What are the common causes of chest and sternum pain. How can you differentiate between cardiac and non-cardiac chest pain. What treatments are available for various types of chest discomfort. When should you seek immediate medical attention for chest pain.

The Complex Nature of Chest and Sternum Pain

Chest and sternum pain can be alarming symptoms that often lead individuals to worry about potential heart problems. However, the reality is that these discomforts can stem from a variety of sources, both cardiac and non-cardiac in nature. Understanding the different causes and characteristics of chest and sternum pain is crucial for proper diagnosis and treatment.

Distinguishing Between Cardiac and Non-Cardiac Chest Pain

One of the most critical aspects of evaluating chest pain is determining whether it originates from the heart or other structures in the chest. Cardiac chest pain typically presents as a squeezing or pressure sensation that may radiate to the arms, jaw, or back. It often worsens with physical exertion and improves with rest.

Non-cardiac chest pain, on the other hand, can have various presentations and may be associated with other symptoms. For example:

• Gastroesophageal reflux disease (GERD) can cause a burning sensation behind the breastbone
• Esophageal spasms may result in severe squeezing pain
• Musculoskeletal issues like costochondritis can cause sharp, localized pain in the chest wall

Gastroesophageal Reflux Disease (GERD) and Chest Discomfort

GERD is a common cause of non-cardiac chest pain that can often mimic the symptoms of heart disease. This condition occurs when stomach acid flows back into the esophagus, causing irritation and inflammation. The resulting pain is typically described as a burning sensation or tightness under the breastbone, which may be mistaken for cardiac-related discomfort.

Key Characteristics of GERD-Related Chest Pain

• Often occurs after meals or when lying down
• May be accompanied by a sour taste in the mouth or regurgitation
• Usually improves with antacids or acid-blocking medications
• Can be exacerbated by certain foods, such as spicy or fatty dishes

Is GERD-related chest pain dangerous? While GERD itself is not life-threatening, chronic acid reflux can lead to complications such as esophagitis, Barrett’s esophagus, or even esophageal cancer if left untreated. Therefore, it’s essential to seek medical attention if you experience persistent symptoms.

Esophageal Disorders and Their Impact on Chest Comfort

The esophagus, the muscular tube that connects the throat to the stomach, can be the source of various chest discomforts. Esophageal spasms and other muscle disorders can cause severe pain that may be mistaken for cardiac issues.

Common Esophageal Disorders Causing Chest Pain

1. Esophageal spasms: Irregular contractions of the esophageal muscles
2. Achalasia: Inability of the lower esophageal sphincter to relax properly
3. Eosinophilic esophagitis: Chronic immune system disease causing inflammation

How can you differentiate esophageal pain from cardiac pain? Esophageal-related chest discomfort is often associated with difficulty swallowing (dysphagia) and may be triggered by eating or drinking. It may also be accompanied by regurgitation or a feeling of food getting stuck in the throat.

Musculoskeletal Causes of Chest and Sternum Pain

Not all chest pain originates from internal organs. The chest wall itself, including the muscles, bones, and cartilage, can be a source of discomfort. Conditions affecting these structures can cause localized pain that may be sharp or dull in nature.

Costochondritis: A Common Cause of Chest Wall Pain

Costochondritis is an inflammation of the cartilage connecting the ribs to the breastbone (sternum). This condition can cause sharp, localized pain in the chest that may be mistaken for a heart attack. However, costochondritis pain is typically reproducible by pressing on the affected area, which is not characteristic of cardiac pain.

What are the best exercises for managing costochondritis? While rest is important during acute flare-ups, gentle stretching and strengthening exercises can help alleviate symptoms and prevent recurrence. Some beneficial exercises include:

• Door stretch: Gently stretching the chest muscles
• Foam roller exercises: Promoting flexibility in the thoracic spine
• Deep breathing exercises: Improving chest expansion and reducing tension
• Posture correction exercises: Addressing underlying muscle imbalances
• Gentle yoga poses: Enhancing overall flexibility and reducing stress

When to Seek Immediate Medical Attention for Chest Pain

While many causes of chest pain are benign, it’s crucial to recognize when immediate medical attention is necessary. Certain symptoms and characteristics of chest pain warrant urgent evaluation to rule out life-threatening conditions such as heart attacks or pulmonary embolisms.

