Angina | NHLBI, NIH

Sometimes it is hard to tell the difference between unstable angina and a heart attack. Angina can be a sign of increased risk of stroke. Angina can also trigger sudden cardiac arrest. These are medical emergencies.

If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.

Heart attack

Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have symptoms such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.

Stroke

If you think someone may be having a stroke, act F.A.S.T. and do the following simple test.

F—Face: Ask the person to smile. Does one side of the face droop?

A—Arms: Ask the person to raise both arms. Does one arm drift downward?

S—Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.

Read more about the signs and symptoms of a stroke.

Sudden cardiac arrest

It is possible for a spasm causing angina to trigger arrhythmia. This can lead to sudden cardiac arrest. Fainting is usually the first sign of sudden cardiac arrest. If you think someone may be in cardiac arrest, try the following steps.

• If you see a person faint or if you find a person already unconscious, first confirm that the person cannot respond. The person may not move, or his or her movements may look like a seizure.
• You can shout at or gently shake the person to make sure he or she is not sleeping, but never shake an infant or young child. Instead, you can gently pinch the child to try to wake him or her up.
• Check the person’s breathing and pulse. If the person is not breathing and has no pulse or has an irregular heartbeat, prepare to use an automated external defibrillator as soon as possible.

Heart Attack Neck Pain | Heart Attack Warning Signs

Most people have neck pain at some point in their life. It’s usually due to neck muscle strain. But neck pain is also a common symptom of a heart attack. Protect your heart by recognizing when your neck pain is more than a temporary strain and might be due to a problem with your heart.

How is neck pain a heart attack warning sign?

A heart attack (myocardial infarction) is most often due to a blood clot that blocks blood flow into the heart muscle. Most commonly, this causes a pressure, cramping or squeezing pain in your chest, but the pain can also spread to your neck. Your pain may also extend to your jaw, shoulder, back or arm because you may sense pain more easily in these areas. During a heart attack, your diaphragm (the sheet of muscle below your lungs and heart) and nearby accessory nerve can become irritated causing pain to refer elsewhere including your neck and shoulders. You can also feel pain, aching or discomfort in the neck and upper body without chest pain. Heart attack neck pain is more likely in women than in men.

What are some other causes of neck pain?

Pain in your neck can be caused by a variety of problems, from arthritis to fatigue. Here is a partial list of potential diseases, disorders and conditions:

• Arthritis of the neck, including osteoarthritis (wear and tear of the neck bones and joints) and rheumatoid arthritis (inflammation of the joints in the neck due to an abnormal immune response)

• Fibromyalgia, a chronic pain disorder that causes muscle pain and tender areas in the front of your neck and other areas of the body

• Meningitis, an infection of the lining of the brain and spinal cord

• Neck muscle stress or strain caused by such activities as sleeping in an awkward position, spending long periods driving, or sitting at a computer

• Ruptured cervical disc between the bones of your neck. A ruptured disc protrudes from its normal position, pressing on nerves and causing pain.

• Spinal stenosis, a narrowing of the spinal canal. Stenosis also leads to nerve pain.

When should I call my doctor or 911?

Contact your doctor if you have ongoing mild to moderate neck pain or stiffness. Call 911 if your neck pain is severe or sudden, or occurs after any type of trauma, such as a car accident or fall.

During a heart attack, people are known to have feelings of fear, panic, uneasiness, or a sense that something terrible is going to happen. Call 911 if have neck pain with these feelings or any of these other symptoms:

• Any type of chest pain, pressure, tightness or discomfort

• Feeling sick to your stomach or vomiting. This can happen with or without stomach pain.

• Pain expands from your neck to your shoulders, arms, back, teeth or jaw

• Shortness of breath

• Dizziness or passing out

• Breaking out in a cold sweat or having very pale skin

• Tiredness or weakness

You may be concerned about calling 911, especially if you are not sure that your neck pain is serious. But it is better to call 911 for a minor neck problem than ignore a possible heart attack. Every minute counts in a heart attack. As a precaution, on site and hospital emergency personnel will treat you as if you are having a heart attack until all your tests are complete.

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.

Continued

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.

Continued

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.

Continued

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.

Continued

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.

Continued

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.

Continued

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.

Continued

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.

Continued

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

Angina (Chest Pain) | American Heart Association

Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

But, angina is not a disease. It is a symptom of an underlying heart problem, usually coronary heart disease (CHD).There are many types of angina, including microvascular angina, Prinzmetal’s angina, stable angina, unstable angina and variant angina. View an animation of angina(link opens in new window).

This usually happens because one or more of the coronary arteries is narrowed or blocked, also called ischemia.

Angina can also be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries and is more likely to affect women than men. Coronary MVD also is called cardiac syndrome X and non-obstructive CHD. Learn more about angina in women.

Depending on the type of angina you have, there are many factors that can trigger angina pain. The symptoms also vary based on the type of angina you have.

