Pain that occurs in the middle part of the chest is familiar to many people. The reasons for this ill health are varied. Pain in the chest in the middle can be both the result of ordinary physical overstrain and the result of serious diseases.

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It is well known that the sternum is a flat bone located in the center of the chest, which articulates with the ribs. The sternum consists of three parts: the body itself, the handle and the xiphoid process. It has been repeatedly noted that with excessive physical exertion, all of the above parts can move. With injuries, bruises, pain in the injured area of ​​\u200b\u200bthe sternum, of course, increases. The same pain observed when pressing on the sternum, bending the torso.

Perhaps the causes of pain in the middle of the chest are cardiovascular diseases. If there is continuous chest pain, predominantly in the upper part of the chest, this may be an indication of an aortic aneurysm. The aorta itself is a large vessel that comes from the left ventricle of the heart. Vessel dilation, or aneurysm, can occur for many reasons. In this case, pain is observed quite long time, and with physical exertion, they are significantly enhanced. The slightest suspicion of an aortic aneurysm requires immediate hospitalization. Surgical intervention is necessary to overcome the existing ailment.

Also, pain in this part of the chest is sometimes the cause of a disease such as pulmonary embolism, characteristic of the right ventricle of the heart. The pain in this case is strong, resembling angina pectoris, but they do not radiate to other areas. The main symptom of pulmonary embolism is an increase in pain with each breath. Painkillers help relieve pain, but even after taking them, the pain syndrome does not subside for several hours. No urgent medical assistance not enough.

Angina pectoris is another disease that is manifested by short bouts of squeezing pain in the chest. With angina pectoris, pain can occur not only on the left side, but also in the sternum. Usually after walking or other physical activity, the pain goes away.

One of the most dangerous possible manifestations chest pain in the middle may be a myocardial infarction requiring immediate hospitalization. In this case, the pain is somewhat reminiscent of angina pectoris, but the pain is much longer and stronger. Moreover, the pain syndrome does not go away even at rest. A man is seized by an inexplicable fear.

For diseases gastrointestinal tract also possible pain manifestations in the middle of the chest. Pain occurs due to muscle spasms of the walls of the stomach and has a rather specific features. It can appear on an empty stomach, it can occur after a certain period of time after eating. A person feels nausea, vomiting, heartburn. Remove this muscle spasm help with antispasmodics.

Feeling pain in the middle of the chest may be due to strong contractions of the gallbladder. Intense pain in the sternum, radiating to the left side of it, may be a symptom of a lesion bile ducts and bubble. Pain, somewhat reminiscent of the heart, occur in acute pancreatitis. Often chest pain becomes simply unbearable. A person often takes it for a heart attack, not taking into account the lack of spread to other organs. Only with the help of intensive treatment in a hospital can suffering be alleviated.

There are other reasons for the appearance of pain in the middle part of the chest. Chest pain may be due to an increase in thyroid gland, thoracic osteochondrosis, intercostal neuralgia, diaphragmatic hernia. Violations in the structure of the spine are also reflected in pain in the middle part of the sternum. Inflammation in the trachea, lungs, bronchi, pleura is almost always characterized by chest pain.

The final diagnosis can only be made by a doctor based on the studies. Be healthy!

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Pain in the chest can be different in duration, intensity, nature, time of onset, frequency. In addition, there may be pain in the chest on the right or left, and may be extensive. It all depends on the causes that cause them.

Below are the most common causes of chest pain.

Chest pain due to heart problems

Angina pectoris is a fairly common cause of chest pain on the left. Angina pectoris or, as it is also called, angina pectoris causes paroxysmal pain that occurs due to coronary insufficiency, when the heart muscle suffers from hypoxia. There is hypoxia of the heart muscle due to atherosclerosis or spasm of the coronary vessels.