Red Flags for Chest Pain

• Sudden, severe chest pain accompanied by shortness of breath
• Chest pain radiating to the arms, jaw, or back
• Pain associated with lightheadedness, sweating, or nausea
• Chest discomfort that worsens with physical exertion
• Pain accompanied by a sense of impending doom or anxiety

Should you go to the emergency room for all instances of chest pain? While it’s better to err on the side of caution, not all chest pain requires immediate emergency care. However, if you experience any of the red flag symptoms mentioned above or if you’re unsure about the nature of your chest pain, it’s best to seek prompt medical evaluation.

Diagnostic Approaches for Chest and Sternum Pain

Given the diverse range of potential causes for chest and sternum pain, a systematic diagnostic approach is essential. Healthcare providers employ various tools and techniques to determine the underlying cause of chest discomfort and develop an appropriate treatment plan.

Common Diagnostic Tests for Chest Pain

1. Electrocardiogram (ECG): Assesses the heart’s electrical activity
2. Chest X-ray: Evaluates the lungs, heart, and chest wall structures
3. Blood tests: Checks for markers of heart damage or inflammation
4. Stress tests: Examines the heart’s function during physical exertion
5. Echocardiogram: Provides detailed images of the heart’s structure and function
6. Endoscopy: Examines the esophagus and stomach for signs of GERD or other disorders

How do doctors determine which tests to perform? The choice of diagnostic tests depends on the patient’s symptoms, medical history, and physical examination findings. In many cases, a combination of tests may be necessary to reach a definitive diagnosis.

Treatment Options for Various Causes of Chest and Sternum Pain

The treatment of chest and sternum pain varies widely depending on the underlying cause. While some conditions may require immediate intervention, others can be managed with conservative measures or medications.

Treatment Approaches for Common Causes of Chest Pain

• GERD: Lifestyle modifications, antacids, proton pump inhibitors
• Esophageal spasms: Muscle relaxants, calcium channel blockers
• Costochondritis: Rest, anti-inflammatory medications, physical therapy
• Cardiac conditions: Medications, lifestyle changes, possible interventional procedures

Is surgery ever necessary for non-cardiac chest pain? In some cases, surgical intervention may be required for certain esophageal disorders or severe cases of GERD that don’t respond to conservative treatments. However, many causes of non-cardiac chest pain can be effectively managed with non-invasive approaches.

Preventing Recurrent Chest and Sternum Pain

While not all causes of chest and sternum pain are preventable, there are steps individuals can take to reduce their risk of experiencing recurrent discomfort. Implementing lifestyle modifications and addressing underlying risk factors can significantly improve overall chest health.

Strategies for Minimizing Chest Pain Risk

1. Maintain a healthy diet and weight to reduce the risk of GERD and heart disease
2. Practice stress-reduction techniques such as meditation or yoga
3. Avoid trigger foods that may exacerbate reflux or esophageal spasms
4. Engage in regular physical activity to improve cardiovascular health
5. Quit smoking and limit alcohol consumption
6. Practice good posture to reduce musculoskeletal strain on the chest wall

Can lifestyle changes alone prevent all types of chest pain? While lifestyle modifications can significantly reduce the risk of many common causes of chest pain, they may not prevent all instances, especially those related to underlying medical conditions. Regular check-ups with a healthcare provider are essential for comprehensive preventive care.

The Psychological Impact of Chronic Chest Pain

Experiencing recurrent or chronic chest pain can have a significant impact on an individual’s mental health and quality of life. The fear and anxiety associated with potential cardiac issues can lead to heightened stress levels and even panic attacks, which may further exacerbate chest discomfort.