Types of Angina

Knowing the types of angina and how they differ is important.

Understand Your Risk for Angina

If you’re at risk for heart disease or coronary MVD, you’re also at risk for angina. The major risk factors for heart disease and coronary MVD include:

Diagnosis of Angina

All chest pain should be checked out by a healthcare provider. If you have chest pain, your doctor will want to find out whether it’s angina and if it is, whether the angina is stable or unstable. If it’s unstable, you may need emergency medical treatment to try to prevent a heart attack.

Your doctor will most likely perform a physical exam, ask about your symptoms, and ask about your risk factors for and your family history of heart disease and other cardiovascular conditions.

Talk to Your Doctor

Your doctor will probably ask you a series of questions to rule out the most critical or life-threatening possibilities. Think ahead so you can provide as much information as possible. Here are some questions you might be asked:

• How long have you had this condition?
• On a scale of 1 (mild) to 10 (critical), what is your level of discomfort?  
• What behavior(s) provoke the pain? Physical activity? Eating? 
• What relieves the discomfort?

Print our Angina Log to keep track of your angina symptoms.

Treatment of Angina

All chest pain should be checked by a doctor. If your doctor thinks that you have unstable angina or that your angina is related to a serious heart condition, they may recommend the following tests and procedures:

Treatment of angina includes:

These treatments will help reduce pain and discomfort and how often the angina pain occurs. They will also prevent or lower your risk for heart attack and death by treating whatever underlying cardiovascular condition you may have.

Not all chest pain is a sign of heart disease.

Other conditions also can cause chest pain, such as:

• Pulmonary embolism (a blockage in a lung artery)
• Aortic dissection (tearing of a major artery)
• A lung infection
• Aortic stenosis (narrowing of the heart’s aortic valve)
• Hypertrophic cardiomyopathy (heart muscle disease)
• Pericarditis (inflammation in the tissues that surround the heart)
• A panic attack

Learn more:

Heart Attack Symptoms and Warning Signs

A heart attack happens when an artery that feeds oxygen-rich blood to the heart becomes obstructed. The heart muscle begins to die, and heart attack symptoms begin.

Call 911 immediately if you experience the following heart attack symptoms for two minutes or more:

• Sudden shortness of breath.
• Sudden sweating or flu-like symptoms, including nausea, clamminess or cold sweats.
• Unusual fatigue, light-headedness, weakness or dizziness.
• Pain that radiates. Men and women often experience this pain differently, as explained below.
• Intermittent pain that lasts more than a few minutes, or goes away and comes back. This sensation can feel like uncomfortable pressure, squeezing or fullness.
• Anxiety or a feeling of doom.
• If you have angina: Any change in the frequency, duration or intensity of symptoms, which do not respond to nitroglycerin.

Symptoms Can Be Different for Men and Women

Men and women experience heart attack symptoms in slightly different ways. The main difference is how pain radiates.

• For men: Pain will spread to the left shoulder, down the left arm or up to the chin.
• For women: Pain can be much more subtle. It may travel to the left or right arm, up to the chin, shoulder blades and upper back — or to abdomen (as nausea and/or indigestion and anxiety). Women are also more likely to experience these accompanying symptoms: shortness of breath, nausea, vomiting and back or jaw pain. Read an in-depth overview of heart attack symptoms for women here.

Some heart attacks are sudden and intense, but most start slowly with mild pain and discomfort. Surviving a heart attack depends upon how well you recognize and react to these symptoms. Remember that “time is muscle.” The sooner you receive medical care, the sooner heart muscle can be saved.

What is Chest Pain?

When medical professionals talk about chest pain, they’re talking about the pain and discomfort that can be an early sign of heart attack. There are many ways to describe this pain, including tightness or unusual pressure in the center of the chest.

While pain can radiate to the shoulders, arms, neck, jaw or back, people often mistake this pain for indigestion, which can be dangerous.

Because heart attack symptoms in women can be so subtle, heart attacks in women frequently go unrecognized. Unfortunately, treatment is sought long after symptoms are initially felt.

If you’re experiencing the heart attack symptoms listed here, call 911 immediately.

6 Facts About Chest Pain

Have you ever felt a sharp pain in your chest and were convinced you were having a heart attack? Maybe you even went to the emergency room or called your doctor only to find out that your “heart attack” was actually a strained muscle. Or maybe you were absolutely positive your chest pain was just heartburn, but it turned out to be a heart attack after all.

The truth is, it’s not easy to tell what’s behind your chest pain and whether the cause is life-threatening or just a nuisance. So we spoke to interventional cardiologist Gary Schaer, MD, from Rush who shared five things everyone should know about chest pain.

1. It might be angina, not a heart attack.

Your doctor may use the word “angina” or “angina pectoris,” when discussing your chest pain. Actually, angina is the medical term for chest pain, pressure or tightness — but it’s not the same as a heart attack.

