest (for example, in the postoperative period). PE is almost always accompanied by substernal pain or pain in the chest, as well as blue skin color and the general serious condition of the patient.

Dissecting aortic aneurysm(thoracic) is extremely dangerous and prognostic unfavorable emergency condition. Pain when an aneurysm ruptures spreads from the sternum to the interscapular region, to the back, to the abdomen and is accompanied by a serious condition of the patient. Blood pressure drops, signs of shock develop, and without help the patient may die in the coming hours. Often the clinical picture of aortic rupture is mistaken for renal colic or acute surgical pathology of the abdomen. A doctor of any specialty should have an idea that intense, very pronounced retrosternal pain, radiating to the abdomen or back with symptoms of shock, are signs of possible aortic dissection.

At hypertensive crisis pain in the sternum area is not very intense unless the patient develops myocardial infarction. Rather, the patient feels slight discomfort under the sternum, due to the increased load on the heart with high blood pressure.

Any of the described conditions may be accompanied by acute heart failure (left ventricular failure, left ventricular failure). In other words, a patient with chest pain may develop pulmonary edema, which is manifested by wheezing when coughing with sputum that is pink and foamy in nature, as well as pronounced.

So, If a person has chest pain and has difficulty breathing, he should immediately seek medical help, as he may have pulmonary edema.

Pain due to diseases of other organs is slightly different from cardiac chest pain.

Yes, when intercostal neuralgia(most often in women) pain under the breastbone or on the sides of it. If the muscles to the right of the spine are spasmed or inflamed, then the pain is localized on the right side of the sternum, if on the left, then on the left side. The pain is shooting in nature, intensifying at the height of inspiration or when changing body position. In addition, if you palpate the intercostal muscles along the edges of the sternum, sharp pain occurs, sometimes so severe that the patient screams and tries to dodge the doctor’s fingers. The same thing happens on the side of the back in the area of the interspinous muscles at the edges of the spine. So, if a patient has pain in the sternum when inhaling, most likely he has problems with the spine, he took an incorrect body position (“pinched”), or there could be a hole in it somewhere.

At sternum injuries the sensations are of the nature of acute pain, poorly relieved by taking painkillers. After an injury, it is necessary to urgently perform an x-ray of the chest cavity (if a fracture is suspected), since rib fractures are also possible, and this can lead to injury to the lung. Chest deformities are characterized by long-term pain of varying severity, but usually the patient has pain in the middle of the sternum.

If the patient has pathological processes in the esophagus and stomach, then the pain from the epigastric region radiates to the sternum. In this case, the patient may complain of heartburn, belching, and also note bitterness in the mouth, nausea, retching or pain in the abdomen. There is a clear connection with eating disorders or with food. Often the pain radiates to the sternum when the ulcer is localized in the stomach.

In case of gastroesophageal reflux or hiatal hernia, the patient can relieve the pain by drinking a glass of water. The same is observed with achalasia cardia, when food cannot pass through the spasmodic section of the esophagus, but then the pain in the sternum takes on a bursting character, and the patient experiences profuse salivation.

Inflammation of the respiratory system usually accompanied by an increase in body temperature, first with a dry and then a wet cough, and the pain takes on the character of rawness behind the sternum.

In each patient, it is necessary to separate acute and chronic chest pain:

Acute pain is sudden, acute, but the degree of intensity varies from patient to patient - in some it is more pronounced, in others it is comparable to only minor discomfort. Acute pain is caused by acute pathology - heart attack, paroxysmal tachycardia, dissecting aneurysm, esophageal rupture, sternum fracture, etc. As a rule, in extremely dangerous conditions with a high risk of death, the pain is unbearable.
Chronic pain may not be as intense, so people with chest pain consult a doctor later. Such pain in the sternum is characteristic of angina pectoris, sternum deformation, GERD, esophagitis, etc.

In order to determine what exactly causes chest pain, the doctor must carefully evaluate the patient’s complaints.

What actions should you take if you have chest pain?

