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

Pain impulses from the organs of the chest cavity can cause discomfort, described as pressure, fullness, burning, aching and sometimes sharp pain. Since these sensations have a visceral basis, many patients describe them as pain, although it is more accurate to interpret them as discomfort.

Causes of chest pain

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

Chest pain in children and young people (under 30 years of age) is rarely due to myocardial ischemia, but myocardial infarction can develop at 20 years of age. Muscle, skeletal, or lung disease is more common in this age group.

Chest pain is the most common reason for emergency call. The main diseases of the cardiovascular system, in which there are pronounced pain in the chest, are:

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

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

Symptoms of chest pain

The symptoms that appear in severe diseases of the chest cavity are often very similar, but sometimes they can be differentiated.

• Unbearable pain radiating to the neck or arm indicates acute ischemia or myocardial infarction. Patients often compare myocardial ischemic pain with dyspepsia.
• Pain associated with exercise, which disappears at rest, is characteristic of exertional angina.
• Excruciating pain radiating to the back indicates dissection of the thoracic aorta.
• Burning pain radiating from the epigastric region to the throat, aggravated by lying down and relieved by taking antacids, is a sign of GERD.
• High body temperature, chills, and coughing are indicative of pneumonia.
• Severe dyspnea occurs with pulmonary embolism and pneumonia.
• Pain can be triggered by breathing, movement, or both in both severe and mild illnesses; these triggers are not specific.
• Short (less than 5 seconds), sharp, intermittent pain is rarely a sign of a serious pathology.

Objective examination

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

Lack of conduction of breath sounds on the one hand is a sign of pneumothorax; resonant percussion sound and swelling of the jugular veins testify in favor of a tension pneumothorax. Fever and wheezing are symptoms of pneumonia. Fever is possible with pulmonary embolism, pericarditis, acute myocardial infarction, or rupture of the esophagus. Pericardial friction rub is in favor of pericarditis. The appearance of an IV heart sound (S 4), a late systolic murmur of papillary muscle dysfunction, or both of these signs appear with myocardial infarction. Local lesions of the central nervous system, aortic regurgitation murmur, asymmetry of pulse or blood pressure in the arms are symptoms of thoracic aortic dissection. Swelling and tenderness of the lower extremity are indicative of deep vein thrombosis and thus a possible pulmonary embolism. Chest pain on palpation occurs in 15% of patients with acute myocardial infarction, this symptom is not specific for diseases of the chest wall.

Additional research methods

The minimum examination of a patient with chest pain includes pulse oximetry, ECG, and chest x-ray. Adults are often tested for markers of myocardial injury. The results of these tests, together with the data of the anamnesis and physical examination, allow a presumptive diagnosis to be made. A blood test is often not available at the initial examination. Separate normal indicators of markers of myocardial damage cannot be the basis for excluding heart damage. In the event that myocardial ischemia is likely, the studies must be repeated several times, as well as the ECG, it is also possible to perform a stress ECG and stress echocardiography.

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

Pain in the chest (thoracalgia) is an unpleasant sensation that occurs during pathological processes in the internal organs, injuries of the chest or spine. This condition leads to difficulty breathing, stiffness of movements and a significant deterioration in the quality of human life. To eliminate the manifestation, you should contact a medical institution.

Etiology

Pain in the chest in the middle, on the right or left side, is provoked by pathological changes in the cardiovascular system or upper respiratory tract. Also, pathologies associated with the spine are not an exception. In general, chest pain can be caused by the following etiological factors:

• post-traumatic syndrome;
• neurological ailments;
• coronary heart disease;
• cardiovascular pathologies;
• aortic dissection;
• injuries of the back, sternum and spine;
• respiratory diseases;
• pathology of the abdominal organs;
• psychosomatics.

The nature of chest pain may indicate a possible underlying factor. Pressing pain in the chest may indicate a pre-infarction condition, so you should urgently call an ambulance.