• A heart attack occurs when the blood flow to a part of the heart is suddenly and completely cut off, usually by a blood clot.
• Angina occurs when the amount of blood flowing to the heart muscle can’t meet the heart’s demand for blood.

Blood supply to the heart muscle is typically reduced by atherosclerosis, the build-up of fatty plaque in the arteries that supply the heart. When the heart’s demand for blood flow increases (due to exertion or emotional stress) in someone with restricted blood supply to the heart, that person may experience angina symptoms, including squeezing, burning, tightness or a sensation of pressure in the chest.

Health experts classify angina in two categories: stable angina and unstable angina. Stable angina occurs during activity or emotional stress, whereas unstable angina typically happens while at rest.

If you have angina, it means you have underlying coronary artery disease, but it doesn’t necessarily mean you’re having — or are at increased risk of having — a heart attack.  

So how can you tell whether your chest pain is angina or a heart attack? Here are some important differences:

Angina	Heart Attack
Does not cause permanent damage to the heart muscle.	Can cause permanent damage to the heart muscle.
Brought on by physical exertion, excitement or emotional stress. Symptoms can occur on and off for weeks, months or even years, but bouts are short-lived and can be relieved by rest.	Usually comes on suddenly, is not relieved by rest, and is typically accompanied by other symptoms.
More of a mild squeezing, burning or pressure (often described as more of a discomfort than actual pain).	Typically described as severe “crushing” chest pain (although some people do not experience crushing chest pain, or even have chest pain at all).

2. A variety of heart conditions can cause chest pain.

While coronary artery disease is a leading cause of chest pain, Schaer says pain can occur even when there isn’t a partially or completely blocked artery.

These are some other heart conditions that can cause chest pain:

Pericarditis

Pericarditis is an inflammation or an infection of the sac around the heart. This condition can cause chest pain similar to angina, and also tends to cause a sharp, steady pain along the upper neck and shoulder muscle that may worsen when you breathe, swallow food or lie on your back.

Myocarditis

Myocarditis is heart muscle inflammation. Often, the chest pain is accompanied by fever, fatigue and trouble breathing.

Mitral valve prolapse

Mitral valve prolapse is a condition in which the heart’s mitral valve doesn’t close properly.

Aortic dissection

Aortic dissection is an uncommon but life-threatening condition that results when a tear develops in the aorta (the largest artery in the body). This causes sudden, severe pain with a tearing or ripping sensation through the neck, back or abdomen.

Coronary microvascular disease (MVD)

Coronary microvascular disease (MVD) is a disease affecting the walls of the heart’s tiniest arteries. Also called cardiac syndrome X and nonobstructive cardiovascular heart disease, MVD is more common in women.

While chest pain is one of the hallmarks of heart problems, any organ or tissue in your chest can be a source of chest pain.

3. The pain may not be coming from your heart — or even your chest. 

While chest pain is one of the hallmarks of heart problems, it’s important to note that any organ or tissue in your chest — including the lungs, esophagus, muscles, tendons, ribs and nerves — can be a source of chest pain.

“Pain can also radiate to the chest from the neck, abdomen and back, creating the illusion that it’s originating with your heart,” Schaer says. In fact, in roughly 25 percent of people in the U. S. who experience chest pain, the cause is related to parts of the body other than the heart, including the following:

• Gastrointestinal diseases (stomach ulcers, gastritis, heartburn, gastroesophageal reflux disease and gallstones)
• Conditions of the lungs (blood clots, pneumonia and pleurisy, or swelling of the lining around the lung) or a collapsed lung
• Panic attacks (also called panic disorder)
• Inflammation of the areas where the ribs connect to the breastbone or sternum, called costochondritis
• Muscle or tendon strains in the chest area or ribcage
• Asthma
• Shingles

4. Some heart attack sufferers don’t experience chest pain at all.

While chest pain is far and away the symptom most commonly associated with a heart attack, not everyone who has a heart attack feels that crushing chest pain. While some may double over due to a vice-like grip around their hearts, others may feel as though a bear is standing on their chest. Or, they may experience nothing at all.

• Women, for instance, tend to have different heart attack symptoms than men. “Often, women don’t have the classic symptoms, such as pressure-like chest pain,” says Schaer. “They more frequently experience dizziness, nausea or fatigue, and they may have chest pain that radiates to both arms instead of just the left arm, as is common in men.”
• Diabetics also may not experience crushing chest pain because they don’t have the same nerve responses as nondiabetics. When having a heart attack, a diabetic may instead feel weak or dizzy, be short of breath or just not feel well.
• Elderly patients, too, are likely to not experience chest pain.
• Individuals with a high pain tolerance, some researchers believe, may be less likely to recognize the signs of a heart attack.