With angina pectoris, there is prolonged aching pain on the left side, which can spread to the neck, lower jaw and left hand. Often, pain sensations appear in the epigastric region and spread to the region of the left shoulder blade. With angina pectoris, chest pain is easily removed with validol or nitroglycerin. If the pain occurs after intense physical activity, then it is often enough to stop it simply by resting for five minutes. Doctors distinguish between exertional angina and rest angina. If you first have chest pain on the left, you need to know the following nuances:

• It is necessary to take validol or nitroglycerin as soon as possible;
• If chest pain does not go away after five minutes, nitroglycerin should be taken again;
• If the pain has not gone away after another 15 minutes, you need to call an ambulance. If the attack lasts longer than half an hour, the heart muscle begins to experience acute hypoxia, which can cause acute infarction myocardium.

Chest pain can also be caused by acute myocardial infarction. In this case, the pains are intolerable and can even cause pain shock. Immediately at the time of myocardial infarction, patients compare pain with a dagger strike. Pain is accompanied by severe sweating and pallor, lowering blood pressure, fear.

In addition, chest pain on the left can occur with heart defects, paroxysmal arrhythmias, pulmonary embolism, aortic aneurysm, etc.

Chest pain due to injury

Such pains can be different both in nature and localization. As a rule, traumatic pains are aggravated by tilting the torso, breathing, coughing.

If you experience pain, you should immediately consult a doctor. For what? The doctor solves several vital questions for the patient at once, namely:

• whether there is a contusion of the lung and heart;
• whether the spine and ribs are damaged;
• whether there is a blunt trauma soft tissues of the breast;
• whether the pleural cavity is damaged, whether pneumothorax develops;
• whether there are signs of accumulation of blood or fluid in the pleural cavity.

The nature of the treatment of chest pain directly depends on all these nuances.

It is important for patients to know that a variety of bruises and injuries of the chest may seem minor at first, but over time lead to an increase in complications and pain. Therefore, do not postpone a visit to the doctor. Often, patients come with long-term pain syndromes, which significantly hinders doctors in providing adequate medical care.

Chest pain due to pneumonia

Pain in pneumonia is easy to recognize, as they usually begin with a dry cough, which after a few days turns into a cough with sputum. In addition, such pains are usually accompanied by symptoms of the body that occur in response to inflammatory processes: shortness of breath, heat body, excessive sweating, etc.

Retrosternal pain can also occur with pleurisy. The pleura is a pulmonary membrane in which there are many nerve endings. Dry pleurisy can cause stabbing pain when coughing or exhaling. Such pains are localized at the site of the inflammatory focus. So, such pains in the chest on the right or left can be observed, but most often in the lower lateral region of the chest. Exudative pleurisy with the formation of fluid in the pleural cavity are accompanied by more intense pain and cough and are often combined with severe shortness of breath.

Pulmonary emphysema is a bullous expansion of the alveoli of the lungs with a loss of tissue elasticity. Often emphysema develops after various past illnesses lungs, it is a complication of heart defects, pneumosclerosis or some occupational diseases (for example, in miners). Emphysema is always accompanied by respiratory failure and barrel rib cage. Pain in the chest with emphysema is aching in nature and is localized between the ribs.

Diaphragmatic hernia

Chest pain can be caused by diaphragmatic hernia. In this case, the patient feels a burning sensation in the lower part of the sternum and retrosternal space. Often, burning pain is combined with belching. Such a burning sensation is caused by irritation of the mucous membrane of the esophagus by the gastric acidic environment. Pain in diaphragmatic hernia is directly dependent on food intake.

Pain in diseases of the spine

Scoliosis often causes pain in the thoracic spine. This disease is also characterized by pain of a neurological nature and pain in the muscles of the body.

Another disease that can cause chest pain is Scheuermann-Mau disease. For this disease characteristic wedge-shaped deformity of several vertebrae of the thoracic spine, which leads to the formation of a hump. With this disease, the patient experiences aching pain in the muscles of the back and pain of a neurological nature that occurs when the spinal roots are infringed in the zone of deformation of the vertebrae.

Bechterew's disease, or deforming spondylarthrosis. Pain in this disease is aching in nature and spread throughout the spine. They are caused by inflammation in the joints. This disease is also characterized by a feeling of stiffness in the joints, especially in the morning. However, the main symptom of spondylarthrosis is not pain, but slowly developing stiffness in the joints of the spine.