Symptoms

Pain in the chest can be supplemented by the following additional signs of the clinical picture:

• , for no apparent reason;

Depending on the etiology, the general clinical picture can be supplemented by specific signs, which helps to differentiate them:

• sharp, severe pain in the middle or in the left half of the chest, radiating to the arm or neck, may be a sign of acute ischemia or myocardial infarction;
• pain in the chest on the right or left, which occurs during physical exertion and completely disappears at rest, may indicate angina pectoris;
• sharp pain in the left side of the chest, with a return to the back, may be a symptom of aortic dissection;
• chest pain when coughing or taking a deep breath may indicate the development of an upper respiratory disease.

Also, chest pain when inhaling can be a sign of and. In this case, the overall clinical picture may be supplemented by the following manifestations:

• and fever;
• cough;
• labored breathing.

The cause of pain in the chest in the middle may be .. In this case, the clinical picture may have the following symptoms:

• when you try to take a deep breath or exhale, the pain increases sharply and has a stabbing character;
• there is discomfort in the right or left hypochondrium;
• pain radiates to the stomach, liver, in some cases to the heart;
• pain attacks occur periodically or only during physical activity;
• pallor of the skin;
• violation of skin sensitivity;
• decreased tone of the chest muscles.

In the presence of such a clinical picture, you should urgently seek medical help. Otherwise, serious complications and even death are possible if the cause of the pain is.

Diagnostics

Why the chest hurts, only a doctor can say after an examination and an accurate diagnosis. If the patient's condition allows, the attending physician conducts a detailed physical examination with a general history. Be sure to take into account the history of the disease. For an accurate diagnosis, the following laboratory diagnostic measures are used:

• general and biochemical blood test;
• sputum analysis (if there is a strong cough);
• pulse oximetry;
• chest x-ray;
• blood for markers of myocardial infarction;
• diagnostic medication;

If osteochondrosis is suspected, as the root cause of chest pain on the right or left, the general diagnostic program may include such additional examination methods:

• computed tomography of the cervical and thoracic region;
• contrast discography;
• myelography - examination of the spinal cord using a contrast agent.

Additional research methods may be prescribed at the discretion of the doctor, depending on the current clinical picture, anamnesis and medical history. Treatment can be prescribed only after an accurate diagnosis.

Treatment

Treatment directly depends on the etiology of the pathological process that provoked the development of such a symptom. Sometimes, the addition of such symptoms requires urgent hospitalization of the patient.

In general, drug therapy for chest pain on the right or left side may consist of taking drugs of this type:

• painkillers;
• vasodilators;
• chondroprotectors.

However, treatment with drugs comes entirely from the etiological factor that provoked pain in the chest area.

As an adjunct therapy, to eliminate pain in the left side of the chest or with other localization of the symptom, the doctor prescribes the following physiotherapy procedures:

• shock wave therapy;
• mud treatment.

Depending on the etiology of pain, manual therapy may be prescribed.

In any case, therapy should be prescribed only by a competent medical specialist. Pain on the left side of the chest, on the right or in the middle, may indicate the development of a serious pathological process, so self-medication is fraught with serious consequences.

Prevention

There are no specific preventive methods in this case. This is due to the fact that pain in the chest area is a symptom, and not a separate nosological unit. You should adhere to a general healthy lifestyle and diet, do exercises or go to sports sections, do not overcool, seek medical help in a timely manner, do not neglect preventive examinations by medical specialists, and also do fluorography every year without fail.

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). In women, the chest has a flatter shape, so its volume is slightly smaller compared to men of the same age. The chest cavity contains the bronchopulmonary system, thoracic vertebrae, heart, arteries through which blood enters the heart muscle, esophagus and the upper part of the diaphragmatic tube.

If a person has pain in the sternum, the reason may be in the pathology of any of the listed organs, so it is impossible to associate such a symptom only with heart disease. A doctor should treat chest pains: self-medication and untimely 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 damage was received, and the impact of additional factors. For example, when falling, the pain is most often dull, aching, has a moderate or high intensity and increases during bending forward or turning the torso to the side. Injuries received in a fight can lead to rupture of internal organs - such a pathology will be accompanied by acute or cutting pain, which weakens if the patient takes a certain position of the body (most often on his side), but does not go away completely.