When a symptom such as pain in the sternum appears, the patient needs to analyze the factors preceding the pain (stress, injury, exposure to a draft, etc.). If the pain occurs acutely and is very intense, you should immediately consult a doctor. It is advisable to call an ambulance or go to any 24-hour department of the nearest multidisciplinary hospital yourself. If there is minor pain or discomfort in the sternum, which in the patient’s opinion is not caused by acute cardiac pathology (young age, no history of angina, hypertension, etc.), it is permissible to go to the clinic to see a therapist on the same or the next day. But in any case, only a doctor should establish a more precise cause of chest pain.

If necessary, the doctor will prescribe additional examination:

Chest X-ray,
Exercise tests (, – if stable angina is suspected),
Biochemical blood test,

Emergency care for chest pain

Emergency assistance can be provided to the patient if it is presumably known what is causing the pain. For angina pectoris, it is necessary to place a tablet under the patient’s tongue or spray one or two doses of nitromint or nitrospray. In case of high blood pressure, you should let it dissolve or take an antihypertensive drug (25-50 mg captopril, anaprilin tablet). If there are no such drugs at hand, it is enough to dissolve a Validol tablet or drink a glass of water with 25 drops of Corvalol, Valocordin or Valoserdin.

In the case of acute severe cardiac pathology, as well as the patient’s serious condition (PE, myocardial infarction, pulmonary edema), the patient must unbutton the collar, open the window, sit in a reclining position or with his legs down (to reduce blood filling in the lungs) and urgently call an ambulance, describing the severity of the condition to the dispatcher.

If the patient is injured, you should give him a comfortable position and immediately call an ambulance. If a person is not in serious condition, you can give him a painkiller tablet (paracetamol, ketorol, nise, etc.).

Chronic diseases of the respiratory and digestive organs in the acute stage do not require emergency assistance from the patient himself or those around him, if he is not in serious condition. It is enough to wait for the ambulance to arrive or for an appointment with your local doctor.

How to treat chest pain?

Substernal pain should be treated as prescribed by the doctor after a thorough examination. Severe pathology of the heart, esophagus, trachea, as well as injuries are treated in a hospital setting. Hypertension, tracheitis, esophagitis, intercostal neuralgia are treated under the supervision of a local doctor in a clinic at the place of residence.

For angina pectoris, complex treatment is prescribed - antihypertensives (ACE inhibitors), rhythm-lowering drugs (beta blockers), antiplatelet agents (aspirin-based blood thinners) and lipid-lowering drugs (statins).

After suffering severe cardiac diseases (heart attack, pulmonary embolism, aneurysm dissection, pulmonary edema), treated in a cardiology or cardiac surgery hospital, regular ongoing medical supervision is required in a clinic at the place of residence. Treatment is selected strictly individually.

Inflammatory diseases of the trachea and lungs are treated with antibacterial drugs. Thoracalgia is treated by rubbing with anti-inflammatory ointments and drugs from the NSAID group (Nise, Ketorol, diclofenac, etc.).

What consequences can happen if you ignore chest pain?

It often happens that a patient suffers pain attacks behind the sternum for a long time, and as a result may end up in a hospital bed with a heart attack or other serious pathology. If you do not pay attention to attacks of pressing or burning pain in the chest, you can get a dangerous complication of angina in the form of an extensive myocardial infarction, which will not only subsequently lead to chronic heart failure, but can also be fatal.

Ischemia and myocardial infarction and the prerequisites for their development

If we talk about the pathology of other organs, then the consequences may also not be the most pleasant - ranging from chronicity of the process (with pathology of the stomach or lungs), and ending with malignant formations in the mediastinal organs that were not diagnosed in time.

Therefore, for any acute, rather intense, or chronic chest pain, it is necessary to receive qualified medical care.

Chest pain can occur due to various diseases; it is sometimes difficult even for a doctor to understand it right away, so patients with such complaints usually undergo additional examination.

Chest pain can manifest as diseases of the heart, respiratory system, gastrointestinal tract, spine, mediastinum, and central nervous system. All human internal organs are innervated by the autonomic nervous system, the trunks of which arise from the spinal cord. When approaching the chest, the nerve trunk gives off branches to individual organs. That is why sometimes pain in the stomach can be felt like pain in the heart - they are simply transmitted to the common trunk, and from it to another organ. Moreover, the spinal nerve roots contain sensory nerves that innervate the musculoskeletal system. The fibers of these nerves are intertwined with the fibers of the nerves of the autonomic nervous system, and therefore a completely healthy heart can respond with pain in various diseases of the spine.

