Why does my chest hurt? 26 Causes of Chest Pain & Tightness

Chest pain is not something to ignore. But you should know that it has many possible causes. In many cases, it’s related to the heart. But chest pain may also be caused by problems in your lungs, esophagus, muscles, ribs, or nerves, for example. Some of these conditions are serious and life threatening. Others are not. If you have unexplained chest pain, the only way to confirm its cause is to have a doctor evaluate you.

You may feel chest pain anywhere from your neck to your upper abdomen. Depending on its cause, chest pain may be:

• Sharp
• Dull
• Burning
• Aching
• Stabbing
• A tight, squeezing, or crushing sensation

Here are some of the more common causes of chest pain.

Heart Problems

These heart problems are common causes:

Coronary artery disease, or CAD. This is a blockage in the heart’s blood vessels that reduces blood flow and oxygen to the heart muscle. This can cause pain known as angina. It’s a symptom of heart disease but typically does not cause permanent damage to the heart. It is, though, a sign that you are at risk for a heart attack in the future. The chest pain may spread to your arm, shoulder, jaw, or back. It may feel like a pressure or squeezing sensation. Angina can be triggered by exercise, excitement, or emotional distress and is relieved by rest.

Myocardial infarction (heart attack). This reduction in blood flow through heart blood vessels causes the death of heart muscle cells. Though similar to angina chest pain, a heart attack is usually a more severe, crushing pain usually in the center or left side of the chest and is not relieved by rest. Sweating, nausea, shortness of breath, or severe weakness may accompany the pain.

Myocarditis. In addition to chest pain, this heart muscle inflammation may cause fever, fatigue, fast heart beat, and trouble breathing. Although no blockage exists, myocarditis symptoms can resemble those of a heart attack.

Pericarditis. This is an inflammation or infection of the sac around the heart. It can cause pain similar to that caused by angina. But it often causes a sharp, steady pain along the upper neck and shoulder muscle. Sometimes it gets worse when you breathe, swallow food, or lie on your back.

Hypertrophic cardiomyopathy. This genetic disease causes the heart muscle to grow abnormally thick. Sometimes this leads to problems with blood flow out of the heart. Chest pain and shortness of breath often occur with exercise. Over time, heart failure may occur when the heart muscle becomes very thickened. This makes the heart work harder to pump blood. Along with chest pain, this type of cardiomyopathy may cause dizziness, lightheadedness, fainting, and other symptoms.

Mitral valve prolapse. Mitral valve prolapse is a condition in which a valve in the heart fails to close properly. A variety of symptoms have been associated with mitral valve prolapse, including chest pain, palpitations, and dizziness, although it can also have no symptoms, especially if the prolapse is mild.

Coronary artery dissection. Many things can cause this rare but deadly condition, which results when a tear develops in the coronary artery. It may cause a sudden, severe pain with a tearing or ripping sensation that goes up into the neck, back, or abdomen.

Lung Problems

These are common causes of chest pain:

Pleuritis. Also known as pleurisy, this is an inflammation or irritation of the lining of the lungs and chest. You likely feel a sharp pain when you breathe, cough, or sneeze. The most common causes of pleuritic chest pain are bacterial or viral infections, pulmonary embolism, and pneumothorax. Other less common causes include rheumatoid arthritis, lupus, and cancer.

Pneumonia or lung abscess.  These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache. Pneumonia often comes on suddenly, causing fever, chills, cough, and pus coughed up from the respiratory tract.

Pulmonary embolism. When a blood clot travels through the bloodstream and lodges in the lungs, this can cause acute pleuritis, trouble breathing, and a rapid heartbeat. It may also cause fever and shock. Pulmonary embolism is more likely following deep vein thrombosis or after being immobile for several days following surgery or as a complication of cancer.

Pneumothorax. Often caused by an injury to the chest, pneumothorax happens when a part of the lung collapses, releasing air into the chest cavity. This can also cause pain that gets worse when you breathe as well as other symptoms, such as low blood pressure.

Pulmonary hypertension. With chest pain resembling that of angina, this abnormally high blood pressure in the lung arteries makes the right side of the heart work too hard.

Asthma. Causing shortness of breath, wheezing, coughing, and sometimes chest pain, asthma is an inflammatory disorder of the airways.

COPD. This includes one or more of three disease: Emphysema, chronic bronchitis, and chronic obstructive asthma. The disease blocks airflow by shrinking and damaging both the airways that bring gases and air to and from your lungs and the tiny air sacs (alveoli) that transfer oxygen to your bloodstream and remove carbon dioxide. Smoking is the most common cause.

Gastrointestinal Problems

Gastrointestinal problems can also cause chest pain and include:

Gastroesophageal reflux disease (GERD). Also known as acid reflux, GERD occurs when stomach contents move back into the throat. This may cause a sour taste in the mouth and a burning sensation in the chest or throat, known as heartburn. Things that may trigger acid reflux include obesity, smoking, pregnancy, and spicy or fatty foods. Heart pain and heartburn from acid reflux feel similar partly because the heart and esophagus are located close to each other and share a nerve network.

Esophageal contraction disorders. Uncoordinated muscle contractions (spasms) and high-pressure contractions (nutcracker esophagus) are problems in the esophagus that can cause chest pain.

Esophageal hypersensitivity. This occurs when the esophagus becomes very painful at the smallest change in pressure or exposure to acid. The cause of this sensitivity is unknown.

Esophageal rupture or perforation. A sudden, severe chest pain following vomiting or a procedure involving the esophagus may be the sign of a rupture in the esophagus.

Peptic ulcers. A vague, recurring discomfort may be the result of these painful sores in the lining of the stomach or first part of the small intestine. More common in people who smoke, drink a lot of alcohol, or take painkillers such as aspirin or NSAIDs, the pain often gets better when you eat or take antacids.

Hiatal hernia. This common problem occurs when the top of the stomach pushes into the lower chest after eating. This often causes reflux symptoms, including heartburn or chest pain. The pain tends to get worse when you lie down.

Pancreatitis. You may have pancreatitis if you have pain in the lower chest that is often worse when you lie flat and better when you lean forward.

Gallbladder problems. After eating a fatty meal, do you have a sensation of fullness or pain in your right lower chest area or the right upper side of your abdomen? If so, your chest pain may due to a gallbladder problem.

Bone, Muscle, or Nerve Problems

Sometimes chest pain may result from overuse or an injury to the chest area from a fall or accident. Viruses can also cause pain in the chest area. Other causes of chest pain include:

Rib problems. Pain from a broken rib may worsen with deep breathing or coughing. It is often confined to one area and may feel sore when you press on it. The area where the ribs join the breastbone may also become inflamed.

Muscle strain. Even really hard coughing can injure or inflame the muscles and tendons between the ribs and cause chest pain. The pain tends to persist and it worsens with activity.

Shingles. Caused by the varicella zoster virus, shingles may prompt a sharp, band-like pain before a telltale rash appears several days later.

Other Potential Causes of Chest Pain

Another potential cause of chest pain is anxiety and panic attacks. Some associated symptoms can include dizziness, sensation of shortness of breath, palpitations, tingling sensations, and trembling.

When to See the Doctor for Chest Pain

When in doubt, call your doctor about any chest pain you have, especially if it comes on suddenly or is not relieved by anti-inflammatory medications or other self-care steps, such as changing your diet.