The most dangerous injuries of the chest are those resulting from traffic accidents and other emergencies. 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 a severe pain syndrome appears, often requiring emergency hospitalization of the patient using special means.

Common symptoms indicating chest trauma of various origins are:

• severe pain (dull, sharp, dagger-like, cutting) in the central part of the chest and at the site of injury;
• decrease or fluctuations in 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 is fraught with 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 condition of the patient, the symptoms present, and other factors. If the patient has damaged thoracic vertebrae, surgery may be required.

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

The relationship of pain in the sternum with pathologies of the digestive system

Some people think that in 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 in 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 chest cavity, therefore, if this organ is disturbed, 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 the pain in the middle of the chest that makes it possible to differentiate it from other digestive disorders even before the hardware and laboratory diagnostics.

Common signs of esophagitis include:

• stabbing sensation in the throat when swallowing;
• "lump" in the larynx;
• pain while eating when food passes through the esophagus, which occurs in the middle of the chest cavity;
• bad breath;
• pain in the epigastrium and abdominal area, aggravated after eating;
• fetid eructation;
• heartburn.

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

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

With an infectious lesion of the esophagus, the doctor may prescribe antibiotic or antiviral therapy.

Video: Pain in the esophagus when swallowing and passing food

Subdiaphragmatic abscess

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

Disorders in the work of the heart

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.

Important! For any symptoms that may indicate heart disease, you should immediately call an ambulance. The patient should be seated on a chair or laid in bed with a raised head, provide air flow, give a pill " Nitroglycerin" under the tongue (similar to " Nitrospray”, to alleviate the condition, make one injection into the sublingual zone). If there is no effect, the reception can be repeated after 5-7 minutes.

Neurological diseases and pathologies of the musculoskeletal system

Diseases of the spine 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 pain attack in the central part of the chest cavity can occur with thoracic or cervical osteochondrosis. The pain is pressing, intense, aggravated in the supine position.

Treatment of osteochondrosis includes therapeutic exercises, a properly composed 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, Kapsikam), 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 - squeezing or pinching of the intercostal nerves. The pain in this case can be sharp, shooting, pulsating, stabbing in nature and very intense. The pain syndrome occurs against the background of a violation of the respiratory function, may have a constant course or appear in short attacks. In chronic neuralgia, pain 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 occurs in a child, it is urgent to 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; in no case should such symptoms be ignored. read on our website.

Video - Why does the chest hurt?

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

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

Why can the sternum hurt?

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

Often the patient argues like this - if the sternum “covers” the area of ​​\u200b\u200bthe heart, then it can hurt only because of cardiac pathology. But this is far from true. Due to the fact that the sternum is the anterior border of the mediastinal 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,
• acute development,
• - the occurrence of thromboembolism in the pulmonary arteries,
• and - inflammatory processes in the outer shell of the heart and the heart muscle proper.
• or her break

2. Intercostal neuralgia- “infringement” of the intercostal nerves by spasmodic muscles between the ribs or located along the spinal column. In this case, retrosternal pain is called thoracalgia of vertebrogenic genesis, that is, chest pain caused by pathology of the spine.

3. Pathology of the stomach or esophagus:

• GERD (gastro-esophageal reflux disease),
• esophagitis - inflammation of the inner wall of the esophagus,
• tear of the esophageal mucosa, for example, with Mallory-Weiss syndrome (bleeding from the veins of the esophagus with injury to its wall with 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 deformity), keeled chest (chicken breast), heart hump.

6. Inflammatory processes in the respiratory organs- tracheitis (more often causes pain behind the sternum), pneumonia (rarely, but can be manifested by pain in the sternum).

7. Oncological diseases- metastases in the lymph nodes of the mediastinum, lymphomas.

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 the pain syndrome in the chest with various pathologies.

typical area of ​​irridation of pain in angina pectoris

So, with angina pectoris pain behind the sternum 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 exercising in the gym, after sexual intercourse, when running or striding, more often in men. Such 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 can take 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 with an error in the diet. That is, retrosternal pain after physical activity is an almost reliable sign of angina pectoris (angina pectoris). Often, pain in angina pectoris can be given to the area of ​​​​the scapula, in the jaw or in the arm, and is stopped by taking it under the tongue.