Osteoporosis is a disease characterized by calcium deficiency in the bones, as there is a violation of the processes of calcium resorption in bone tissues. This disease is characterized by pain in the chest on the right and left, often aggravated after significant physical exertion. More often, such pains are localized in the lumbar and pelvic spine, and in the chest they occur mainly with a generalized process.

Sudden sharp pain in the chest is the most important symptom acute diseases chest organs and one of the most common causes treatment of patients to the doctor; often in these cases, emergency assistance is required.

It should be emphasized that acute chest pain, which appeared in the form of an attack, may be the earliest and before a certain moment the only manifestation of a disease requiring emergency care; such a complaint should always alert the doctor. Such patients should be examined especially carefully, and in most cases, based on the anamnesis, examination data and ECG, the correct diagnosis can be made already at prehospital stage.

The main causes of pain localized by patients in the chest are as follows.

1. Heart disease - acute myocardial infarction, angina pectoris, pericarditis, myocardial dystrophy.

2. Vascular diseases - dissecting aortic aneurysm, pulmonary embolism (PE).

3. Respiratory diseases - pneumonia, pleurisy, spontaneous pneumothorax.

4. Diseases of the digestive system - esophagitis, hiatal hernia, peptic ulcer stomach.

5. Diseases of the musculoskeletal system - thoracic sciatica, chest injuries.

6. Shingles.

7. Neuroses.

The main task in conducting a differential diagnosis in a patient with acute chest pain is to identify prognostically unfavorable forms of pathology and, first of all, myocardial infarction. Acute strong compressive, squeezing, tearing, burning pain behind the sternum or to the left of it is the most important symptom of this formidable disease. Pain may appear during exercise or at rest in the form of an attack, or often recurring attacks. The pain is localized behind the sternum, often capturing the entire chest, irradiation to the left shoulder blade or both shoulder blades, back, left arm or both arms, neck is characteristic. Its duration is from several tens of minutes to several days. It is very important that pain during a heart attack is the earliest and up to a certain point the only symptom of the disease, and only later appear characteristic changes ECG (rise or depression of the 5T segment, T wave inversion and the appearance of a pathological O wave). Often it is accompanied by shortness of breath, nausea, vomiting, weakness, increased sweating, palpitations, fear of death. Characteristically, there is no effect with repeated administration of nitroglycerin. To relieve pain or reduce its intensity, it is necessary to repeatedly introduce narcotic analgesics.

Short-term acute compressive pain behind the sternum or to the left of it, appearing in the form of seizures, is the main symptom of angina pectoris. Pain in angina pectoris can radiate to the left arm, left shoulder blade, neck, epigastrium; unlike other diseases, irradiation to the teeth and lower jaw is possible. Pain occurs at height physical tension- when walking, especially when trying to walk faster, climbing stairs or uphill, with heavy bags (angina pectoris), sometimes as a reaction to a cold wind. The progression of the disease, further deterioration of the coronary circulation lead to the appearance of angina attacks with less and less physical exertion, and then at rest. With angina pectoris, the pain is less intense than with myocardial infarction, much less prolonged, most often lasts no more than 10-15 minutes (can not last for hours) and is usually removed at rest when taking nitroglycerin. Pain behind the sternum, which appears in the form of attacks, for a long time may be the only symptom of the disease. The ECG may show signs of a previous myocardial infarction, at the time of a painful attack - signs of myocardial ischemia (depression or elevation of the 5T segment or T wave inversion). It should be noted that ECG changes without an appropriate history cannot be a criterion for angina pectoris (this diagnosis is made only with a thorough questioning of the patient).

On the other hand, a careful examination of the patient, including electrocardiographic, even during a painful attack, may not reveal significant deviations from the norm, although the patient may need emergency care.