Call 911 if you have any of these symptoms along with chest pain:

• A sudden feeling of pressure, squeezing, tightness, or crushing under your breastbone
• Chest pain that spreads to your jaw, left arm, or back
• Sudden, sharp chest pain with shortness of breath, especially after a long period of inactivity
• Nausea, dizziness, rapid heart rate or rapid breathing, confusion, ashen color, or excessive sweating
• Very low blood pressure or very low heart rate

Call your doctor if you have any of these symptoms:

• Fever, chills, or coughing up yellow-green mucus
• Problems swallowing
• Severe chest pain that does not go away

Myocarditis: Causes, Symptoms, and Treatments

Myocarditis is inflammation of the heart muscle (myocardium). Exactly how many people are affected is hard to know because it often has no symptoms.

Many people who get myocarditis are otherwise healthy. Many things can lead to it. The best ways to prevent it are to treat infections quickly and take action to prevent them

Causes

Viral infection is the most common cause of myocarditis.

When you have one, your body produces cells to fight the virus. These cells release chemicals. If the disease-fighting cells enter your heart, some chemicals they release can inflame your heart muscle.

Some things that can cause myocarditis include:

Fungal and parasitic infections can also cause it.

Other causes include certain chemicals or allergic reactions to medications or toxins like:

An autoimmune disease that causes inflammation throughout your body, like lupus or rheumatoid arthritis, may also lead to myocarditis.

Signs and Symptoms

Myocarditis often has no symptoms. In fact, most people recover and never even know they had it.

If you do have symptoms, they may include:

• Shortness of breath
• Abnormal heartbeat, which causes fainting in rare cases
• Light-headedness
• A sharp or stabbing chest pain or pressure, which may spread to your neck and shoulders
• Fatigue
• Signs of infection, such as
• Painful joints
• Swollen joints, legs, or neck veins
• Small amounts of urine

If you have symptoms like these, your doctor will check you for an abnormal or rapid heartbeat, fluid in your lungs, or leg swelling.

Your doctor may order tests such as:

• Blood tests to check for infection, antibodies, or blood cell counts
• A chest X-ray so they can see your heart, lungs, and other chest structures
• An electrocardiogram (EKG) to record your heart’s electrical activity
• A heart ultrasound (echocardiogram) to make an image of your heart and its structures

In a few cases, doctors order cardiac MRI scans or heart muscle biopsies to help confirm it.

When to Call Your Doctor

Call your doctor right away if you have symptoms of myocarditis. If you have or had an infection, it’s more likely that you have the condition. Seek immediate medical care if your symptoms are severe. If chest pain, trouble breathing, or swelling have gotten worse since you were told you have myocarditis, call 911 or go to the hospital.

Treatment

If you have myocarditis, your doctor will treat its cause, if possible. They’ll also try to take the extra load off your heart, if needed, and take steps to prevent or control complications.

Usually, you’ll be prescribed medicines to help your heart work better. Examples include:

Your doctor will also probably suggest rest or reduced activity. They’ll probably also put you on a low-salt diet to keep fluid from building up.

You may be hospitalized if you have complications, like a blood clot or weakened heart. If abnormal heart rhythms are severe, you may need other medications, a pacemaker, or an implantable cardioverter-defibrillator (ICD).

Your outlook depends on:

• What causes your myocarditis
• Your overall health
• If you have complications

You may recover completely. Or you may have a chronic condition. Either way, follow-up care can help keep track of any ongoing problems. It’s also important to know that myocarditis can recur, although it’s not common.

Possible Complications

If left untreated, myocarditis may lead to symptoms of heart failure, where your heart has trouble pumping blood the way it should. In rare cases, it leads to other problems, such as:

Cardiomyopathy : The heart muscle weakens or the structure of the heart muscle changes.

Pericarditis : Inflammation of the sac covering the heart (called the pericardium).

Myocarditis and cardiomyopathy are leading causes of heart transplants in the U.S. In very rare cases, myocarditis can lead to sudden death.

Pulmonary Arterial Hypertension: Symptoms, Causes, and Treatments

What Is Pulmonary Arterial Hypertension?

Pulmonary hypertension is a life-threatening condition that gets worse over time, but treatments can help your symptoms so you can live better with the disease. It may take some planning, but plenty of people who have it find ways to do all the things they love, just as they did before they were diagnosed.

Having pulmonary arterial hypertension (PAH) means that you have high blood pressure in the arteries that go from your heart to your lungs . It’s different from having regular high blood pressure.

With PAH, the tiny arteries in your lungs become narrow or blocked. It’s harder for blood to flow through them, and that raises the blood pressure in your lungs. Your heart has to work harder to pump blood through those arteries, and after a while the heart muscle gets weak. Eventually, it can lead to heart failure.

Causes

Sometimes doctors can’t find a reason for high blood pressure in the lungs. In that case, the condition is called idiopathic pulmonary hypertension. Genes may play a role in why some people get it.

In other cases, there is another condition that’s causing the problem. Any of these illnesses can lead to high blood pressure in your lungs:

Symptoms

You may not notice any symptoms for a while. The main one is shortness of breath when you’re active. It usually starts slowly and gets worse as time goes on. You may notice that you can’t do some of the things you used to without getting winded.

Other symptoms include:

Getting a Diagnosis

If you have shortness of breath and see your doctor, they will ask you about your medical history. They may also ask you:

• Do you smoke?
• Does anyone in your family have heart or lung disease?
• When did your symptoms start?
• What makes your symptoms better or worse?
• Do your symptoms ever go away?

Your doctor may order tests, including:

Echocardiogram: This ultrasound picture of the beating heart can check blood pressure in the pulmonary arteries.

CT scan: This can show enlarged pulmonary arteries. A CT scan can also spot other problems in the lungs that could cause shortness of breath.

Ventilation-perfusion scan (V/Q scan): This test can help find blood clots that can cause high blood pressure in the lungs.

Electrocardiogram (EKG or ECG): An EKG traces the heart’s activity and can show whether the right side of the heart is under strain. That’s a warning sign of pulmonary hypertension.

Chest X-ray: An X-ray can show if your arteries or heart are enlarged. Chest X-rays can help find other lung or heart conditions that may be causing the problems.

Exercise testing: Your doctor may want you to run on a treadmill or ride a stationary bike while you are hooked up to a monitor, so they can see any changes in your oxygen levels, heart function, lung pressure, or other things.

Your doctor may also do blood tests to check for HIV and conditions like rheumatoid arthritis or lupus.

If these tests show that you might have pulmonary hypertension, your doctor will need to do a right heart catheterization to be sure. Here’s what happens during that test:

• The doctor places a catheter into a large vein, most often the jugular vein in your neck or femoral vein in your leg, and then threads it into the right side of your heart.
• A monitor records the pressures in the right side of the heart and in the pulmonary arteries.
• The doctor may also inject medicines into the catheter to see if the pulmonary arteries are stiff. This is called a vasoreactivity test.

Right heart catheterization is safe. The doctor will give you a sedative and use local anesthesia. You can usually go home the same day, although you will need someone to drive you home.

Questions for Your Doctor

You may want to write down a list of questions before your appointment, so you can make sure you ask your doctor everything you want to. It can also help to have a friend or family member with you to help you get the answers you want.