If the patient develops an acute myocardial infarction, then 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 such pain is combined with shortness of breath, a general severe condition, blue face and dry cough. There may be pain in the abdomen. However, in some patients, the pain may not be very pronounced, 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 on his own 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 pain irritation in myocardial infarction

PE - a deadly condition, accompanied by retrosternal pain

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

Dissecting aortic aneurysm(thoracic region) is extremely dangerous and prognostically adverse emergency. Pain during an aneurysm rupture 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 next few hours. Often, the clinic of aortic rupture is mistaken for renal colic or for acute surgical pathology of the abdomen. A doctor of any specialty should be aware that intense, very pronounced retrosternal pain, radiating to the abdomen or back with a shock clinic, are signs of a possible aortic dissection.

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

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

So, if a person has pain in the sternum and it is difficult for him to breathe, you should immediately seek medical help, as he is likely to have pulmonary edema.

Pain in diseases of other organs is slightly different from cardiac retrosternal pain.

Yes, at intercostal neuralgia(most often in women) pain under the sternum or on the sides of it. If the muscles to the right of the spine are spasmodic or inflamed, then the pains are localized on the right side of the sternum, if on the left, then on the left side. The pain is shooting in nature, aggravated at the height of inspiration or with a change in body position. In addition, if you feel the intercostal muscles at the edges of the sternum, there is a sharp soreness, sometimes so pronounced that the patient screams and tries to dodge the doctor's fingers. The same thing happens from the side of the back in the region of the interspinous muscles along the edges of the spine. So, if the patient has a pain in the sternum when inhaling, most likely he has problems with the spine, he took the wrong position of the body (“pinched”), or he could pass through somewhere.

At sternum injuries sensations are in the nature of acute pain, poorly relieved by taking painkillers. After an injury, an urgent x-ray of the chest cavity is required (if a fracture is suspected), since fractures of the ribs are also possible, and this is fraught with a lung injury. Chest deformities are characterized by prolonged pain of varying severity, but usually the patient has pain in the sternum in the middle.

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

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

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

For each patient, it is necessary to separate acute and chronic retrosternal pain:

• Acute pain is sudden, acute, but the degree of intensity varies in different patients - for some it is more pronounced, for others it is comparable only to minor discomfort. Acute pain is caused by an acute pathology - heart attack, paroxysmal tachycardia, dissecting aneurysm, rupture of the esophagus, fracture of the sternum, 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 retrosternal pain see a doctor later. Such pain in the sternum is characteristic of angina pectoris, sternum deformity, GERD, esophagitis, etc.

In order to determine what exactly caused retrosternal pain, the doctor must carefully evaluate the patient's complaints.

What actions to take with retrosternal pain?

When a symptom such as pain in the sternum appears, the patient needs to analyze the factors preceding the pain (load, injury, being in a draft, etc.). If the pain is acute and very intense, you should immediately consult a doctor. It is advisable to call an ambulance or go to any round-the-clock department of the nearest general hospital on your own. If there is slight pain or discomfort in the sternum, which, in the patient's opinion, is not caused by acute cardiac pathology (young age, anamnestic absence of angina pectoris, hypertension, etc.), it is permissible to contact a therapist on the same or the next day. But in any case, only a doctor should establish a more accurate cause of retrosternal pain.

If necessary, the doctor will prescribe an additional examination:

1. chest radiograph,
2. Tests with physical activity (, - if stable angina is suspected),
3. Biochemical blood test,

First aid for chest pain

Emergency care can be provided to the patient if it is presumably known what caused this pain. With angina pectoris, it is necessary to put a tablet under the patient's tongue or sprinkle one or two doses of nitromint or nitrospray. In case of high blood pressure, an antihypertensive drug (25-50 mg of captopril, an anaprilin tablet) should be allowed to dissolve or drink. 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 case of acute severe cardiac pathology, as well as a serious condition of the patient (PE, myocardial infarction, pulmonary edema), the patient must unfasten the collar, open the window, sit in a reclining position or with legs down (to reduce blood filling of the lungs) and urgently call an ambulance, describing the severity of the condition to the dispatcher.