In cases where acute, sharp, constricting pain behind the sternum or in the region of the heart with irradiation to the left shoulder, the lower jaw develops at rest (more often in sleep or in the morning), lasts 10-15 minutes, is accompanied by a rise in the 5T segment at the time of the attack and quickly stopped by nitroglycerin or nifedipine (Korinfar), one can think of variant angina pectoris (Prinzmetal's angina pectoris).

Chest pain, indistinguishable in nature from angina pectoris, occurs with stenosis of the aortic orifice. The diagnosis can be made on the basis of a characteristic auscultatory picture, signs of severe left ventricular hypertrophy.

Pain in pericarditis is characterized by a gradual increase, but at the height of the process (when exudate appears), the pain may decrease or disappear; it is related to breathing and depends on the position of the body (usually decreases in a sitting position with a forward bend). The pain is often cutting or stabbing in nature, localized behind the sternum, can radiate to the neck, back, shoulders, epigastric region, usually lasts for several days. A pericardial friction rub detected on auscultation allows for an accurate diagnosis. The ECG may reveal a synchronous (concordant) rise in the 5T segment in all leads, which often leads to an erroneous diagnosis of myocardial infarction. Typically, the lack of effect from taking nitroglycerin, pain is best relieved by non-narcotic analgesics.

Chest pain, which is not inferior in intensity to the pain of myocardial infarction, and sometimes exceeds it, may be a symptom of a relatively rare disease - dissecting aortic aneurysm. Pain occurs acutely, more often against the background of a hypertensive crisis or during stress (physical or emotional), localized behind the sternum with irradiation along the spine, sometimes spreading along the aorta into lower divisions abdomen and legs. It has a tearing, bursting, often undulating character, lasting from several minutes to several days. The pain may be accompanied by an asymmetric pulse on the carotid and radial arteries, rapid fluctuations in blood pressure (BP) from a sharp rise to a sudden drop until the development of collapse. Often there is a significant difference in the level of blood pressure on the left and right hands corresponding to the asymmetry of the pulse. Due to the deposition of blood under the intima of the aorta, signs of anemia increase. Differential diagnosis with acute myocardial infarction is especially difficult in cases where changes appear on the ECG - non-specific or in the form of depression, sometimes the rise of the 5T segment (although without the cyclicity of ECG changes characteristic of myocardial infarction during dynamic observation). Re-introduction narcotic analgesics, including intravenous, often does not stop the pain syndrome.

Pulmonary embolism often develops in patients who have undergone surgery, suffering from phlebothrombosis of the deep veins of the legs or atrial fibrillation. In this case, there is an acute, intense pain in the center of the sternum, the right or left half of the chest (depending on the location of the pathological process), which lasts from 15 minutes to several hours. The pain may be accompanied by severe shortness of breath, a drop in blood pressure, in every tenth patient - fainting (syncope). On the ECG, signs of overload of the right heart can be recorded - a high pointed P wave in leads II, III, aUR, deviation of the electrical axis of the heart to the right, McGean-White sign (deep ^ wave in standard lead I, deep O wave in lead III) , incomplete blockade of the right leg of the bundle of His. The pain is relieved with narcotic analgesics.

In lung diseases, chest pain is usually characterized by a clear connection with breathing. Localization of pain in pleuropneumonia, lung infarction depends, as a rule, on the location of the inflammatory focus in the lungs. Respiratory movements, especially deep breathing and coughing, lead to increased pain, which in these diseases is due to irritation of the pleura. In this regard, when breathing, patients usually spare the affected side; breathing becomes shallow, the affected side lags behind. It should be emphasized that with pleuropneumonia and pleurisy in the first hours and days of illness, pain is often the main subjective symptom, against which other manifestations of the disease are less significant for the patient. Critical role for staging correct diagnosis percussion and auscultation of the lungs play, allowing to identify objective signs of pulmonary pathology. The pain associated with irritation of the pleura is well relieved by non-narcotic analgesics.