Some possible questions are:

• What’s the best treatment for me?
• How often should I see a doctor for my condition?
• Do I need to see a specialist?
• When should I go to the emergency room?
• Do I need to limit the salt or fluids in my diet?
• What kind of exercise can I do?
• Are there any activities I should stay away from?
• Should I get a pneumonia vaccine and a flu shot?

Treatment

Pulmonary hypertension varies from person to person, so your treatment plan will be specific to your needs. Ask your doctor what your options are and what to expect.

First, your doctor will treat the cause of your condition. For example, if emphysema is causing the problem, you’ll need to treat that to improve your pulmonary hypertension.

Most people also get treatment to improve their breathing, which makes it easier to be active and do daily tasks. Oxygen therapy, when you breathe pure oxygen through prongs that fit in your nose, will help if you’re short of breath and have low oxygen levels in your blood. It helps you live longer when you have pulmonary hypertension. If you are at risk for blood clots your doctor will recommend blood thinners. Other medicines improve how well your heart works and keep fluid from building up in your body.

If you have severe pulmonary hypertension, your doctor may prescribe medications called calcium channel blockers. These medicines lower blood pressure in the lungs and the rest of the body.

If calcium channel blockers aren’t enough, your doctor may refer you to a specialized treatment center. You may need more targeted therapies that can open up your narrowed blood vessels. They may be pills, medicines you breathe in, or drugs that are given through an IV. Options include:

• Pills: ambrisentan (Letairis), bocentan (Tracleer), macitentan (Opsumit), riociguat (Adempas), selexipag (Uptravi), sildenafil (Revatio), tadalafil (Adcirca), treprostinil (Orenitram)
• Inhalers: Iloprost tromethamine (Ventavis), treprostinil (Tyvaso)
• IV drugs: epoprostenol sodium (Flolan, Veletri), treprostinil

In more severe cases, or if medicines don’t help, your doctor may recommend a lung transplant or a procedure called atrial septostomy. A surgeon creates an opening between the right and left sides of the heart. This surgery can have serious side effects.

Taking Care of Yourself

One of the best things you can do for yourself is to stay active, even if you have shortness of breath. Regular exercise, like taking a walk, will help you breathe better and live better. Talk to your doctor first to find out what kind of exercise is best for you, and how much you should do. Some people may need to use oxygen when they exercise.

Get plenty of rest, too. Pulmonary hypertension makes you tired, so get a good night’s sleep and take naps when you need to.

Just like anyone else, it’s good for you to eat a healthy diet with lots of fruits, vegetables, and whole grains. That’s important for your overall health.

What to Expect

A lot depends on what’s causing your pulmonary hypertension. Treating an underlying condition will help you feel better. There’s no cure for pulmonary hypertension, but the earlier it’s diagnosed, the easier it is to live with.

If you have idiopathic pulmonary hypertension — the kind where doctors can’t find a cause — your symptoms may get worse over time. But treatment can slow down the progress of the disease and help you live longer.

Remember that each person is different, and there are good treatments available. Work with your doctor to find what’s right for you.

Where to Find More Information

The Pulmonary Hypertension Association offers in-depth information on everything from medications to tips on making daily tasks easier. It also has an active online support community.

Mitral Valve Prolapse: Symptoms, Causes, and Treatment

Mitral valve prolapse is a common cause of a heart murmur caused by a “leaky” heart valve. Most cases of mitral valve prolapse are not serious and only need to be monitored.

Mitral valve prolapse is associated with many other symptoms and conditions. But experts aren’t sure that mitral valve prolapse is what causes them.

What Is Mitral Valve Prolapse?

The mitral valve is a valve that lets blood flow from one chamber of the heart, the left atrium, to another called the left ventricle. In mitral valve prolapse, part of the mitral valve slips backward loosely into the chamber called the left atrium. This happens when the main heart muscle, called the left ventricle, squeezes during each heartbeat. Mitral valve prolapse differs from mitral valve stenosis. In mitral valve stenosis, the mitral valve is stiff and constricted.

In mitral valve prolapse, the valve slips backward due to the abnormal size of or damage to the mitral valve tissues. For most people with mitral valve prolapse, the cause is unknown.

Mitral valve prolapse can run in families. It can also be caused by conditions in which cartilage is abnormal (connective tissue disease). Nearly 8 million people in the U.S. have mitral valve prolapse.

Symptoms of Mitral Valve Prolapse

Most people with mitral valve prolapse have no symptoms. They also never experience any health problems due to mitral valve prolapse.

Chest pain is the most frequent symptom in people who have symptoms with mitral valve prolapse. The chest pain may be very bothersome and frightening, but it does not increase the risk of heart attack, death, or other heart problems.

Mitral valve prolapse is a common cause of mitral regurgitation. That’s a condition in which some blood flows backward through the mitral valve with each heartbeat. Over years, moderate or severe mitral regurgitation can cause weakness of the heart muscle, known as congestive heart failure. Symptoms of congestive heart failure include:

• Shortness of breath with exertion
• Swelling in the legs and feet

Mitral valve prolapse has also been associated with other symptoms:

• Fluttering or rapid heartbeat called palpitations
• Shortness of breath, especially with exercise
• Dizziness
• Passing out or fainting , known as syncope
• Panic and anxiety
• Numbness or tingling in the hands and feet

When these symptoms occur together, they are sometimes called mitral valve prolapse syndrome. However, experts don’t know if mitral valve prolapse itself causes these symptoms. Since these symptoms and mitral valve prolapse are so common, they could often occur together by chance.

Diagnosis of Mitral Valve Prolapse

A doctor may suspect mitral valve prolapse after listening to someone’s heart with a stethoscope. The abnormal movement of the mitral valve can make a distinct sound, called a “click.” If mitral regurgitation is also present, a doctor may hear a heart murmur caused by the backward flow of blood.

Definite diagnosis of mitral valve prolapse requires an echocardiogram, which is an ultrasound of the heart. A doctor can watch the abnormal valve movement on a video of the beating heart. Mitral regurgitation, if present, will also be seen with an echocardiogram.

Treatment of Mitral Valve Prolapse

Mitral valve prolapse causes no problems for most people, so treatment is usually not needed.

People who develop severe mitral regurgitation due to mitral valve prolapse often can benefit from surgery to repair or replace the leaky valve. For people with symptoms of congestive heart failure caused by mitral valve prolapse with mitral regurgitation, surgery is usually the best treatment.

If no mitral regurgitation is present on echocardiogram, symptoms of mitral valve prolapse rarely pose any risk. The best treatment for each person may vary, but can include:

• Exercise
• Pain relievers
• Relaxation and stress reduction techniques
• Avoidance of caffeine and other stimulants

Beta-blockers, which are medications to slow the heart rate, may be helpful in people who have episodes of palpitations with a rapid heartbeat, known as tachycardia, with mitral valve prolapse.

Follow-Up of Mitral Valve Prolapse

Most people with mitral valve prolapse never experience health problems related to the condition. Experts recommend that people with mitral valve prolapse see a doctor on a regular basis. That way, any developing problems can be found early:

• Most people with mitral valve prolapse should see a cardiologist every 2 to 3 years. They do not need regular echocardiograms.
• People with mitral valve prolapse and moderate or severe mitral regurgitation should see a doctor and undergo echocardiography every 6 to 12 months.
• Echocardiography and a doctor’s visit are also recommended if a person develops new symptoms, or if the symptoms change.