Addressing the Emotional Aspects of Chest Pain

• Cognitive-behavioral therapy to manage anxiety related to chest pain
• Relaxation techniques to reduce muscle tension and stress
• Support groups for individuals dealing with chronic pain conditions
• Education about the benign nature of many chest pain causes
• Mindfulness practices to improve overall well-being

How does chronic chest pain affect daily life? Chronic chest pain can lead to decreased physical activity, social isolation, and reduced work productivity. Addressing both the physical and emotional aspects of chest pain is crucial for comprehensive management and improved quality of life.

In conclusion, chest and sternum pain can arise from a wide range of causes, ranging from benign musculoskeletal issues to life-threatening cardiac conditions. Understanding the various presentations and characteristics of different types of chest pain is essential for proper diagnosis and treatment. While immediate medical attention is necessary for certain red flag symptoms, many causes of chest discomfort can be effectively managed with appropriate interventions and lifestyle modifications. By adopting a holistic approach that addresses both the physical and psychological aspects of chest pain, individuals can work towards improved chest health and overall well-being.

Chest or Back Pain – Digestive Disorders

By

Jonathan Gotfried

, MD, Lewis Katz School of Medicine at Temple University

Reviewed/Revised Jan 2022 | Modified Sep 2022

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Pain in the middle of the chest or upper back can result from disorders of the esophagus Overview of the Esophagus The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. Food does not just fall through the esophagus into the stomach. The walls of the esophagus propel food to… read more or from disorders of the heart or aorta ( see Chest Pain Chest Pain Chest pain is a very common complaint. Pain may be sharp or dull, although some people with a chest disorder describe their sensation as discomfort, tightness, pressure, gas, burning, or aching… read more ). Symptoms may be similar. Gastroesophageal reflux disease Gastroesophageal Reflux Disease (GERD) In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom… read more (GERD), caused by stomach acid splashing up into the esophagus, can cause a burning sensation or a tightness under the breastbone (sternum), which may resemble the pain of heart disease. Spasms of the esophagus Esophageal Spasm Esophageal spasm is a disorder of the rhythmic waves of muscular contractions (peristalsis) of the esophagus. The cause of this disorder is not known. Symptoms include chest pain and difficulty… read more and other esophageal muscle disorders can cause a severe squeezing sensation also resembling the pain of heart disease.

Some symptoms are more suggestive of esophageal disorders. Severe pain that occurs suddenly after vomiting or after a procedure involving the esophagus suggests a rupture of the esophagus, although this is rare. Heartburn is a burning pain caused by GERD that rises into the chest and sometimes the neck and throat, usually after meals or when lying down. Heartburn is among the most common digestive symptoms in the United States. Difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become… read more and discomfort that occurs only with swallowing also suggest an esophageal disorder. Chest discomfort that occurs routinely with exertion and goes away after a brief rest suggests a heart problem. However, because symptoms frequently overlap, and because heart disease is particularly dangerous, doctors often do a chest x-ray X-Rays of the Chest Anyone thought to have a heart disorder has chest x-rays taken from the front and the side. Typically, the person is standing upright, but chest x-rays can be done with people lying in bed if. .. read more , an electrocardiogram Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)… read more (ECG), and sometimes a cardiac stress test Stress Testing Stressing the heart (by exercise or by use of stimulant drugs to make the heart beat faster and more forcibly) can help identify coronary artery disease. In coronary artery disease, blood flow… read more before doing tests to look for esophageal disease.

• Depends on cause

Treatment of chest or back pain is usually given only when the cause is known, but people with very typical symptoms of GERD may be given a trial of acid-blocking drugs.

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Top 5 Exercises for Costochondritis

Costochondritis is a condition that affects the chest wall and is pathologically not-serious, despite being reasonably common. It results from inflammation of the cartilage connecting the ribs to the breastbone (sternum). Typically, it causes a sharp, localised chest pain, typically at the costosternal joint (where the ribs attach to the breastbone).

The condition is frequently misdiagnosed as a heart attack or heart problem, because the pain can be intense and spread to the neck and shoulder. However, it is not life-threatening, and the pain subsides in a few days or weeks on average. However, caution should always be first, and if you get pain that you think may be costochondritis, you must go to see your GP to rule out any heart-related issue.