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

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

How to treat chest pain?

Retrosternal pain should be treated according to the doctor's prescriptions after a thorough examination. Severe pathology of the heart, esophagus, trachea, as well as injuries are treated in a hospital. Hypertension, tracheitis, esophagitis, intercostal neuralgia are treated under the supervision of a local doctor in a polyclinic at the place of residence.

With angina pectoris, complex treatment is prescribed - antihypertensives (ACE inhibitors), rhythm-reducing (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 cardiological or cardiac surgery hospital, regular constant monitoring by a doctor in a polyclinic at the place of residence is required. 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 are the consequences if you ignore retrosternal pain?

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

Ischemia and myocardial infarction and prerequisites for their development

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

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

Chest pain can be a manifestation of cardiovascular diseases, respiratory diseases, less often - with diseases of the esophagus, musculoskeletal system, nervous system. The important role of the organs in the chest cavity requires an extremely serious and attentive attitude to the appearance of chest pain and the earliest possible medical attention.

If there was pain after a chest injury

Rib fracture. Occurs with chest injuries (chest blow or blow to the chest) during falls, in a fight, in a traffic accident.

Manifestations: sharp pain at the fracture site. Pressing on the site of injury may be accompanied by a crunch, which increases pain. The movement of the chest during breathing is limited due to pain. Breathing becomes frequent, shallow. When breathing, you can hear the crunch of fragments of the costal bone rubbing against each other. On inspiration, the patient tries to spare the chest on the side of the fracture.

Treatment performed by a surgeon, traumatologist. Before that, you can take painkillers.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin.

The pain is not relieved by taking 1-2 tablets of nitroglycerin, its duration is more than 20 minutes, myocardial infarction can be assumed.

myocardial infarction. It occurs due to a long-term disruption of the blood supply to a section of the heart muscle (impaired coronary circulation), complete blockage and the resulting death of muscle cells.

Manifestations: The main symptom of myocardial infarction is pain. It occurs at the very beginning of the disease. Pain occurs both after exercise and at rest. Pain occurs in the left half of the chest, it can be given to the arm, shoulder blade, neck, lower jaw. Character of pains: breaking, pressing. Difference from an attack of angina pectoris: the pain during a heart attack significantly exceeds the strength and duration of a normal attack of angina pectoris (duration - from 10-20 minutes to several hours. Duration of a painful attack: from one hour to several days. The pain does not decrease from taking nitroglycerin. The attack may be accompanied by sharp general weakness, fainting.

Treatment: immediate hospitalization of the patient in a cardiological hospital! Before that, you can take 2-3 tablets of nitroglycerin. Untimely seeking medical help or attempts to self-medicate with myocardial infarction are fraught with death!

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. Is chest pain accompanied by high body temperature, cough with greenish or yellow sputum?

Pneumonia. Inflammatory processes in the lungs are usually caused by an infection. With pneumonia, not only lung tissue is involved in the inflammatory process, but also the membrane covering them - the pleura. In the pleura there is a large number of nerve endings, when irritated by the inflammatory process, pain occurs.

Manifestations: the disease begins after hypothermia. Headache, weakness, malaise, fever up to 39-40°C, chills are noted. During the day, a cough appears, initially dry, then with yellowish or greenish sputum. At the same time, pain appears over the affected part of the lung. The pain is associated with respiratory movements: it intensifies with a deep breath, coughing. Because of this, breathing becomes frequent and shallow (shallow). The skin of the cheeks is bright red, in other areas it is pale, the lips are cyanotic.

Treatment: the selection of treatment is carried out by a general practitioner, a pulmonologist. Before that, you can take antipyretic drugs.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. If sudden chest pain is accompanied by shortness of breath, dry cough.

Pneumothorax. Occurs suddenly after a chest injury or spontaneously, for no apparent reason. In this case, air penetrates through the damaged lung or bronchus directly into the pleural cavity. This leads to an increase in pressure in it and squeezing the lung, to a decrease in its volume with the exclusion of the compressed areas from the breathing process.