In the past, doctors recommended that people with mitral valve prolapse take antibiotics before medical or dental procedures to prevent infection of the heart valve, known as endocarditis. The American Heart Association has determined that taking antibiotics before procedures is not helpful for people with mitral valve prolapse and is no longer recommended.

Chest pain – Symptoms and causes

Overview

Chest pain appears in many forms, ranging from a sharp stab to a dull ache. Sometimes chest pain feels crushing or burning. In certain cases, the pain travels up the neck, into the jaw, and then radiates to the back or down one or both arms.

Many different problems can cause chest pain. The most life-threatening causes involve the heart or lungs. Because chest pain can indicate a serious problem, it’s important to seek immediate medical help.

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Symptoms

Chest pain can cause many different sensations depending on what’s triggering the symptom. Often, the cause has nothing to do with your heart — though there’s no easy way to tell without seeing a doctor.

Heart-related chest pain

Although chest pain is often associated with heart disease, many people with heart disease say they experience a vague discomfort that isn’t necessarily identified as pain. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:

• Pressure, fullness, burning or tightness in your chest
• Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms
• Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity
• Shortness of breath
• Cold sweats
• Dizziness or weakness
• Nausea or vomiting

Other types of chest pain

It can be difficult to distinguish heart-related chest pain from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:

• A sour taste or a sensation of food re-entering your mouth
• Trouble swallowing
• Pain that gets better or worse when you change your body position
• Pain that intensifies when you breathe deeply or cough
• Tenderness when you push on your chest
• Pain that is persistently present for many hours

The classic symptoms of heartburn — a painful, burning sensation behind your breastbone — can be caused by problems with your heart or your stomach.

When to see a doctor

If you have new or unexplained chest pain or suspect you’re having a heart attack, call for emergency medical help immediately.

Causes

Chest pain has many possible causes, all of which need medical attention.

Heart-related causes

Examples of heart-related causes of chest pain include:

• Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to your heart muscle.
• Angina. Angina is the term for chest pain caused by poor blood flow to the heart. This is often caused by the buildup of thick plaques on the inner walls of the arteries that carry blood to your heart. These plaques narrow the arteries and restrict the heart’s blood supply, particularly during exertion.
• Aortic dissection. This life-threatening condition involves the main artery leading from your heart (aorta). If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture.
• Pericarditis. This is the inflammation of the sac surrounding your heart. It usually causes sharp pain that gets worse when you breathe in or when you lie down.

Digestive causes

Chest pain can be caused by disorders of the digestive system, including:

• Heartburn. This painful, burning sensation behind your breastbone occurs when stomach acid washes up from your stomach into the tube that connects your throat to your stomach (esophagus).
• Swallowing disorders. Disorders of the esophagus can make swallowing difficult and even painful.
• Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder or pancreas can cause abdominal pain that radiates to your chest.

Muscle and bone causes

Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall, including:

• Costochondritis. In this condition, the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed and painful.
• Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
• Injured ribs. A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung disorders can cause chest pain, including:

• Pulmonary embolism. This occurs when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue.
• Pleurisy. If the membrane that covers your lungs becomes inflamed, it can cause chest pain that worsens when you inhale or cough.
• Collapsed lung. The chest pain associated with a collapsed lung typically begins suddenly and can last for hours, and is generally associated with shortness of breath. A collapsed lung occurs when air leaks into the space between the lung and the ribs.
• Pulmonary hypertension. This condition occurs when you have high blood pressure in the arteries carrying blood to the lungs, which can produce chest pain.

Other causes

Chest pain can also be caused by:

• Panic attack. If you have periods of intense fear accompanied by chest pain, a rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be experiencing a panic attack.
• Shingles. Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from your back around to your chest wall.

Dec. 08, 2017

Angina and Other Causes of Chest Pain

Chest pain is one of the most common symptoms of angina. You can learn more about Angina Causes and Risk Factors, but chest pain can also signal other problems. This is why it is very important to discuss your symptoms with your doctor to determine the underlying problem and the best course of treatment.

In general, heart-related chest pain feels different from other sources of chest pain, but if you have any doubt, it is safest to call 911 for immediate medical assistance. It could save your life. Click here to learn more about heart attack, its symptoms and what to do if you or someone you love could be having one.

Other Heart Problems That Can Cause Chest Pain

Aortic Dissection

Over time, uncontrolled high blood pressure can weaken the wall of the main artery from the heart (the aorta) until it eventually tears, causing aortic dissection, a medical emergency. Aortic dissection usually causes sudden, severe pain in the chest, neck, throat or jaw, and often a sensation of tearing in the chest that radiates to the back. Aortic dissection is a dangerous condition. You can learn more about aortic dissection here.

Heart Valve Disease

The heart has four chambers. The upper and lower chambers are connected by valves with flaps that open and close to ensure that blood flows in only one direction. If you have valve disease, these flaps harden, join together, or leak and do not work properly. The effects of these valve problems can cause chest pain. You can learn more about valvular heart disease by clicking here.

Myocarditis and Pericarditis

Chest pain is also caused by irritation and swelling of the heart (myocarditis) or its outer covering (pericarditis). This inflammation can be caused by an infection or happen after a heart attack or heart surgery. Pain from myocarditis or pericarditis is usually is sharp and in the center of the chest. It tends to get worse when you breathe, lie down, cough or swallow. Sitting or leaning forward sometimes reduces the pain.

Hypertrophic Cardiomyopathy (HCM)

HCM is a thickening of part of the heart. If you have this condition, your heart has to work harder to pump the blood in and out of your heart, which can cause chest pain. To learn more about hypertrophic cardiomyopathy, click here.

Non-Heart-Related Causes of Chest Pain

When you talk with your doctor about your chest pain, try to be as descriptive as possible. Where is the pain? How long does it last? Is it sharp or dull?

The following symptoms are less likely to signal a heart attack or angina:

• Sour taste in mouth
• Trouble swallowing
• Pain that improves or worsens after changing your body position
• Pain that gets worse with coughing or breathing deeply
• Chest pain that is tender to the touch
• Chest pain that lasts less than 5 seconds
• Chest pain that lasts continuously (all day, every day) for several days

If you have one or more of these symptoms, it is important to see your doctor for diagnosis or referral to get the help you need to feel better. You may have one of the following non-heart related causes of chest pain:

Lung and Breathing Problems

• Pulmonary Embolism (PE): If you have trouble breathing, call 911. It could be a heart attack or other type of medical emergency, such as a blood clot in the lung, which is called a pulmonary embolism (PE).  The chest pain from PE usually comes on suddenly with difficulty breathing, especially when you take a deep breath. You are at greater risk for PE if you have had surgery in the past three months, a blood clotting disorder, or cancer, or if you take oral contraceptives. PE is a life-threatening situation. The clot must be dissolved by medication to allow the heart and lungs to work properly.
• Pulmonary Hypertension: Increased blood pressure in the blood vessels of the lungs, called pulmonary hypertension, can also cause chest pain and difficulty breathing, especially if you are exerting yourself. Other symptoms include feeling very tired and fainting.
• Pneumonia is an infection in the lungs that can cause chest pain. Other symptoms of pneumonia include fever, difficulty breathing and a cough that brings up phlegm.
• Pneumothorax is a lung problem that occurs when air gets trapped in between the lung and the chest wall, causing the lung to compress and making it difficult to breathe. In some cases, the pressure is so great it can cause a lung to collapse and even push the lungs, heart, and major vessels to the opposite side of the chest. This condition usually causes immediate chest pain and difficulty breathing. The pressure must be relieved immediately by a needle or tube through the chest wall.
• Pleural Effusion: If fluid builds up around the lungs, it’s called pleural effusion. Just like air, fluid can press on the lungs making it difficult to breathe and causing some chest pain.
• Pleurisy (also called pleuritis) is the inflammation of the lung covering. The pleura is composed of two layers, one surrounding the lungs and one lining the inside of the chest wall. In between these two layers is a small amount of fluid that prevents friction between the two layers when you breathe. If the pleura becomes inflamed, usually from infection, then the friction between the two layers will cause chest pain when you breathe.
• Lung cancer is a rare but often deadly cause of chest pain. Symptoms can include a cough, difficulty breathing, weight loss, coughing up blood and chest pain. If the chest pain is severe or does not go away, it may mean the cancer has spread to the chest wall.

Musculoskeletal Problems That Can Cause Chest Pain

The vast majority of chest pain seen by doctors is actually related to muscles, bones, or joints rather than the heart or lungs. It is often sharp pain, specific to one area (although not always), and may improve or worsen with deep breathing, turning or arm movements. It may last several hours or weeks and is often easily reproducible. Sometimes, after giving it some thought, patients with this type of chest pain recall recent heavy lifting or other unusual physical activities that may have caused the pain. But for middle-aged or older people with risk factors, it is important to have your doctor make this determination.

• The muscles between the ribs can be pulled or even torn by excessive exercise (especially if you don’t exercise regularly) or by direct injury to the muscle. Injury to these muscles can also cause sharp chest pain.
• Costochondritis, a condition where the cartilage between the ribs becomes inflamed, is another common cause of chest pain.
• Other sources of musculoskeletal chest pain may be due to broken ribs, cancer in the chest wall, sickle cell anemia, or infections, such as osteomyelitis or septic arthritis.
• Rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis or fibromyalgia can affect joints in the chest area and cause chest pain.

Digestive Problems That Can Cause Chest Pain

The heart and the esophagus (the tube between the mouth and stomach) share some of the same nerves. The esophagus runs directly behind the heart. Therefore, problems with the esophagus can feel similar to heart-related chest pain. Even if your chest pain improves with antacids or on its own, see your doctor to make sure your chest pain is not heart related.

• Gastro-esophageal reflux disease (GERD), often simply referred to as heartburn, can give you chest pain. The esophagus and the stomach are connected by the lower esophageal sphincter (LES) that closes to prevent stomach contents from backing up into the esophagus. In GERD, the sphincter leaks and allows acids from the stomach to escape up into the esophagus and damage it. Symptoms of GERD are very similar to heart attack symptoms, so if you are not sure, call 911. GERD can cause squeezing, burning pain, often located in the center of the chest that sometimes radiates to the back, neck, jaw or arms. It can last minutes to hours. Many times younger people having their first episode of angina or heart attack do not think that their chest discomfort is coming from their heart. They do not see themselves as being at risk yet. Do not assume that these symptoms are due to your stomach. Unlike a heart attack, GERD may resolve on its own or with antacids. Symptoms from GERD tend to occur after meals, worsen with stress, and wake you up from sleep. GERD can also cause stomach pain, regurgitation, and an acid taste in mouth.
• Other problems affecting the esophagus can also cause chest pain. These problems include spasms, ruptures (caused by vomiting, ulcers, chemicals, or medical instruments), and foods or small objects getting stuck in the esophagus.
• Medications: Certain medications may also cause chest pain by damaging the esophagus or stomach. In some cases, swallowing becomes difficult because of the pain. This kind of irritation and pain most often happens after pills are swallowed without water, especially at bedtime.
• Pain radiating from the abdomen can also feel like chest pain. This type of pain can be caused by peptic ulcer disease, inflammation of the gallbladder, gallstones, inflammation of the pancreas (pancreatitis), kidney stones or inflammation of the appendix (appendicitis).

Perforated Viscus

A perforated viscus is a hole in one of the organs in the body, such as the stomach, appendix, spleen, gallbladder or bladder—usually from injuries, such as from a car accident, gunshot, or stab wound or infection. The hole allows toxic materials and waste from the perforated organ to escape into the body cavity, which can cause chest pain.

Skin and Sensory Nerves

The skin and nerves of the chest may be the source of chest pain. For example, chest pain may occur before the shingles rash appears. Nerve-related chest pain can occur after certain therapies and radiation, but it is fairly uncommon.

Psychological Disorders That Can Cause Chest Pain

Panic disorders, anxiety, depression, emotional stress or other psychological disorders may also cause chest pain. In these psychological disorders, the chest pain is not related to angina or digestive causes but instead seems to be triggered by the emotional stress. Emotional stress is a relatively common cause of chest pain, but it is extremely important that you see your doctor to rule out coronary artery disease (CAD) before attributing your chest pain to psychological disorders, even if you do not have a history of coronary artery disease.

Learn More

While not all chest pain is a heart attack, it is important for everyone to know the symptoms of a heart attack and what to do if these symptoms occur. It is safer to assume you may be having a heart attack and seek medical attention, even if a heart attack is NOT the cause, than to ignore the symptoms of a heart attack. This is because a heart attack indicates that the heart is not getting enough blood. Without the blood it needs, the heart muscle begins to die. This is why doctors say “time is muscle” — because the more time that passes without the heart getting the oxygenated blood it needs, the more likely it is that heart muscle will die, leading to long-term heart problems such as heart failure, or even death.  

You can learn more about other causes of chest pain that mimic heart attack, such as angina and takotsubo syndrome (also known as Broken Heart Syndrome), among others, here.

3 Signs It’s Not a Heart Attack and Possible Causes – Cleveland Clinic

A fleeting burst of pain slams your chest, and a terrifying two-word combination — HEART ATTACK — immediately enters your thoughts.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Take a deep breath. Oftentimes, the situation isn’t what you fear.

Some chest pain symptoms, while scary and alarming, are unlikely to signal a heart attack. Let’s walk through some of those indicators and what they might mean with cardiologist Curtis Rimmerman, MD.

An important note, though: Never assume chest pain is nothing to worry about. Given the game-ending potential of a heart attack, any chest pain deserves attention. Don’t wave it off.

“When in doubt, err on the side of caution and visit a doctor or emergency room,” notes Dr. Rimmerman.

How to tell if chest pain is serious

Some types of chest pain should send you to the emergency room — particularly if it lasts for at least five minutes.

Symptoms could include new or unexplained chest pain coupled with shortness of breath, a cold sweat, nausea, fatigue or lightheadedness. Aside from your chest, the pain, pressure or discomfort also may radiate to your:

• Arms.
• Back.
• Jaw.
• Neck.
• Upper stomach.

Lasting and unrelenting pain in these areas may signal a heart attack, or myocardial infarction, says Dr. Rimmerman. Call 911 to seek immediate treatment to save heart muscle.