“They may pass out, or feel weak or confused,” Schaer says. “If you’re a diabetic or older adult — or are a caregiver for a diabetic or older adult — it’s important to know that these populations often experience out-of-the-ordinary heart attack symptoms so you don’t write them off. “

5. Time = heart muscle, so don’t wait to get help.

If you think you’re having a heart attack, call 911 immediately. Time is of the essence: The longer a coronary artery is 100 percent blocked, the more heart damage will occur.

“Never drive yourself or have someone drive you to the hospital,” says Schaer. “The emergency medical technicians who respond to the 911 call are best equipped to care for heart attack patients, monitor them for any abnormal heart rhythms that can develop and rapidly transport them to the nearest hospital capable of opening the artery with angioplasty.”

If you’re concerned about chest pain, or if persistent chest pain is interfering with your quality of life, talk to your doctor. He or she can run tests to pinpoint the source of your pain, help you get relief and potentially prevent more serious health problems down the road.

6. Expect to answer, and ask, questions if you see a doctor for chest pain.

Whether your chest pain is evaluated in a doctor’s office or an ambulance, you can expect health care providers to ask you questions.

Commonly asked questions

• When did you first experience discomfort? Hasn’t it gotten worse or better?
• Are you having other symptoms, such as dizziness or vomiting?
• Is there anything that lessens or increases your discomfort?
• Do you have a family history of heart disease?
• Do you have high cholesterol or diabetes?
• What medications or supplements do you take regularly?

Questions

you should ask

• What do you think is causing my chest discomfort? Could there be other causes?
• Will I need tests?
• What are my treatment options and are there any risks related to these treatments?

Angina – when you have chest pain Information | Mount Sinai

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. PMID: 25260718 pubmed.ncbi.nlm.nih.gov/25260718/.

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 62.

Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 56.

Fihn SD, Blankenship JC, Alexander KP, Bittl JA, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg. 2015 Mar;149(3):e5-23. PMID: 25827388 pubmed.ncbi.nlm.nih.gov/25827388/.

O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;127(4):529-555. PMID: 23247303 pubmed.ncbi.nlm.nih.gov/23247303/.

Last reviewed on: 7/30/2020

Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

90,000 Neck pain – causes of occurrence, under what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct treatment prescription, you should contact your doctor.

Neck pain – the causes of the appearance, with what diseases it occurs, the diagnosis and methods of treatment.

Almost two-thirds of people have experienced neck pain – cervicalgia at least once in their lives. Such pain does not always indicate a serious illness. But if relapses occur more and more often, this can be a wake-up call.

Varieties of pain

Conditionally, the causes of cervicalgia are divided into two groups:

1. arising from diseases of the spine (herniated intervertebral discs, arthrosis, dysfunction of the intervertebral joints) and subluxation of the vertebrae (whiplash).The consequences of such injuries can manifest themselves throughout life;
2. arising from other causes: infectious and endocrine diseases, tumor processes, rheumatism.

Possible Causes

Myofascial syndrome

Prolonged overstrain of the neck muscles, sprains, hypothermia lead to pain, which is of moderate intensity and short duration.At the same time, there is often a limitation of the mobility of the head and a spasm of the cervical muscles, in which seals and soreness are felt when pressed.

As a rule, pain in myofascial syndrome disappears on its own within a few days.

Osteochondrosis of the cervical spine

Osteochondrosis is a degenerative-dystrophic lesion of the spine, which occurs as a result of deformation and destruction of the intervertebral discs.Loss of elasticity, compression and destruction of discs lead to overloading of the intervertebral (facet) joints, arthrosis, pinched nerve roots and pain. With age, due to the drying out of cartilage, the distance between the vertebrae decreases, which causes damage to the intervertebral joints and ligaments.

Facet joint dysfunction

Damage to the structure of the intervertebral, or facet, joints is one of the most common causes of pain in the neck.

Thinning of cartilage on the articular surfaces leads to the appearance of bone growths – osteophytes. They narrow the lumen of the intervertebral foramen and squeeze the nerve endings. As a rule, dull pain occurs (gradually increasing, of low intensity), especially in the morning after sleeping in an uncomfortable position (on a high pillow, in a prone position). When moving, it increases, and at rest it weakens. The pain can radiate to the back of the head, ear, temple or shoulder.

Herniated and protruded intervertebral discs

Compression of the intervertebral discs that have lost their elasticity leads to their protrusion (protrusion) into the spinal canal and the subsequent formation of a hernia.

As a result, the spinal cord is compressed, leading to impaired hand sensitivity (numbness, burning, weakness) and pain. Shooting (irregular one-sided) pain intensifies when tilting, rotating or throwing the head back, so that the person instinctively tilts his head forward and to the side opposite to the localization of pain.

Cervical myelopathy

Prolonged compression of a hernia of the spinal cord leads to impaired cerebrospinal circulation.

Painful sensations arise not only in the neck, but also radiate between the shoulder blades, in the shoulders. They increase with movement and do not stop even after taking painkillers. Typical signs are the appearance of goose bumps, numbness of the limbs, problems with fine motor skills.Dizziness, memory impairment, gait changes are possible.