Finally, chest pain may depend on the state of the central nervous system: with constant stress and high neuropsychic stress, a malfunction occurs in its functioning - neurosis, which can also manifest itself as pain in the chest.

Some chest pains are unpleasant, but not life-threatening, but there are chest pains that need to be relieved immediately - a person’s life depends on it. In order to figure out how dangerous chest pain is, you need to see a doctor.

Chest pain caused by obstruction of the coronary (heart) arteries

The coronary arteries bring blood to the heart muscle (myocardium), which works nonstop throughout life. The myocardium cannot do even for a few seconds without a new portion of oxygen and nutrients delivered with the blood; its cells immediately begin to suffer from this. If blood delivery stops for several minutes , then the myocardial cells begin to die. The larger the coronary artery suddenly becomes obstructed, the more of the myocardium is affected.

Spasms (compression) of the coronary arteries usually occur against the background of coronary heart disease (CHD), the cause of which is partial blockage of blood vessels by atherosclerotic plaques and narrowing of their lumen. Therefore, even a minor spasm can block blood access to the myocardium.

A person feels such changes in the form of an acute piercing pain behind the sternum, which can radiate to the left shoulder blade and left hand, right up to the little finger. The pain can be so severe that the patient tries not to breathe - breathing movements increase the pain. During severe attacks, the patient turns pale, or, on the contrary, turns red, and his blood pressure, as a rule, increases.

Such chest pain can be short-term and occur only during physical or mental stress (angina pectoris), or can occur on its own, even during sleep (angina at rest). Angina attacks are difficult to get used to, so they are often accompanied by panic and fear of death, which further intensifies the spasm of the coronary vessels. Therefore, it is so important to clearly know what to do during an attack and to have everything you need at hand. The attack ends as suddenly as it began, after which the patient feels a complete loss of strength.

The peculiarity of these pains is that a person should under no circumstances endure them - they must be relieved immediately. You can’t do this without consulting a doctor - he will prescribe both the course of basic treatment and the medicine that needs to be taken when pain occurs (the patient should have it with him at all times). Usually, in emergency cases, a nitroglycerin tablet is taken under the tongue, which relieves pain within 1 to 2 minutes. If after 2 minutes the pain has not gone away, then take the tablet again, and if this does not help, then you must immediately call an ambulance.

What can happen if you endure chest pain? The cells of the area of the myocardium that is supplied by the affected artery begin to die (myocardial infarction) - the pain intensifies, becomes unbearable, a person often experiences painful shock with a sharp decrease in blood pressure and acute heart failure (the heart muscle cannot cope with its work). Such a patient can only be helped in a hospital setting.

A sign of the transition of an angina attack to myocardial infarction is an increase in pain and the lack of effect from the use of nitroglycerin. The pain in this case has a pressing, squeezing, burning character, begins behind the sternum, and then can spread to the entire chest and abdomen. The pain can be continuous or in the form of repeated attacks one after another, increasing in intensity and duration. There are cases when the pain in the chest is not very severe and then patients often suffer a myocardial infarction on their legs, which can cause immediate disruption of the heart and the death of the patient.

There are also atypical (atypical) forms of myocardial infarction, when pain begins, for example, in the area of the anterior or posterior surface of the neck, lower jaw, left arm, left little finger, left scapula, etc. Most often, such forms occur in older people and are accompanied by weakness, pallor, cyanosis of the lips and fingertips, heart rhythm disturbances, and a drop in blood pressure.

Another atypical form of myocardial infarction is the abdominal form, when the patient feels pain not in the heart area, but in the abdomen, usually in its upper part or in the area of the right hypochondrium. Such pain is often accompanied by nausea, vomiting, loose stools, and bloating. The condition sometimes closely resembles intestinal obstruction.

Chest pain caused by changes in the central nervous system

Chest pain can also occur with other diseases. One of the most common diseases that causes frequent and prolonged pain in the chest is cardioneurosis, which develops against the background of a temporary functional disorder of the central nervous system. Neuroses are the body’s response to various mental shocks (intense short-term or less intense, but long-lasting).