Symptoms that suggest another problem

More often than not, chest pain does not signal a heart attack. A study of emergency room visits found that less than 6% of patients arriving with chest pain had a life-threatening heart issue.

Here are some examples of chest pain that usually doesn’t result in a heart attack diagnosis.

Momentary chest discomfort

You’re sitting at the kitchen table sipping coffee when chest pain strikes like a lightning bolt. It’s sudden, swift and stabbing. The feeling — which many compare to getting an electrical shock — lasts only an attention-grabbing moment.

The good news? The brief zap is usually not indicative of a heart attack, which often brings an unrelenting pain that lasts several minutes.

Momentary chest discomfort is more likely to result from:

Pinpoint chest discomfort

With every deep breath or cough, pain pierces your chest. Moving around and changing positions only seems to make it worse, too.

If this describes your symptoms, odds are that you’re dealing with a lung-related issue. This is even more likely if the pain is focused on the right side of your chest, away from your heart. Possible causes include:

And while these lung issues are not a heart attack, they are concerning enough to warrant a call to your healthcare provider.

Discomfort that lessens with exercise

If a sharp pain strikes your chest but improves as you move around a bit… well, you may be looking at a case of heartburn (acid reflux) or some other gastrointestinal issue.

An estimated 15 million Americans a day experience heartburn, which brings an uncomfortable burning feeling in your chest and a sour feeling in your throat. An over-the-counter antacid can help bring some relief.

Another reason your chest may hurt

That pain in your chest could be linked to another kind of attack that has nothing to do with your heart.

A panic attack or anxiety can reveal itself with symptoms — chest tightness, sweating, shortness of breath — that mimic those of a heart attack. There are some key differences between a panic attack and a heart attack, though.

• Many heart attacks follow physical strain or exertion, an indicator not typically connected to panic attacks.
• Panic attacks often feature a stabbing pain as opposed to the elephant-on-your-chest squeezing feeling that often accompanies a heart attack.
• Pain from heart attacks frequently radiates to other areas. In a panic attack, it usually stays in the chest area.

Heart attack symptoms vary widely

Dr. Rimmerman emphasizes that the symptoms of heart attack or angina can vary greatly from person to person. Some people experience no symptoms at all. Others experience crushing chest pain. Others may feel only arm, throat or jaw discomfort.

But the discomfort is usually unrelenting, typically lasting five minutes or more.

“Regardless of where the pain is, people typically can’t find a position that relieves the pain,” Dr. Rimmerman says. “Nor do they find relief by taking a drink of water, popping antacids or taking deep breaths.”

And that means it’s time to call 911.

90,000 Breastfeeding after a cesarean section

Often expectant mothers worry – will they be able to breastfeed their babies if they have a cesarean section?
Considering that now all over the world the percentage of births by caesarean section is increasing every year, the problem of organizing breastfeeding after an operative delivery does not lose its relevance.
To date, the effect of caesarean section on subsequent breastfeeding has been fairly well studied, and in general the frequency and duration of breastfeeding among mothers who gave birth by caesarean section are approximately the same as among those who gave birth by vaginal delivery.
The process of establishing breastfeeding after cesarean is often surrounded by many myths. For example, there is still an opinion that mothers who gave birth by cesarean section may not have milk after childbirth, or that there will be very little of it later, and the mother will not be able to breastfeed longer than a couple. three months. In fact, this is not the case!
What does a mother need to know, whose childbirth will occur or has already occurred by cesarean section? Most importantly, you will definitely be able to breastfeed your baby! So, what features in the establishment of breastfeeding can await you in reality after a cesarean section … both with the surgical intervention itself, and with the fact that the first attachment of a newborn to the breast after a cesarean section in Russian maternity hospitals, as a rule, occurs later than in cases when the mother gives birth naturally.In addition, mothers after a cesarean section often have fewer opportunities to organize early and frequent feedings of their baby in the first days due to their poor health or the separation of the mother and baby in the hospital after the operation.
The period before the “arrival” of milk after cesarean section is most often 3-7 days, depending on the amount and type of medications used in childbirth, the rate of recovery of the mother’s body, as well as the time of the first attachment, the correct latch of the breast, the frequency and duration of breastfeeding from the moment of his birth.
If, after a caesarean section in a maternity hospital, it is possible to stay in the same ward with a baby, this is an excellent chance to successfully start the breastfeeding process. And even if you feel so bad that you don’t even want to think about breastfeeding yet, try to keep your baby close to you as much as possible. Even a simple look at your long-awaited baby, stroking his fingers, light touches to his back, arms and legs, his gentle and familiar scent will help you to relax faster after a difficult birth and at the same time get to know your baby better.
Pain
Pain that accompanies the recovery process after any surgery can actually worsen the flow of milk from the breast during feedings or expressing. This is because the pain and stress experienced by a nursing mother temporarily block the production of the hormone oxytocin, which is responsible for the easy separation of milk from the breast. Especially often, those mothers whose caesarean section was performed on emergency indications experience problems with milk flow.
In such a situation, gentle massage of the mammary glands before feeding or pumping can help to improve milk flow (ask the nurse or midwife to show you how to do this!), As well as a gentle massage of the shoulder girdle, neck area and back, which can be done by the nurse. in the hospital or your spouse; in addition, a cup of warm drink, drunk immediately before or at the beginning of feeding, will also contribute to an increase in the level of oxytocin and milk will flow out of the breast more easily, and the baby will be much more willing to suckle.
If the pain is very severe, you can discuss with your doctor the appropriateness of using pain relievers – select those medications that will be safe when breastfeeding.
The need for helpers
After giving birth by caesarean section, it is especially necessary to have a helper nearby, who in the first days will be able to bring your baby to you and pick him up after feedings, and will also help you find comfortable positions for latching the baby to the breast.
After discharge from the hospital, the assistant, who usually becomes one of close relatives or friends, will be able to take on some of the household chores so that the mother can fully devote herself to caring for the newborn and speedy recovery after surgery.
The need to choose comfortable breastfeeding positions
Ask the nurse at the hospital or a breastfeeding consultant to help you choose breastfeeding positions in which the baby’s weight will not be supported by the healing incision.
Some mothers in the first days after surgery are comfortable to breastfeed while sitting in a chair with low armrests in the “cradle” position using a special feeding pillow, others prefer feeding the baby “from under the arm” or lying down.
When lying on your side, you can surround yourself with pillows for comfort. Pillows will help keep your back and head in a comfortable position while breastfeeding, and an extra small cushion or simply rolled up large towel will support the incision area if you place it between your belly and your bed.
In general, any position you choose must meet the following requirements: not cause physical discomfort to the mother, allow the baby to control the correct latch on to the breast, and be comfortable enough for prolonged feedings.
Potential lethargy of the baby
Babies born by caesarean section may be more lethargic and sleepy, especially if they have been exposed to anesthetics and analgesics for a long time during childbirth. But even if this is so, you need to understand that a slight delay in the start of active feedings will not determine the further fate of breastfeeding in general – it is just that the establishment of lactation may occur a little later than in the case of natural childbirth.
If your baby is not interested in breastfeeding for the first attachment after birth, stay calm.Many mothers face similar difficulties in the beginning, but fortunately, these difficulties are quite surmountable, with a certain perseverance and patience.
Allow your baby to spend as much time as possible in bodily contact with you, dozing on your breast – this will help him to adapt faster after childbirth and awaken his innate instincts and reflexes in him.
Even if he is not able to pick up the breast and start sucking right now, everything will definitely work out, perhaps in a few minutes, hours or days.Sooner or later, all babies take breast, if the mother makes an effort.
Try to make attempts to attach the baby to the breast not on schedule, but in those moments when the baby is calm and ready to learn to suckle. Frequent feedings will help the mother quickly learn to attach the baby to the breast, and the child will quickly get used to the mother’s unique shape of the nipple, learn to grab the nipple and areola and properly hold the breast in the mouth while sucking.
Colostrum droplets can be squeezed onto the baby’s lips or into the baby’s mouth to stimulate the infant’s desire to suckle.If it doesn’t work, you can express some colostrum and spoon it to your baby.
Until the baby is able to suckle well, the mother can stimulate and maintain lactation by expressing the breast with her hands or a breast pump every 2-3 hours, and feeding the expressed colostrum to the baby from a spoon, pipette or syringe without a needle. If the baby was born prematurely or the mother probably knows that breastfeeding will not be possible for several days, then it makes sense to start expressing colostrum as soon as possible after childbirth.
The issue of feeding the baby in such situations is decided individually. If a mom can express colostrum and pass it on to her newborn, this is by far the best option. If this option is not possible, then the issue of temporary feeding with donor milk or formula is resolved. It is important to remember that the amount of food in one feeding should correspond to the volume of the newborn’s stomach, as well as the physiological needs and capabilities of the child. In addition, if the child receives food not from a bottle, but from an object that excludes sucking (a cup, spoon, syringe, pipette), it will be much easier for the mother to teach him how to properly latch on to the breast when it becomes possible; and the baby will learn faster and easier to get milk directly from the breast.
So, breastfeeding after a caesarean section is not really all that different from breastfeeding after a vaginal birth. It is not at all necessary that you will have any of the above difficulties, because most mothers and babies feel good immediately after the operation and are ready to start feeding in the first hours after childbirth or even, in some cases, immediately in the delivery room.
In any case, caesarean section affects only the beginning and formation of breastfeeding, but not its duration or quality in the future.A mother’s desire and willingness to breastfeed plays a decisive role in how and for how long breastfeeding will ultimately continue, regardless of how the birth went.
# national projectdemography89