At spontaneous pneumothorax the pain is usually prolonged, most pronounced at the time of development of pneumothorax, aggravated by breathing, then shortness of breath comes to the fore. Pain is accompanied by pallor skin, weakness, cold sweat, cyanosis, tachycardia, decreased blood pressure. Characterized by lagging half of the chest during breathing and tympanitis detected by percussion on the side of the lesion, breathing over these departments is sharply weakened or not audible. On the ECG, you can see a slight increase in the amplitude of the K wave in the chest leads or a sharp change in the electrical axis of the heart. The appearance in a patient with pneumonia of the sharpest pain in the chest, combined with severe shortness of breath, intoxication, sometimes collapse, is characteristic of the breakthrough of a lung abscess into the pleural cavity and the development of pyopneumothorax. In such patients, pneumonia from the very beginning may have the character of abscessing, or an abscess develops later.

Acute chest pain caused by diseases of the esophagus (ulcerative esophagitis, damage to the mucous membrane by a foreign body, cancer of the esophagus) is characterized by localization along the esophagus, connection with the act of swallowing, the appearance or sharp increase in pain when food passes through the esophagus, good effect antispasmodics and local anesthetics. Antispasmodic action nitroglycerin determines its effectiveness in pain syndrome due to spasm of the esophagus, which may complicate differential diagnosis with an angina attack.

Prolonged pain in the lower third of the sternum at the xiphoid process, often combined with pain in the epigastric region and usually occurring immediately after eating, may be due to a hernia esophageal opening diaphragm with the exit of the cardial part of the stomach into the chest cavity. For these cases, in addition, the appearance of pain in the position of the patient sitting or lying down and its reduction or complete disappearance in an upright position are characteristic. Usually, when questioning, signs of reflux esophagitis (heartburn, increased salivation) and good exercise tolerance are revealed.

Antispasmodics and antacids are effective (for example, Maalox, Rennie, etc.); Nitroglycerin in this situation can also stop the pain syndrome. Often, pain caused by diseases of the esophagus or a hernia of the esophageal opening of the diaphragm, in terms of localization, and sometimes in nature, resembles pain in angina pectoris. The difficulty of differential diagnosis is exacerbated by the effectiveness of nitrates and possible electrocardiographic changes (negative T waves in the chest leads, which, however, often disappear when ECG is recorded in a standing position). It should also be borne in mind that with these diseases, true angina attacks of a reflex nature are often observed.

Acute prolonged chest pain associated with the movement of the body (tilts and turns) is the main symptom of thoracic sciatica. For pain in sciatica, in addition, the absence of paroxysmal, increased with hand movements, tilting the head to the side, deep inspiration and localization along the nerve plexuses and intercostal nerves are characteristic; in the same place, as well as on palpation of the cervicothoracic spine, severe pain is usually determined. When determining local pain, it should be clarified with the patient whether it is the pain that forced him to seek medical attention. medical care, or is it another, independent pain. Reception of nitroglycerin, validol almost never reduces the intensity of pain, which often weakens after the use of analgin and mustard plasters.

With a chest injury, diagnostic difficulties may arise in cases where the pain does not appear immediately, but after a few days. However, indications in the anamnesis of an injury, a clear localization of pain under the ribs, its intensification during palpation of the ribs, movement, coughing, deep inspiration, i.e. in situations where there is some displacement of the ribs, facilitate the recognition of the origin of pain. Sometimes there is a discrepancy between the intensity of pain and the nature (strength) of the injury. In such cases, it should be borne in mind that with the slightest injury, hidden pathology may be revealed. bone tissue ribs, for example, with their metastatic lesion, multiple myeloma. Radiography of the ribs, spine, flat bones of the skull, pelvis helps to recognize the nature of bone pathology.

Acute pain along the intercostal nerves is characteristic of herpes zoster. Often the pain is so strong that it deprives the patient of sleep, is not relieved by repeated intake of analgin, and somewhat decreases only after the injection of narcotic analgesics. Pain occurs before the typical skin rash of shingles appears, making diagnosis difficult.