Pain due to cardioneurosis can have a different character, but most often it is constant, aching and is felt in the area of the apex of the heart (in the lower part of the left half of the chest). Sometimes pain due to cardioneurosis may resemble pain due to angina pectoris (short-term acute), but taking nitroglycerin does not relieve it. Often attacks of pain are accompanied by reactions from the autonomic nervous system in the form of facial flushing, moderate heartbeat, and a slight increase in blood pressure. With cardioneurosis, other signs of neuroses are almost always present - increased anxiety, irritable weakness, etc. Helps with cardioneurosis are the elimination of traumatic circumstances, the correct daily routine, sedatives, and for sleep disorders - sleeping pills.

Sometimes cardioneurosis is difficult to distinguish from coronary heart disease (CHD); the diagnosis is usually made based on careful observation of the patient, since there may be no changes on the ECG in either case.

Chest pain caused by inflammatory processes in the heart area

The heart has three membranes: outer (pericardium), middle muscular (myocardium) and internal (endocardium). The inflammatory process can occur in any of them, but pain in the heart is characteristic of myocarditis and pericarditis.

Myocarditis (an inflammatory process in the myocardium) can occur as a complication of certain inflammatory (for example, purulent tonsillitis) or infectious-allergic (for example, rheumatism) processes, as well as toxic effects (for example, certain medications). Myocarditis usually occurs a few weeks after the illness. One of the most common complaints of patients with myocarditis is pain in the heart area. In some cases, chest pain may resemble the pain of angina, but it lasts longer and does not go away with nitroglycerin. In this case, they can easily be confused with pain during myocardial infarction. Pain in the heart may occur not behind the sternum, but more to the left of it; such pain appears and intensifies during physical activity, but is also possible at rest. Chest pain may recur many times during the day or be almost continuous. Often chest pain is stabbing or aching in nature and does not radiate to other parts of the body. Often heart pain is accompanied by shortness of breath and attacks of suffocation at night. Myocarditis requires careful examination and long-term treatment of the patient. Treatment primarily depends on the cause of the disease.

Pericarditis is an inflammation of the outer serous membrane of the heart, which consists of two layers. Most often, pericarditis is a complication of various infectious and non-infectious diseases. It can be dry (without accumulation of inflammatory fluid between the pericardial layers) and exudative (inflammatory fluid accumulates between the pericardial layers). Pericarditis is characterized by dull, uniform pain in the chest, most often the pain is moderate, but sometimes it becomes very severe and resembles an angina attack. Pain in the chest depends on respiratory movements and changes in body position, so the patient is tense, breathes shallowly, and tries not to make unnecessary movements. Chest pain is usually localized on the left, above the heart area, but sometimes spreads to other areas - to the sternum, upper abdomen, under the shoulder blade. These pains are usually combined with fever, chills, general malaise and inflammatory changes in the general blood test (high number of leukocytes, accelerated ESR). Treatment of pericarditis is long-term, it usually begins in a hospital, then continues on an outpatient basis.

Other chest pain associated with the cardiovascular system

Often the cause of chest pain is diseases of the aorta, a large blood vessel that arises from the left ventricle of the heart and carries arterial blood through the systemic circulation. The most common disease is aortic aneurysm.

Aneurysm of the thoracic aorta is an enlargement of a section of the aorta due to disruption of the connective tissue structures of its walls due to atherosclerosis, inflammatory damage, congenital inferiority, or due to mechanical damage to the aortic wall, for example, due to trauma.

In most cases, the aneurysm is of atherosclerotic origin. In this case, patients may be bothered by prolonged (up to several days) chest pain, especially in the upper third of the sternum, which, as a rule, does not radiate to the back and left arm. Often the pain is associated with physical activity and does not improve after taking nitroglycerin.

A terrible consequence of an aortic aneurysm is its breakthrough with fatal bleeding into the respiratory organs, pleural cavity, pericardium, esophagus, large vessels of the chest cavity, out through the skin in case of chest injury. In this case, there is a sharp pain in the chest, a drop in blood pressure, shock and collapse.

A dissecting aortic aneurysm is a channel formed in the thickness of the aortic wall due to its dissection by blood. The appearance of dissection is accompanied by sharp bursting retrosternal pain in the heart area, severe general condition, and often loss of consciousness. The patient needs emergency medical care. Aortic aneurysm is usually treated with surgery.