Whiplash

Whiplash injury of the cervical spine occurs in a person with a sharp bend of the neck forward or backward, followed by recoil in the opposite direction. Such damage most often occurs in road traffic accidents. In this case, stretching and damage to muscles, ligaments, intervertebral discs and cervical vertebrae occurs. In the most severe cases, dislocations and fractures of the cervical vertebrae occur.

The consequences of trauma can be pain in the cervical spine and shoulders, migraines, spasms of the neck muscles, and impaired mobility.

Concomitant symptoms include blurred vision, fatigue, and headaches.

Neck pain due to muscle-tonic syndromes

Muscle-tonic syndrome is a condition caused by prolonged spasm of several muscle groups in the head, neck, and chest.Compression of the neurovascular bundles leads to pulling, sometimes severe pain. In particular, the syndrome of the scalene muscle is a symptom complex in which the innervation and blood supply of the scalene muscles of the neck, going from the cervical vertebrae to the first and second ribs, are disturbed. This syndrome is characterized by pain and stiffness in the neck, often in the morning, a certain position of the head (the head is tilted forward and slightly towards the tense muscle). The pain can be mild, aching, but sometimes sharp, worse at night, with a deep breath, when the head is tilted to the healthy side.Sometimes pain is transmitted to the shoulders, to the axillary and interscapular regions, to the anterior chest.

Neck pain due to other causes

Persistent and prolonged neck pain can be caused not only by diseases of the spine.

First of all, infectious diseases should be excluded, in particular, nonspecific or tuberculous spondylitis, epidural abscess.Persistent pain that intensifies, rather than diminishes at rest, can be a sign of metastatic lesions of the vertebrae. These symptoms are accompanied by an increase in body temperature, general weakness, and sweating. When pressing on the spinous processes, local pain occurs.

The defeat of the spine is possible with rheumatoid arthritis. As a rule, at an early stage of the disease, pain occurs in the neck, occiput and head. The pain can radiate to the forehead and eye sockets, and increase with bending and turning the head. Loss of sensitivity in the neck and arms.

Diagnostics and examinations

First of all, the doctor pays attention to clinical symptoms: localization and spread of pain, impaired sensitivity in the neck, shoulders, arms, decreased reflexes, general condition, the nature of pain (increases with movement or at rest).

The doctor may prescribe:

• general blood test

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3 840 rub

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General urine analysis (Urinalysis with sediment microscopy)

The study of a single morning portion of urine, including the determination of physical (color, transparency, specific gravity), chemical (pH, protein content, glucose, ketones, urobilinogen, bilirubin, hemoglobin, nitrites and leukocyte esterase), as well as an assessment of the qualitative and quantitative …..

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C-reactive protein (CRP, CRP)

Synonyms: Serum C-reactive protein.

C-reactive Protein (CRP), quantitative.

Brief characteristics of the analyte C-reactive protein

C-reactive protein got its name from its ability to enter into a precipitation reaction with the C-polysaccharide of pneumococci (one of the mechan…

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To clarify the diagnosis, the doctor will need the results of computed and magnetic resonance imaging

90,000 Cardiologist: chest pain is not always associated with heart disease

Often people with chest pains think that their heart hurts. But this can be a sign of completely different diseases.

Dina Sulimanova, a cardiologist, , told the viewers how to learn to distinguish between heart pain.

“We need to pay attention to the localization of pain,” advises Dina Rushanovna. – Heart pain occurs just behind the sternum or in the left side of the chest. It appears with excessive physical exertion. For example, when a person climbs stairs faster, speeds up a step, or carries something heavy.

According to the description, heart pain – pressing, constricting, burning. It can be given to the lower jaw, left arm, or under the left shoulder blade.

Such pain disappears if a person calms down, stops, rests his breath.Or if a patient who has had a heart attack before takes a nitroglycerin tablet. ”

The cardiologist received a lot of questions from viewers and the presenter.

For example:

“It hurts in the left side of the chest, closer to the heart. When inhaling, the pain increases. Maybe it hurts your heart? ”

Doctor: “This pain is characteristic of osteochondrosis of the thoracic spine. It increases with inhalation, exhalation, change in body position. You need to go to a neurologist for appointments and recommendations. “

“Do people often come to see you with pain in the chest, which turns out to be not cardiac?”