Manifestations: sudden sharp pain in the chest, aggravated by breathing, talking, during physical exertion. The pain is constant and prolonged. A characteristic feature of pneumothorax is shortness of breath and dry cough. They are accompanied by pallor of the skin, general weakness, cold sweat, frequent weak pulse. To facilitate breathing, the patient takes a sitting position. When breathing, there is a noticeable lag in the movement of the ribs on the side of the lesion.

Treatment performed by a surgeon. Before that, you can take painkillers.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. If chest pain is accompanied by heartburn, belching of sour

Esophagitis. Inflammation of the mucous membrane of the esophagus. It occurs, as a rule, when contents from the stomach are thrown into it.

Manifestations: pain when swallowing, located behind the sternum. May radiate to the neck. The pain is accompanied by a painful burning sensation, heartburn, sour belching, nausea. The pain is associated with food, occurs in a horizontal position. The patient wakes up at night because of pain and heartburn in order to drink water to reduce them. A decrease in the intensity of pain and burning occurs if the patient sits up in bed.

Treatment: the choice of treatment is carried out by a gastroenterologist.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. If the pain is localized along the intercostal spaces and at the same time rashes appear on the skin in these places

Shingles. An infectious disease caused by the herpes virus. The virus infects the paravertebral ganglions, from which the spinal nerves emerge. The zone of damage and spread of inflammatory manifestations corresponds to the spinal node.

Manifestations: the onset of the disease resembles a cold: headache, general malaise, fever up to 38 ° C, nausea. Then there are sharp pains along the nerves in the intercostal spaces. The pains are severe, burning, and permanent. Often the pain is accompanied by itching of the skin. Soon, the skin of one or two intercostal spaces turns red, a group of small nodules appear on it, which then turn into bubbles filled with a cloudy liquid. After 3-4 days they turn into yellow-brown crusts.

Treatment selected by an infectious disease specialist. Before that, you can take painkillers.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. Pain in the intercostal spaces in the absence of rashes on the skin in these places

Intercostal neuralgia. It is a manifestation of diseases of the thoracic spine. Most often, intercostal neuralgia occurs with osteochondrosis of the thoracic spine. Degenerative-destructive processes in the spine lead to changes in the vertebrae, their displacement, changes in the intervertebral discs, while the roots of the spinal nerves emerging from the thoracic spinal cord are irritated.

Manifestations: pain is most often of a constant nature along the intercostal spaces. Pressing on the points located on the side of the spinous processes of the vertebrae is painful. Pain can be traced throughout the entire intercostal space: from the spine to the anterior surface of the chest. The pain intensifies with a deep breath, coughing, sneezing, while moving the torso. Numbness of the skin over the corresponding intercostal space is often noted.

Treatment: The choice of treatment is carried out by a neurologist. Before that, you can take painkillers, apply anti-inflammatory ointment.

If the pain is located in the region of the heart, radiating to the arm, shoulder blade, neck, lower jaw, does it occur during exercise. If the pain is relieved after taking 1-2 tablets of nitroglycerin. The pain lasts no more than 15-20 minutes

An attack of angina pectoris in ischemic heart disease. The disease occurs when there is a decrease in blood flow through the coronary arteries that supply the heart muscle with blood. The decrease in the lumen of the arteries, as a rule, occurs due to the development of atherosclerotic plaques in them.

Manifestations: sudden paroxysmal pain in the region of the heart, behind the sternum, radiating to the arm, shoulder blade, neck, lower jaw. The duration of the pain attack: from a few seconds to 15-20 minutes. The pain is intense, according to the description - burning, baking. Pain may occur less often - after physical or emotional stress, less often - at rest or during sleep. The pain is accompanied by restlessness, anxiety and fear. Pain is not associated with respiratory movements. The pain is relieved by taking nitroglycerin.

Treatment: the choice of treatment is carried out by a general practitioner, a cardiologist. Before that, you can take 1-2 tablets of nitroglycerin. Obligatory examination by a doctor, with an electrocardiogram! Timely treatment helps to avoid a formidable complication of coronary heart disease - myocardial infarction!