An equally serious disease is thromboembolism (blockage by a detached blood clot - embolus) of the pulmonary artery, which extends from the right ventricle and carries venous blood to the lungs. An early symptom of this serious condition is often severe chest pain, sometimes very similar to the pain of angina, but usually not radiating to other areas of the body and increasing with inspiration. The pain continues for several hours, despite the administration of painkillers. The pain is usually accompanied by shortness of breath, bluish skin, palpitations and a sharp decrease in blood pressure. The patient requires emergency medical care in a specialized department. In severe cases, surgery is performed to remove the embolus (embolectomy)

Chest pain due to stomach diseases

Stomach pain can sometimes feel like chest pain and is often mistaken for heart pain. Typically, such chest pain is the result of spasms in the muscles of the stomach wall. These pains are longer lasting than heart pain and are usually accompanied by other characteristic features.

For example, with a stomach ulcer, chest pain is most often associated with eating. Pain can occur on an empty stomach and go away with food, occur at night, after a certain time after eating, etc. Symptoms of stomach disease such as heartburn, nausea, vomiting, etc. also appear.

Stomach pain is not relieved by nitroglycerin, but it can be relieved with the help of antispasmodics (papaverine, no-shpa, etc.) - medications that relieve spasms of the muscles of internal organs.

The same pain can occur with certain diseases of the esophagus and diaphragmatic hernia. A diaphragmatic hernia is an enlarged opening in the diaphragm (the muscle that separates the chest cavity from the abdominal cavity) of the stomach and some other parts of the gastrointestinal tract. When the diaphragm contracts, these organs are pinched. A diaphragmatic hernia manifests itself as a sudden onset (often at night, when the patient is in a horizontal position) of severe pain, sometimes similar to the pain of angina pectoris. This pain does not go away from taking nitroglycerin, but it becomes less when the patient moves to a vertical position.

Severe chest pain can also occur with spasms of the gallbladder and bile ducts. Despite the fact that the liver is located in the right hypochondrium, pain can occur behind the sternum and radiate to the left side of the chest. Such pain is also relieved with antispasmodics.

It is quite possible to confuse pain with acute pancreatitis with heart pain. The pain is so severe that it resembles a myocardial infarction. They are accompanied by nausea and vomiting (this is also common with myocardial infarction). These pains are very difficult to relieve. Usually this can only be done in a hospital during intensive treatment.

Chest pain, very similar to heart pain, can occur with various diseases of the spine, for example, with osteochondrosis, herniated discs, ankylosing spondylitis, etc.

Osteochondrosis is dystrophic (metabolic) changes in the spine. As a result of malnutrition or high physical activity, bone and cartilage tissue, as well as special elastic pads between individual vertebrae (intervertebral discs), are gradually destroyed. Such changes cause compression of the spinal nerve roots, which causes pain. If changes occur in the thoracic spine, the pain may be similar to pain in the heart or pain in the gastrointestinal tract. The pain can be constant or in the form of attacks, but it always intensifies with sudden movements. Such pain cannot be relieved with nitroglycerin or antispasmodics; it can only be relieved by painkillers or heat.

Chest pain occurs especially often when there is a disease of the pleura (the serous sac that covers the lungs and consists of two layers, between which the pleural cavity is located). With inflammation of the pleura, pain is usually associated with coughing, deep breathing and accompanied by fever. Sometimes such pain can be confused with heart pain, for example, with pain due to pericarditis. Very severe chest pain occurs when lung cancer grows in the pleural area.

In some cases, air (pneumothorax) or fluid (hydrothorax) enters the pleural cavity. This can happen with a lung abscess, pulmonary tuberculosis, etc. With spontaneous (spontaneous) pneumothorax, sharp, sudden pain appears, shortness of breath, cyanosis, and blood pressure decreases. The patient has difficulty breathing and moving. The air irritates the pleura, causing severe stabbing pain in the chest (in the side, on the affected side), radiating to the neck, upper limb, and sometimes to the upper abdomen. The patient's chest volume increases and the intercostal spaces widen. Help for such a patient can only be provided in a hospital.