“Yes, of course, because chest pain is a fairly significant symptom, and people most often come to a cardiologist to rule out the pathology of the cardiovascular system. With a clear collection of anamnesis, complaints, we understand whether it is cardiac pain, or is it still osteochondrosis, diseases of the stomach or lungs. Further, we already recommend contacting the specialist who will help to cope with this pain. “

“Disturbed by anxiety and chest pain. I did an ultrasound of the heart. In the conclusion, the doctor wrote “aortic sclerosis”, but verbally said that everything was normal. Tell me what is aortic sclerosis? Is it worth worrying about this? ”

“Don’t worry. Aortic sclerosis indicates a hardening of the walls of the aorta. It occurs most often with a prolonged increase in pressure during hypertension. It is recommended to do an ultrasound of the heart once a year. You need to see a therapist at your place of residence. “

“I was picking up a gas stove with a friend. It was light, carried away at a time. An hour later, when I came home, I felt pain in my chest. I have a heart defect, could this somehow affect? Or just pulled a muscle? Acute pain: when bending, turning, or when moving the arm . .. “

“This pain is also associated with osteochondrosis. If the pain is related to movement, it is not heart pain. When a person’s heart hurts, he can lie down, sit, but the pain will not change the intensity, it will also be squeezing, squeezing, burning.Muscle pain or osteochondrosis will be during body movements, turns. If you are worried about this, you need to see a therapist and a neurologist and take an X-ray of the thoracic spine. ”

“Recently, while climbing the stairs at the entrance, I had pain and heaviness in the chest area on the left. The left hand was numb and burning. I came home, took nitroglycerin and lay down. Did I do the right thing? ”

“You did the right thing, but in addition to taking glycerin, you had to call an ambulance.Your pain is very similar to cardiac pain. The ambulance doctors would have taken a cardiogram. If the blood flow is disturbed, changes appear on the ECG that indicate a pre-infarction state and then you would be hospitalized. You need to see a cardiologist. ”

“Recently, I have a sharp constricting pain in the center of the chest. The pain lasts for about two seconds. Everything goes without medication. Could this be a heart problem? ”

“Most likely, the pain is associated with osteochondrosis, but to clarify the diagnosis, it is worth contacting a neurologist and a cardiologist to clarify the diagnosis.”

More important and useful information, interesting questions and answers – in the program “Tell me, doctor” NT, led by Svetlana Sterligova.

How to distinguish heart disease from others

Many people experience chest pain, not necessarily due to any kind of heart disease. This is often due to another ailment. If the heart hurts, it can be caused by diseases of the musculoskeletal system, respiratory, digestive and other diseases.However, only a doctor can make an accurate diagnosis by examining the patient.

But any person who has had such symptoms should understand, if the heart hurts, what to do and how to recognize that this is indeed a heart ailment. You need to know this in order to consult a specialist in a timely manner for some serious pathologies. The signs of the disease may differ, you must definitely learn to recognize them. The most important thing is to distinguish between heart and non-heart pain.To this end, you need to know what is the duration, intensity of the attack. In addition, it is desirable to have information about other diseases, the symptoms of which are similar to those of the heart.

First symptoms of a heart attack

Discomfort in the chest can appear for various reasons. To understand that the heart hurts, it is advisable to know several characteristic symptoms. Attacks are not always accompanied by unpleasant sensations. At the same time, people with other ailments complain that it is difficult for them to breathe, it hurts in the left side of the chest.But all this is not a consequence of cardiac diseases.

The earliest signs that indicate that the motor of the human body is impaired, most often appear for several months, or even years before the first attack. Therefore, everyone should know how and where the heart hurts. Early signs of illness that should alert you are:

1. Pain behind the ribs. They give in the back, arm, neck, teeth. The left side is most often affected.At the same time, there is shortness of breath, nausea, increased sweating.
2. Discomfort after physical activity, stress, which disappears after rest, or nitroglycerin tablets.
3. Dyspnea appears even with moderate exertion, simple work, while eating and even when lying down. Before the onset of the attack, the patient may be sitting asleep or suffering from insomnia.
4. Severe fatigue from the usual activities can begin long before the first attack.
5. The stronger sex sometimes develops erectile dysfunction several years before the diagnosis of coronary artery disease.
6. Puffiness. This symptom is considered the most basic evidence of cardiac dysfunction. At first, the swelling is almost invisible, but becomes larger over time. This is noticeable when a person takes off his shoes or rings from his toes. If swelling is observed, you should consult a specialist and undergo an examination.
7. Cessation of breathing during night sleep, as well as snoring. These signs indicate a predisposition to an attack of heart disease.

Signs of coronary diseases

1.Myocardial infarction

Heart attacks can proceed in different ways and then, how the heart hurts , the symptoms in women and men in different situations can be different. In the case of myocardial infarction, everything happens approximately like this:

• A feeling of heaviness appears, it hurts in the central part of the chest, arm.
• Discomfort extends to the left arm, neck, throat, and lower jaw.
• The head is spinning, sweating appears, the skin is paler, nauseous.
• There is a feeling of heaviness in the stomach, it burns in the chest.
• Anxiety, weakness.
• Rapid pulse.

The course of a heart attack may be different. Signs are sometimes completely absent. Sometimes the patient says that he experiences chest discomfort, sometimes such symptoms are absent and the process can be painless. Signs of a massive heart attack: shortness of breath, blue lips, etc. very similar to the symptoms of acute heart failure.