Foggy Sentinel, chapter Chapter 1, page 1 read online

Chapter 1

Is there a more bleak landscape than the one I look at from the window of the observation tower every day?

Hidden behind the fog, the trunks of huge trees. The sky, eternally covered with dirty clouds, drizzling with a light rain. Gray, faded earth. Dead land – Marcus correctly said.

He has been gone for three months, and I still cannot come to terms with the loss of my only friend.

We all know that sooner or later we will die – otherwise it does not happen here. I’m considered a lucky guy, but how long will my luck last? Month? A week? Day?

They can come any day. They don’t care what mood we are in, how we feel, hungry or tired.They will take everyone they can.

Sometimes I want to be taken away too. I’m tired.

I got into this world just a year ago, but during this time I managed to look death in the face dozens of times, literally feel its fetid breath. Local thugs tried to kill me, I poisoned myself with unfamiliar food, red fever devoured my body for two whole weeks.

Rrach did not want to accept the stranger, he attacked me again and again, like white blood cells attack a malicious virus.

This went on for three months, and then everything stopped abruptly.Was I happy? Then yes. It seemed to me that I have a chance. Marcus, to whom I literally fell on the head, gave me, a stranger, shelter and food. I still don’t know why he did it. I didn’t ask, and he didn’t explain. We didn’t say much at all.

Six months after my arrival, Marcus enrolled in the Dawn Guard. I signed up with him. By and large, this was the only job I could get in this world. And my friend … he was about forty, and in the last breakthrough he lost his whole family: mother, wife, son.They took everyone he loved. Marcus had nothing to be afraid of – all the worst had already happened to him.

Rrach, my new world, was similar to my native Earth, but lagged behind in development for two or two hundred and fifty years. There were no cars, no electricity or hot water. But they were. Those who come at dawn. Non-humans.

Dawn is the time when most suicides are committed. The time when all decent people sleep in their homes. And we, the Mistguards, are responsible for ensuring that they can sleep peacefully.That’s right, with a capital letter. We are respected.

We are well paid – for a year of the contract, you can earn for a whole house in the capital. Only not a single Guardian has yet bought it for themselves.

People came here to die. Dying rich, dying with honor. Relatives could not even bury the bodies – They took all the defeated with them.

My new partner, Mort, a boy of about twenty-three, took over from Marcus. I tried to be helpful and told him everything I knew, but I felt it was not enough.Although even three months in the Guard for such a hot impulsive guy is an achievement.

People did not get used to each other, did not get attached, did not try to find friendship and hardly talked to each other. My warm relationship with Marcus was rather the exception to the rule.

There were about a hundred people in the Guard at the same time – this was the necessary minimum, which allowed us to throw the enemy back into the fog over and over again. I’ve always wondered if Non-humans live in fog or come from another world? No one knew this, because none of those who dared to enter the fog never returned.

Every day, without casualties, I marked a line on the wall of my room, but I have never been able to cross out ten in a row.

The voice of Ara, the squad leader, pulled me out of my memories:

– Van, your shift will start in fifteen minutes. Have you finished?

Nodded, not bothering to answer. Mechanically he licked the spoon, got up, straightened up, loudly crunching his joints. I am only thirty, but the red fever left its present goodbye – degenerative changes in the joints.So far this does not interfere, but in the future …

He smiled bitterly. What is the future? For several months, health is enough for sure.

I went into my room and changed my clothes. The shifts did not happen very often – only once a month. They were on duty for days, three people. The logic in this was: if one of the attendants falls asleep, the second and third will be able to see the danger in time.

The shift began long before dawn – we went up to the observation tower right after dinner, having slept in the afternoon. And although the Non-humans had never come at another time, there were legends that this once happened.

Today my new partner and Yars, a fifty-year-old overweight man, one of the newcomers, were on duty with me. I bet two gold coins that it won’t last even a month.

Mort nodded to me as I climbed into the tower – he, as always, came first. The guy was always in a hurry.

Yars was the last to burst in, scratching his belly and breathing heavily.

I shook my head and glanced at my partner. We both knew that the fat man would fall asleep while on duty. Alas, the Guardians go through only a superficial selection: there are very few people willing, and recruiters are forced to travel all over the mainland, looking for desperate men who do not really care about their lives or who need money badly.

Yars began to cough hysterically, Mort and I looked at each other again. He made round eyes, I shrugged in response.

I don’t care even if it’s contagious. There is no illness worse than red fever, and I have already suffered from it. The second time will not stick.

Half an hour later it began to get dark, and my partner and I got up from our seats. Shaking my head in the direction of the fat man, saying “don’t get up, we’ll handle it ourselves,” I cracked my joints again. It’s time to light the fire.

We went out through a small door to the other side of the tower and found ourselves on a ledge.Not protected by anything, he teased me every time, beckoned and attracted me. I wanted to come up, look into the abyss, step into it.