The pleura can also be affected by periodic disease - a genetic disease manifested by periodic inflammation of the serous membranes covering the internal cavities. One of the variants of the course of periodic disease is thoracic, with damage to the pleura. This disease manifests itself in the same way as pleurisy, occurring in one or the other half of the chest, rarely in both, causing the same complaints in patients. As with pleurisy. All signs of exacerbation of the disease usually disappear spontaneously after 3 to 7 days.

Chest pain associated with the mediastinum

Pain in the chest can also be caused by air entering the mediastinum - the part of the chest cavity limited in front by the sternum, behind by the spine, on the sides by the pleura of the right and left lungs and below by the diaphragm. This condition is called mediastinal emphysema and occurs when air enters from the outside during injuries or from the respiratory tract, esophagus during various diseases (spontaneous mediastinal emphysema). In this case, there is a feeling of pressure or pain in the chest, hoarseness, and shortness of breath. The condition can be severe and requires immediate attention.

What to do for chest pain

Chest pain can be of different origins, but at the same time very similar to each other. Pains that are similar in sensation sometimes require completely different treatments. Therefore, if you experience chest pain, you should consult a doctor who will prescribe an examination to identify the cause of the disease. Only after this will it be possible to prescribe the correct adequate treatment.

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

The basis of such diseases is most often a genetic predisposition, as well as an incorrect lifestyle.

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

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

Chest pain as a precursor to heart disease

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

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

Such pain occurs as a result of:

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

The phenomenon of angina pectoris occurs when the blood flow stops satisfying the oxygen needs of the cardiac muscle masses. People call angina pectoris "angina pectoris." The doctor recognizes this disease literally at the patient’s first visit.

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

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

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

Heart disease that causes chest pain

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

Diagnosis of chest pain

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

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

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

Additional research methods

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

pulse oximetry,
chest x-ray.

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

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

Diagnostic administration of nitroglycerin tablets or liquid antacid under the tongue cannot reliably differentiate gastritis, GERD or myocardial ischemia. Each of these medications is capable of reducing symptoms of disease.

Treatment of chest pain

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

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

Prevention of heart disease

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

Walk more, regularly do feasible and simple physical exercises. It is not recommended to start physical exercises with the greatest loads, and before starting such training it is imperative to consult with doctors so that the chosen program only brings benefits to the body.
Try to maintain an optimal body weight.
It is imperative to keep under control possible factors for the development of atherosclerosis, for example, high blood pressure, cholesterol levels, etc.
Meals should always be regular and nutritious; the diet should contain more protein foods and vitamins and minerals.
It is recommended to visit your doctor regularly and carry out the necessary laboratory tests.
Remember the golden rule of health: it is always easier to prevent a disease than to treat it.

Prediction of chest pain symptom

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

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

If a person experiences pain in the sternum area, the cause may be a pathology of any of the listed organs, so such a symptom cannot be associated only with heart disease. Treatment of chest pain should be carried out by a doctor: self-administration of medications and delays in seeking medical help can cause a deterioration in well-being and progression of the underlying disease.

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

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

Common symptoms indicating chest injuries of various origins are:

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

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

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

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

Some people think that with diseases of the stomach and intestines, pain occurs only in various parts of the abdomen, but this is not so. Pathologies of the digestive system are another common cause of pain in the center of the sternum, so people with chronic disorders of the gastrointestinal tract need to know the features of the clinical course of this group of diseases.

Diseases of the esophagus

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

Common signs of esophagitis include:

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

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

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

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

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

Video: Pain in the esophagus when swallowing and passing food

Subphrenic abscess

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

Heart problems

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

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

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

Neurological diseases and pathologies of the musculoskeletal system

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

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

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

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

Video - Why does my chest hurt?

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

If it hurts somewhere, it means that not everything is in order with the body. Many people quite rightly think so. Pain cannot be tolerated, nor can it be ignored. Especially when the pain is concentrated in the middle of the sternum.

Causes of pain

The sternum is an oblong bone located right in the middle of a person's chest. The ribs are attached to the sternum and together they form the rib cage. This bone structure protects the heart, large blood vessels, lungs, and esophagus from mechanical damage from the outside.