The duration of such an attack is approximately thirty minutes.Nitroglycerin does not help at all.

2. Ischemia

The main manifestation of ischemic heart disease is angina attacks. In this case, pain in the heart occurs, the symptoms in women and men are the same. Among them:

• heart palpitations;

90,018 shortness of breath;

• cardiac dysfunction;
• pulse inconsistent;
• dizzy, nauseous;
• weakness, sweating.

With ischemic disease, patients say that they have a burning sensation, pressures in the chest.There is a feeling of overflow. Often, discomfort is transmitted to the arm, neck, throat. Most often observed during physical activity, stress and stop when a person is left alone.

With rest angina, pain in the heart, the causes of which are different, appear at any time, even at night. This form is considered unfavorable.

Inflammatory heart disease

1. Pericarditis

Pericarditis is an inflammation of the outer cardiac membrane, the main symptom of which is a dull pain in the region of the heart.It usually hurts in the center of the chest, in some cases it radiates to the arm, back, neck. When swallowing, coughing, etc. the discomfort increases. It gets worse lying down, better sitting up. Although the nature of the pain is usually dull and aching, in some cases it is acute. Pericarditis is also characterized by palpitations.

2. Myocarditis

Inflammation of the myocardium is one of the reasons why the heart hurts, about 90 percent of people complain about it. Its shape can be different, it appears regardless of physical activity, but after a while after that it can become stronger.Nitroglycerin doesn’t help.

Diseases of the heart valves

When valvular disease is present, its severity cannot be judged by symptoms. The patient may not complain about anything and at the same time be in a serious condition. Main symptoms:

• Dyspnea, which is observed not only during high exertion, but even during the most common activities and in the supine position;
• Discomfort in the chest during exertion, breathing in cold air;
• Weakness, dizziness;
• Abnormal heart rhythm.These are, in particular, an uneven pulse, a frequent heartbeat, irregularities in the work of the heart.

A similar pathology often leads to heart failure. Then the following symptoms appear: the legs swell, the giaot swells, the body weight increases.

Cardiomyopathy

Almost all people who have this pathology complain of painful sensations. With the development of the disease, how the heart hurts , the symptoms change. At first, the pain is prolonged, does not depend on physical activity, nitroglycerin does not help.Felt in various places. Further, it is spontaneous or paroxysmal after exercise and most often passes after taking a nitroglycerin tablet. Its character is different, its localization is accurate, but sometimes it spreads over a large area. Nitroglycerin does not always help.

Arrhythmia

There are several types of arrhythmias. They are characterized by changes in heart rate. There are several types of ailments in which heart pains are noted that radiate to the left arm.

Heart defects

These diseases can be acquired or inherited. For a long time they may not talk about themselves in any way. Sometimes the heart hurts, what to do, the doctor should tell. This pain is usually aching, cutting or stabbing. It is accompanied by high blood pressure.

Mitral valve prolapse

Aching or pressing pain on the left is not caused by physical activity. They don’t stop after taking nitroglycerin.In addition, dizziness, heart palpitations, and headaches may occur in the morning and evening. Shortness of breath, light-headedness is possible.

Aortic stenosis

In such a disease, there is a pressing sensation in the chest. There is a strong heartbeat, weakness, fatigue, shortness of breath during physical activity. Over time, shortness of breath is added during night sleep, dizziness. If you suddenly change your body position, fainting may occur. Asthma attacks and angina pectoris are possible.

Pulmonary artery thromboembolism

This is a very serious condition that needs urgent help. The first sign of the disease is a stabbing pain in the region of the heart, which becomes stronger with inhalation and does not radiate to other places. The patient’s skin turns blue, blood pressure decreases, shortness of breath appears, heart palpitations. Nitroglycerin does not work.

Pathology of the aorta

Sudden, very strong painful bursting sensations in the chest are the result of aortic dissection.They are sometimes so painful that a person can lose consciousness. The patient needs urgent medical attention.

If there is an aortic aneurysm, aching or throbbing pain in the heart, the specialist must decide what to do. If the aneurysm ruptures, the pain becomes unbearable. If you do not take action, it can be fatal.

Non-cardiac diseases

1). Intercostal neuralgia. Many people who experience similar pain in the region of the heart mistake it for heart pain.However, in reality they are different. With neuralgia, pain is acute, stabbing. They are aggravated by coughing, deep breathing, sharp turns of the body, etc. It can go away pretty soon, sometimes the pain lasts several hours. The patient can accurately determine the place of discomfort, it is located between the right ribs. In the case of angina pectoris, the person experiences a burning, aching sensation that does not go away when the position of the trunk is changed. It is impossible to determine the exact location.