Table 1

Differential diagnosis of non-coronary cardialgia and angina pectoris

Clinical

Non-coronary

cardialgia

Variant

angina pectoris

angina pectoris

voltage

occurrence

attack

Intensity and nature of pain

The rate of development of a pain attack

With emotional stress or for no apparent reason

Often dull, aching, stabbing, deaf, aggravated by breathing

The pain is monotonous or slowly increases and slowly stops, the duration of the increase and decrease in pain is not the same

The periods of increase and decrease in pain are the same

The duration of the increase in pain exceeds the duration of its weakening, the attack often ends abruptly

Localization

Irradiation

The length of the pain period

cyclicity

Patient behavior during an attack

physical

loads

Diffuse in the left half of the chest, sometimes in the region of the apex of the heart or left nipple

More often missing

Several minutes to several hours

Available, corresponds to daily fluctuations in the mood of the day

psychomotor

excitation

Stops an attack

Behind the sternum or in the precordial region

In the left shoulder, shoulder blade, neck, lower jaw

Usually a few minutes

Missing

Yes, attack occurs more often during sleep or in the morning

Inhibited

Immobility

Causes an attack in some patients

Pain in the region of the heart of a aching, stabbing character is a frequent complaint of patients with neurosis. Differential diagnosis of such cardialgia and angina pectoris is given in Table. 1. Pain in neuroses almost never have a clear paroxysmal, are not associated with physical activity located at the apex of the heart. The pains appear gradually, last for hours, sometimes days, while maintaining a monotonous character and not significantly affecting general condition sick. Often attention is drawn to the unusual variety of complaints of the patient, the excessive colorfulness of his description of pain. Careful questioning reveals no relationship between the onset or increase of pain and physical activity (however, sometimes pain occurs after physical activity or against the background of emotional stress). Moreover, often physical labor, sports activities lead to pain relief. Pain in the region of the heart does not prevent patients with neurosis from falling asleep - a situation that is impossible in the event of an attack of angina pectoris. The effect of nitrates in these patients in most cases is indistinct, sometimes patients note a decrease in pain 20-30 minutes after taking nitroglycerin. The attack can be stopped by taking validol and sedatives. course treatment beta-blockers and psychotropic drugs usually leads to an improvement in the well-being of patients and the cessation of pain attacks.

With dyshormonal myocardial dystrophy (climacteric cardiopathy), patients describe cardialgia as a feeling of heaviness, tightness, cutting, burning, piercing, piercing pain to the left of the sternum, in the region of the apex of the heart or left nipple with possible irradiation to the left arm, shoulder blade. The pain can be short-term, but more often lasts for hours, days, months, periodically intensifying (especially at night, as well as in spring and autumn), is not associated with physical activity, does not decrease at rest, and is not clearly stopped by nitrates. Dyshormonal myocardial dystrophy can be suspected in a patient of the appropriate age (45-55 years) with a combination of cardialgia with hot flashes (a sudden feeling of heat in the upper half of the body, skin of the face and neck, followed by hyperemia and sweating), vegetative crises, often mental disorders (usually depression). Characteristic ECG changes, often mistaken for a sign of myocardial ischemia, are a negative T wave in leads U: -U 4. Medical therapy includes beta-blockers, if necessary - psychotropic drugs (neuroleptics, antidepressants).

With toxic myocardial dystrophy (alcoholic cardiomyopathy), pulling, aching, stabbing pain is localized in the region of the nipple, the apex of the heart, sometimes it captures the entire precordial region; not associated with physical activity, appears gradually, gradually; lasts for hours and days, not stopped by nitroglycerin. Pain is often combined with a feeling of lack of air (dissatisfaction with inspiration), palpitations, cold extremities. On the early stages diseases, the correct diagnosis is helped by the connection of the occurrence of cardialgia with alcoholic kurtosis, revealed upon careful questioning - the pain occurs the next day or a few days after alcohol abuse, at the patient's exit from binge. characteristic appearance the patient - hyperemia of the face, severe tremor of the hands. For more late stages diseases at objective research there are signs of an increase in the left and right parts of the heart, rhythm disturbances and symptoms of heart failure. On the ECG - an overload of the right and left parts of the heart, characteristic changes in the terminal part of the ventricular complex in the form of depression of the 5T segment, the appearance of a pathologically high, two-phase, isoelectric, negative T wave. Rapid - within 5-7 days - restoration of a normal ECG pattern with the absence of a characteristic clinic of angina pectoris allows, as a rule, to exclude ischemic disease hearts, so for staging accurate diagnosis often require hospitalization and observation in conditions cardiology department. Additional research methods - daily ECG-^T-monitoring, bicycle ergometry, echocardiography - may also be required for differential diagnosis.