Pain in the middle of the sternum can be caused by the following pathological conditions:

Diseases of the heart and aorta;
Diseases of the esophagus;
Stomach diseases;
Diseases of the diaphragm;
Mediastinal diseases;
Diseases of the skeletal system;
Neuropsychiatric diseases.

Heart diseases

If pain occurs in the middle of the sternum, you first need to rule out possible heart problems as the most dangerous cause. Indeed, in most cases, pain in the sternum is caused precisely by heart disease, and more specifically by ischemic heart disease. develops when there is insufficient oxygen supply to the heart muscle. In conditions of lack of oxygen, the myocardium suffers greatly and signals this in the form of acute pain. Both and are clinical forms of IHD. However, the nature of pain in these diseases is different.

Typical for angina is pressing pain in the chest. Patients themselves describe this pain as if someone placed a brick on their chest. The pain often radiates to the left arm and neck. Painful attacks last up to twenty minutes, the pain then overtakes and then releases the person.

Pay attention! A characteristic sign of angina is the elimination of pain after taking nitroglycerin.

With a severe lack of oxygen, the heart muscle dies and myocardial infarction develops. This disease is accompanied by pressing, burning pain behind the sternum, but the pain is much more intense than with angina pectoris. Pain can also radiate to the left arm, neck, under the lower jaw, throughout the chest and even the abdomen. Often the pain is accompanied by a feeling of pronounced fear of death, cold sweat on the face. The pain is unbearable, does not go away after 15-20 minutes, and is also not relieved by nitroglycerin.

Pain in the sternum can also occur with inflammatory heart diseases - and pericarditis. This pathology often occurs after an infectious disease. In general, inflammatory heart diseases are characterized by the following symptoms:

Pain on the left side of the chest, as well as in the sternum;
Fever;
Weakness, malaise.

Aortic diseases

The occurrence of pain in the sternum can also be caused by disease of the aorta, in particular, its aneurysm. This is a local expansion of the aorta. in the early stages it is asymptomatic, but as the disease progresses, characteristic symptoms appear.

Signs of a thoracic aortic aneurysm are:

Prolonged pain in the sternum, heart area (pain attacks can last several days);
The pain does not radiate;
It is not eliminated after taking nitroglycerin.

The danger of the disease is that the aneurysm can rupture at any time, which leads to fatal bleeding. A rupture of a thoracic aortic aneurysm is indicated by symptoms such as the appearance of sharp pain behind the sternum, often radiating to the back, as well as a drop in blood pressure.

Diseases of the esophagus

The esophagus is located along the sternum. Therefore, it is not surprising that diseases of this organ often manifest as chest pain. One of the common diseases of the esophagus is achalasia cardia.. This is insufficient relaxation of the lower esophageal sphincter (cardia), due to which the patency of the esophagus is impaired. Thus, during swallowing, the food bolus gets stuck at the level of the spasmodic lower esophageal opening and cannot get further into the stomach.

Symptoms of achalasia are:

The appearance of pain in the middle of the sternum can also be associated with (synonymous with GERD). The disease is characterized by the development of inflammation of the esophageal mucosa due to reflux of gastric contents. Retrosternal pain with GERD can radiate to the interscapular region, neck, lower jaw, and left side of the chest. It is worth noting that esophageal pain is often mistakenly perceived as an attack of angina due to a similar clinical picture. However, pain in the sternum with GERD has its own characteristics:

Chest pain occurs after eating;
It intensifies after tilting the body forward, as well as in a horizontal position of the body;
Decreases after using antacids.

Important! Symptoms such as sour belching and regurgitation of food also support GERD.

Diaphragm diseases

The diaphragm is a muscle-tendon plate that separates the chest cavity from the abdominal cavity. The diaphragm has a natural opening, the esophageal opening, through which the esophagus exits from the chest cavity into the abdominal cavity. The development of a hiatal hernia is said to occur when the abdominal organs protrude through the said hole into the chest cavity.

A diaphragmatic hernia occurs with pain in the sternum in the middle and below, spreading to the epigastric region. The pain can radiate to the back, interscapular area, and even to the hypochondrium, which imitates the girdling pain of. Features of retrosternal pain with diaphragmatic hernia:

Pain often occurs after eating, intensifies when coughing, after lifting heavy objects;
Intensifies after tilting the body forward;
Decreases after belching, taking a deep breath, or if the person assumes an upright position;
The pain can be described as moderate, dull;
The pain is accompanied by symptoms of GERD.