Mort struck the wood with a koshal, striking sparks, and I poured a combustible mixture on the wood. They will have to be thrown up all night. There was a special meaning in the fire burning on the tower: if it was extinguished, the inhabitants of the nearest settlements immediately understood that a breakthrough had occurred.

90,000 Boxer Zhankosh Turarov threatened the bailiff – ChSI Chamber: 05 October 2021, 11:12

The Republican Chamber of Private Bailiffs stated that the man who hit the bailiff in Almaty summoned boxer Zhankosh Turarov to his place, Tengrinews reports.kz.

As stated in a statement on the website of the Republican Chamber of Private Bailiffs, the attack on the bailiff Yermekov occurred during the execution actions to demolish an extension in Bostandyk district of Almaty. The organization reported that the attacker strangled, threatened and demanded that the bailiff stop demolishing the building, and then hit him in the ribs and lung area.

“These beatings were carried out in the presence of police officers. The ambulance doctor found that the harm was of moderate severity.At the time of the incident, the police officers fled directly and no longer appeared on the territory of the execution actions. The bailiff wrote a statement on the initiation of a criminal case on the fact of the beatings and presented it to the district police officer and the police, who ran out into the street after the beating. The police officers were completely inactive and outright refused to detain the perpetrator. On the request of the bailiff to detain M.N. Iskakov police officers were silent and inactive (there is video filming).

To exert pressure on the bailiff and other persons in the execution of Iskakov M.N. summoned the world boxing champion Turarov Zhankosh Zhasulanovich to the place of performing actions of . Upon arrival, Turarov Zhankosh began to demand from the bailiff to take the statement from the police filed against M.N. Iskakov. for beating, “says a publication on the website of the Chamber of Private Bailiffs.

The chamber also said that the boxer “called the performing actions lawlessness and threatened to arrange a mutual lawlessness for the bailiff for this.”

“At this stage, new pressure and direct threats against Yermekov began. Iskakov M.N. and Turarov Zh.Zh. have already begun to directly threaten the bailiff and other persons during execution with unlimited physical beating. and forced him to refuse to comply with the requirements of the judicial act, “the organization added.

It is noted that the bailiff failed to demolish the extension, the work was suspended at the initial stage.

The incident with the attack on the executor was captured on video.

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90,000 Regina Todorenko changed her appearance – how she looks – photo

The famous Ukrainian singer and TV presenter Regina Todorenko, who lives and builds a career in Russia, shocked fans with a new photo.The celebrity appeared in front of fans in a new image, with short brown hair.

She published the corresponding post on her personal page in Instagram. “Even for me this is a surprise”, – shortly signed the post by the artist (to see the photo, scroll to the end of the page) .

In the photo, Todorenko poses without a gram of makeup in a white T-shirt with a print and accessories. The highlight of her image was short brown hair.

Regina made several shots, in one of which the fans were able to discover that this was not the real hair color and haircut at all.In the third photo, you can see that behind the celebrity you can see her real brown hair and it becomes clear that Regina is wearing a wig.

Video of the Day

Fans are divided. Some believe that Todorenko is beautiful with such a haircut and hair color, while others criticized the image.

“Doesn’t go very well”, “You can see the blond hair from under the wig”, “Very good”, “Regina lost her tenderness and romance with this hairstyle”, “Hair is not teeth, it will grow back”, “Stylish and effective, and most importantly that you like “,” You are very beautiful, but not so very “,” For me, dark is not yours “,” Great “,” Beautiful “,” Unusual and beautiful “,” Great wig “,” Horror “,” Very beautiful “, People write.

Briefly about a celebrity :

• Regina Todorenko is a Ukrainian TV presenter, singer, composer and blogger born in 1990 in Odessa.

• Best known for her travel show “Heads and Tails”, as well as her participation in the group “Real O”.

• Since 2018, she has been married to singer Vlad Topalov, in marriage with whom they had a son, Mikhail.

Earlier OBOZREVATEL wrote that Regina Todorenko unexpectedly made a confession about her health.During another business trip, the star opened up and admitted that she had suffered from back pain since childhood.

Peking cabbage cabbage rolls in the oven – Recipe

Preparation time: 90 minutes Calorie content 269 kcal Cuisine International Peking cabbage nipples are very tasty / tvcook.ru

Peking cabbage dishes are very easy to cook. One of these is cabbage rolls from Peking cabbage. Such cabbage rolls are very tender and fragrant.

Poultry meat goes well with thin cabbage leaves, giving the dish an unusual original taste.Instead of chicken fillet for minced meat, you can use turkey, pork or beef, then the dish will turn out to be more satisfying and high-calorie.

Glavred has collected two of the simplest recipes for cabbage cabbage rolls in the oven and slow cooker.

Cabbage rolls with Peking cabbage in the oven – recipe

You will need:

• Peking cabbage – 1 head of cabbage;
• minced meat 700 gr;
• rice – ½ cup;
• salt ½ tsp;
• spices – to taste;
• carrots – 2 pcs.;
• onions – 1 pc;
• vegetable oil – 2 tbsp. l.

Step # 1

How to prepare Peking cabbage for stuffed cabbage / edimdoma

Disassemble Peking cabbage into leaves. Fold 5 – 7 leaves into a cup and heat in the microwave for 5 minutes at maximum power. As a result of this procedure, the Chinese cabbage leaves will become soft and curl without breaking.

Step # 2

Boil rice until half cooked, mix with minced meat. Salt and pepper.

Read alsoPeking cabbage salads: five delicious recipes

Step # 3

Grate carrots on a coarse grater, chop onions and fry everything in vegetable oil until soft. Transfer to a dish in which the cabbage cabbage rolls will be stewed.

Step # 4

Cut off the thickening of the prepared cabbage leaves. Put 1 – 2 tbsp to one edge. l. fillings (the size of cabbage rolls will depend on the size of the leaves of Peking cabbage), wrap in a roll, picking up the edges.

Peking cabbage cabbage rolls must be wrapped very carefully / edimdoma

Step # 5

Place the wrapped cabbage rolls in a stewing dish, on top of the carrot roast.

Step # 6

Having made the cabbage rolls, pour slightly salted water into a baking dish so that it reaches just above the middle of the upper level of the cabbage rolls.

Peking cabbage stuffed cabbage is very tasty and tender / edimdoma

Peking cabbage stuffed cabbage in the oven simmer in a bowl with a lid – 1 hour 20 minutes.

Peking cabbage cabbage rolls in a slow cooker – recipe

You will need:

• Peking cabbage – 1 pc;
• minced meat – 500 gr;
• rice – 2 tables spoons;
• onions – 1 pc;
• carrots – 1 pc;
• greens – to taste;
• salt, pepper.

Peking cabbage stuffed cabbage in a slow cooker is very easy to cook / dolmec

Peking cabbage can be disassembled into leaves and heated in the microwave at maximum speed for 5 minutes, as for a recipe for Peking cabbage cabbage rolls in the oven, or you can boil Peking cabbage leaves.

Boil them for 1.5-2 minutes in boiling salted water. You can also prepare the leaves by steaming them in a multicooker. To do this, pour a glass of water into the bowl, put the leaves in a container for steaming and select the “Steam” mode. Set the timer to 5 minutes.

The prepared leaves should be cooled a little, then the thickened stems should be carefully cut off from them.