A symptom of many pathologies is pain in the middle of the chest. The condition causes discomfort in a person, fear about the cause pain syndrome. It can be of different intensity, but with any characteristics, a visit to the therapist is mandatory. This will prevent possible consequences can save a patient's life.

Organs located in the middle of the chest

The central part of the chest is called the mediastinum. It is located between the lungs and consists of:

• bronchi;
• lymph nodes;
• hearts;
• large vessels(vena cava, aorta);
• trachea;
• esophagus
• muscles, ligaments, nerves.

Pain in the chest in the middle can cause pathologies located near the mediastinum organs (diaphragm, abdomen, chest wall, liver). This condition is called referred pain syndrome.

How does chest pain manifest?

The classification of chest pain in the middle is carried out according to the main features:

• localization - behind the sternum, in the central part, under the ribs, with irradiation from organs located outside the mediastinum;
• intensity - weak, moderate, strong, unbearable;
• duration - constant, periodic, paroxysmal;
• the nature of sensations is dull, pressing, cutting, sharp, stabbing, aching.

Causes of pain in the middle of the chest

The etiology of pain in the thoracic region is due to a violation normal operation systems, compression of nerve endings. Symptoms suggest the cause of the discomfort:

• when coughing - laryngotracheitis, pneumonia;
• inhalation - bronchitis, pericarditis, rib injury, stomach ulcer;
• after eating - reflux, esophagitis, peptic ulcer;
• when moving - myocardial infarction, intercostal neuralgia;
• strong pain - cardiac neurosis, aortic dissection of the heart;
• when pressed, pressing - muscle strain;
• aching pain - oncology of the respiratory system, atrial fibrillation.

Diseases of the digestive system

Disorders of the gastrointestinal tract are characterized by symptomatic soreness of the middle of the chest. Discomfort occurs due to spasm of the stomach, esophagus, gallbladder. aching, Blunt pain aggravated by pressure on the epigastric region, complemented by irradiating pain in the back. Acute pancreatitis causes burning pain in the sternum.

Unpleasant sensations appear both before and after meals. Soreness weakens after the use of antispasmodics. Possible diseases and additional features:

• inflammation of the mucous membrane of the esophagus (esophagitis) - a lump in the throat, heartburn, increased discomfort after eating, difficulty swallowing, belching;
• peptic ulcer - soreness is similar to heart disease, appears 1-2 hours after eating and disappears if you eat something;
• subdiaphragmatic abscess - increased discomfort when coughing, movement, high temperature;
• gastroesophageal reflux - burning pain in the central region of the sternum, nausea.

Cardiovascular pathologies

This group of diseases is the most common cause of pain in the sternum in the middle. Characteristics:

• myocardial infarction - stabbing in the chest in the middle, occurs panic fear, soreness is observed on the left and spreads throughout the chest;
• angina pectoris - there is a feeling of fullness of the chest, reflected pain in the left arm or under the shoulder blade, the pain does not go away at rest, lasts 3-15 minutes;
• thromboembolism - discomfort on inspiration due to a blood clot in the pulmonary artery.

Relationship between chest pain and spine

If it presses in the middle of the sternum, this is a symptom of problems with the spine:

• Osteochondrosis - pain depends on the position of the body (paroxysmal or constant). It decreases in lying position, aggravated by walking. Clinical course characteristic of radiculopathy of the thoracic region (a complication of osteochondrosis).
• Intercostal neuralgia - in the spine it can compress the nerve endings, which causes painful, cutting colic. Neuralgia is characterized by throbbing, intense pain in the middle of the sternum, the lack of effect after taking heart medications.