Costochondritis is commonly caused by repetitive activities such as heavy lifting, sports participation, and overstretching. There are a lot of people who also believe that stress is a key factor.

The most common symptom of costochondritis is sharp, localised chest pain. It is sometimes worsened by deep breathing or coughing, and is sometimes felt in the back or abdomen. Other possible symptoms include chest tenderness, difficulty breathing, and fatigue.

Costochondritis is typically diagnosed through a physical examination, without the need for additional testing. However, if the chest pain is severe or persistent, the doctor may order an X-ray to rule out other potential causes.

Typically, costochondritis is treated with rest, anti-inflammatory drugs, and heat or cold therapy. It is essential to avoid painful activities and avoid lifting heavy objects. In some cases, physiotherapy may also be beneficial to reduce pain, stretch the chest, and mobilise the ribs. At Surrey Physio, we perform manual therapy and electrotherapy to help reduce the pain, and it does seem to work well.

If the pain persists or is severe, the doctor may prescribe stronger painkillers, but again it must be mentioned that if symptoms become more severe with symptoms of strong chest pains, palpitations, sweating or fever, or severe shortness of breath, you should go to A&E and seek investigation.

In the majority of cases, costochondritis is a temporary condition, and the pain subsides within a few days or weeks. However, if the pain is severe or persists, it is crucial to see a doctor immediately.

Let’s look at our top five exercises for costochondritis:

1. Pec Stretch: Place your arms at 90 degrees, with your palms flat on the wall, and face towards a corner. Push your body into the corner keeping your hands in the same position. You will feel a stretch across your upper arms, front shoulders and chest.

2. Straight Arm Pec Stretch: Hook your fingers around a door frame or corner of a wall, and lean forwards creating a stretch across your upper arm, front shoulder and slightly into your chest. This exercise stretches the pectoral muscle.

3. Ice the Chest: Place an ice pack or frozen peas over your chest. Wrap it in a thin towel so its not too cold. Hold it here for the required time as recommended by your therapist.

4. Diaphragmatic Deep Breathing: Place one hand on your stomach, and the other on your chest. Take a deep breath in, and push your belly (and your hand) outwards. Try and keep the movement of your chest to a minimum, so you concentrate on the deep breathing. Relax your neck and shoulders as you breathe. This will help you to use your diaphragm, the main inspiratory muscle.

5. Mid-Scalene Sternocleidomastoid Stretch: Hook your fingers above your collar bone, and gently side-bend your neck to the opposite side. Hold the stretch. You should feel the stretch at the front/side of your neck. This exercise will help improve mobility to your neck.

If you are a therapist and like the exercises and information in this document, please go to www.rehabmypatient.com and sign up to this amazing exercise prescription software. If you are a patient and need some advice, treatment or a consultation, please go to www. surreyphysio.co.uk/bookonline. We provide virtual and face-to-face appointments with our expert team.

If you want to buy any equipment seen on these articles, please go to www.rehabme.com/shop.

For more advice on carpal tunnel syndrome, check out this page: https://www.rehabmypatient.com/thoracic-spine/costochondritis

Chronic chest pain

Chronic chest pain | Center Dikul

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2023-06-23

Chronic chest pain

Chronic chest pain develops gradually after one or more acute periods. The disease is often associated with incorrect posture (stooped back and head tilted forward) and manifests itself in the form of pain between the shoulder blades, sometimes along with pain in the back of the head and shoulder girdle. Pain is aggravated by deep breathing and bending forward and to the side. In persons suffering from asthma or other lung diseases, the very shape of the chest predisposes to chronic chest pain.

Manifestations.

In stooped thoracic vertebrae, ribs, ligaments, muscles and nerve fibers for a long time are subjected to additional stress, and it is the cause of the disease. Professional drivers and office workers are more likely than others to experience chronic chest pain. The disease is characterized by a long development with asymptomatic periods and increasing stoop.