Stomach diseases

It is known to manifest itself as pain in the epigastric region, often spreading to the lower part of the sternum. Depending on the location of the ulcerative defect, pain can also radiate to the left half of the chest, right hypochondrium, and back. The occurrence of pain is directly related to food intake. Often, discomfort appears half an hour to an hour after eating.

Ulcer pain decreases after the use of drugs that reduce gastric secretion. In addition, at the height of a painful attack, a person may experience acidic contents, which brings relief. Belching also speaks in favor of peptic ulcer. It is also worth noting that in rare cases, acute pain in the sternum area also manifests itself, although for this ailment it is more typical for the pain to be localized in the upper abdomen.

Respiratory diseases

Diseases of the lungs and pleura occur with pain in the chest on the affected side. But only tracheobronchitis can manifest itself as pain directly in the middle of the sternum. Usually this disease develops within. Therefore, at the beginning of the disease, a person is worried about weakness, fever, and sore throat. Discomfort quickly descends, spreading to the trachea and bronchi.

Pain with tracheobronchitis is localized behind the sternum in its upper and middle third and intensifies in time. At the beginning of the disease, the cough is dry and unproductive. When a person coughs, he feels an unpleasant sensation behind the sternum. After a few days, the cough becomes wet and the sputum comes out easier. Chest pain gradually decreases and overall well-being improves.

Mediastinal diseases

The mediastinum is the anatomical space located in the chest cavity. The space is limited in front by the sternum, in the back by the spine, and on the sides of the mediastinum are the lungs. The mediastinum contains organs such as:

Thymus;
Trachea;
Upper part of the esophagus;
Heart;
Main bronchi;
Large vessels and nerves.

Inflammation of the mediastinal tissue is called mediastinitis. The disease develops when infection enters the mediastinum from neighboring inflamed organs (trachea, lungs, esophagus, heart, etc.), or when mediastinal organs are injured. Acute mediastinitis develops suddenly and its first sign is the appearance of intense pain in the chest. The pain is especially intensified when swallowing and throwing the head back. The following signs are also noted:

Fever;
Chills;
Profuse sweat;
Cough;
Suffocation;
Heart rhythm disturbances;
Puffiness of the face and upper body;
Blueness of the skin.

Pay attention! Mediastinitis is an extremely serious condition and requires immediate medical intervention.

Diseases of the skeletal system

It is logical to assume that pain in the sternum can be caused directly by diseases of this bone. But it is worth noting that diseases of the sternum are very rare. Therefore, when chest pain occurs, first of all it is still necessary to think about a possible pathology of the heart or esophagus.

In traumatological practice, doctors, although rarely, still encounter. People receive this injury as a result of an accident when their chest hits the steering wheel, or less often - with a direct blow to the sternum or severe compression of the chest. When a fracture occurs, the victim feels severe pain in the sternum, which intensifies with breathing. Swelling and subcutaneous hemorrhage are detected at the fracture site. When fragments of the sternum are displaced, damage to neighboring organs, in particular the lungs, may occur, with the development of pneumo- or hemothorax.

The sternum, like any other human bone, can be affected by a malignant process. Sternum cancer is a fairly rare disease and is still worth mentioning. Cancer can occur in the sternum primarily or secondarily after metastases penetrate the bone. At the initial stages, the disease does not manifest itself in any way and the patient is not even aware of his diagnosis. As the disease progresses, weakness, malaise, anorexia, and low-grade fever develop. Also at this stage, a person begins to experience pain in the sternum.

Neuropsychiatric diseases

Sometimes a person goes to the doctor with troubling pain in the sternum, but after research it turns out that the person is absolutely healthy. In this case, the pain is psychogenic in nature; this condition is also called cardioneurosis. The patient himself describes his painful sensations, like a lump or stone behind the sternum. There may also be a complaint about a rapid heartbeat, interruptions in rhythm, “as if the heart wants to jump out.” As a rule, all these phenomena occur after emotional experiences. A person is very worried about chest pain and suspects that he has a dangerous disease. In general, a person with cardioneurosis is characterized by anxiety, worry, multiple fears,