Heaviness behind the sternum as a sign of respiratory disease

Pain behind the sternum in the middle, accompanied by a continuous cough, is caused by a violation of the functionality of the respiratory organs (pleurisy, tracheitis, lung abscess, pneumonia). The pain syndrome is aggravated by sneezing and coughing. The condition is characterized additional features:

• cyanosis of the skin;
• labored breathing;
• fever;
• arrhythmia.

Why does the chest hurt in the middle in men

One of the causes of pain in the middle of the sternum in men is increased physical activity. Pain is due to:

• ischemia, heart failure - the stabbing nature of increasing pain;
• scoliosis - the pathology of bones and muscles is manifested by constant, aching pain in the central part of the chest;
• diaphragmatic hernia - severe pain in the supine and sitting position, passing when standing up;
• arterial hypertension- acute pain in the middle of the chest, accompanied by shortness of breath, dizziness, fainting;
• joint diseases - increased pain at night, after intense physical exertion;
• injuries - cutting pain (rib fracture), dull (bruised when falling), growing (hit);
• smoking - exacerbates existing health problems, provokes soreness when coughing.

Causes of pain in the center of the sternum in women

Median chest pain syndrome is caused by emotional experiences, frequent stress in women. Common causes:

• mastopathy - soreness of the mammary gland with irradiation to the sternum due to compression of nerve receptors;
• thyroid diseases (nodular goiter, hyperthyroidism) - intermittent aching pain, accompanied by pressure drops, a lump in the throat;
• excess weight – overload on the spine causes pain when walking, physical exertion;
• wearing uncomfortable underwear - a tight bra compresses the nerve endings, which causes pain in the middle of the chest area;
• bad habits(smoking) - cause the development chronic bronchitis;
• mastalgia - pain, swelling of the glands appear 3-5 days before the onset menstrual cycle;
• breast cancer - manifested in the later stages by a burning sensation around the mammary gland, reflected by pain in the middle of the sternum.

Retrosternal pain, pain in the sternum: causes, symptoms and what can be associated with, help, treatment

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,
• - occurrence of thromboembolism 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 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 during 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- shoemaker'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 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 - almost sure sign 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 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 mild discomfort under the sternum due to increased stress on the heart during high figures HELL.

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 up sputum. Pink colour and foamy character, 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 along 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 pain in the sternum when inhaling, most likely he has problems with the spine, he took wrong position body (“pinched”), or it could be pierced somewhere.

At sternum injuries sensations are in the nature of acute pain, poorly relieved by taking painkillers. After an injury, an emergency x-ray is required chest cavity(if a fracture is suspected), since fractures of the ribs are also possible, and this is fraught with injury to the lung. Chest deformities are characterized by prolonged pain varying degrees 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 someone it is more pronounced, for someone it is comparable only with minor discomfort. Acute pain caused acute pathology- heart attack paroxysmal tachycardia, dissecting aneurysm, rupture of the esophagus, fracture of the sternum, etc. As a rule, at extremely dangerous states With high risk 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 24-hour branch of the nearest multidisciplinary hospital. 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, 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. At high blood pressure should be allowed to dissolve or drink antihypertensive drug(25-50 mg of captopril, anaprilin tablet). If not at hand similar drugs, 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, he should be given comfortable position and immediately call an ambulance. If a person is not in serious condition, you can give him an anesthetic pill 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 by 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?

Chest pain should be treated according to the doctor's prescriptions after 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.

Prescribed for angina pectoris complex treatment- hypotensive ( ACE inhibitors), rhythm-reducing (beta-blockers), antiplatelet agents (blood thinners based on aspirin) 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 the patient for a long time suffers pain attacks behind the sternum, and as a result may end up in a hospital bed with a heart attack or other severe pathology. If you do not pay attention to bouts of pressure or burning pains behind the sternum, you can get dangerous complication angina in the form massive heart attack myocardium, which not only subsequently leads 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 - starting from the chronization of the process (with pathology of the stomach or lungs), and ending with not diagnosed in time malignant formations in the organs of the mediastinum.

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