2). Osteochondrosis. This disease is quite simple to mistake for angina pectoris. A person is sure that his heart hurts, the symptoms are as follows: numbness of the left hand occurs, it becomes more painful when moving. This is especially similar to angina pectoris, when an attack occurs during a night’s sleep. The main difference is that nitroglycerin does not work.

3). Diseases of the central nervous system. In such a situation, patients often complain. However, the symptoms vary. It can be regular, short-term, sharp or aching pain in the region of the heart.Neuroses are usually characterized by a variety of autonomic disorders. A person may experience an anxious feeling, insomnia, or, on the contrary, increased drowsiness. Hands get cold or cold, headache begins, and much more. Often, neurotic patients complain about numerous symptoms they do not actually experience. And the “cores” are very restrained in sharing their feelings. Sometimes it is difficult to understand that the patient has coronary artery disease or cardioneurosis, since the cardiogram does not show any changes.

4). Disorders of the functioning of the gastrointestinal tract. However, in this case, heart pain symptoms are somewhat different. They last longer, while the person is sick, vomits, he has heartburn. The intensity is due to the food intake. Often, the symptoms of acute pancreatitis are similar to myocardial infarction. Sometimes exacerbations of diseases of the gallbladder are given to the left side of the chest and it seems that there are pains in the heart. To understand what the problem is, you should take antispasmodics.If there is relief, then the patient has gastrointestinal diseases.

5). Pulmonary diseases. Painful sensations similar to those of the heart sometimes appear with pneumonia. This can be with pleurisy. But in this case, the pain is acute, aggravated by inhalation and coughing.

What to do?

Each person who has felt painful sensations in his chest thinks what to do next. If there is a suspicion that the heart hurts, you need to take urgent measures. After all, the reason can be serious, in particular myocardial infarction or an attack of angina pectoris.Therefore, you need to do the following:

• Calm down and sit down. Stress will only worsen the situation.
• We must try to take a different position. If relief comes after that, there is a possibility that the cause is different. If the painful sensations increase, pressing pain appears in the region of the heart, there is a risk that it is angina pectoris.
• It is recommended to provide fresh air and open a window.
• So that breathing is not constrained, you need to make the clothes looser, open the collar
• If you suspect angina pectoris, you need to take a nitroglycerin tablet and put it under the tongue.If relief does not come within a quarter of an hour, you need to take another pill. Call for emergency help. With a heart attack, the medicine does not work.

In conclusion

If even the pain in the area of ​​the heart, the causes of which must be established by a specialist, has passed, you need to go to the hospital as soon as possible and be examined. Self-medication is unacceptable.

In Nizhny Novgorod, you can undergo a preventive examination at the “Road Clinical Hospital”, where professionals in their field work.

Chest pain

Chest pain is a symptom of diseases of many organs and systems : respiratory and cardiovascular, stomach and esophagus, intercostal nerves and spine. All diseases manifest themselves in different ways, you cannot rely on the intensity of the pain: with a normal digestive disorder, the pain can be acute, and with a dangerous heart or spine disease, it can be dull and chronic.

Chest pain in diseases of the musculoskeletal system

The nerves that are responsible for breast tenderness are connected to the spinal nerves. With the development of diseases of the thoracic spine, the nerves are pinched and damaged, which causes chest pain, a feeling of squeezing of the heart. The chest is as if squeezed by a hoop. Chest pain is caused by the following pathologies of the spine:

• Thoracic osteochondrosis. Wear and premature aging of intervertebral discs.
• Thoracic disc protrusion. Fissure in the annulus of the intervertebral disc, into which the nucleus is displaced. Because of this, the disc bulges into the spinal canal.
• Thoracic hernia. Damage to the intervertebral disc with the exit of the nucleus outside the spine.
• Kyphosis. Curvature of the thoracic region backward, away from the chest.
• Scoliosis. Curvature of the thoracic region to the right or left.
• Kyphoscoliosis. Combination of kyphosis and scoliosis: curvature of the thoracic spine in all directions.
• Spondyloarthrosis. Inflammation and atrophy of the intervertebral joints.
• Radiculitis. Inflammation of the spinal nerve roots.
• Myositis. Inflammation of the muscles.

Separately, one should single out such a group of diseases of the musculoskeletal system as arthritis.Arthritis of the shoulder joint gives off pain in the chest, shoulder blades, neck, and causes numbness in the fingers.

Dangerous complications

Against the background of constant pinching and inflammation of the spinal nerves, intercostal neuralgia develops. There is constant severe pain throughout the chest or on one side, which is aggravated by movement, deep inhalation and coughing. There is a sensation of skin numbness, burning or tingling.

Diseases of the spine are dangerous and other complications: decrease and loss of mobility, paralysis, disability.The same complications occur with advanced shoulder arthritis.

Chest pain treatment

First of all, diagnostics are carried out to identify the root cause of chest pain. If a pathology of the spine is detected, an X-ray or MRI study is most often prescribed. In case of joint damage, ultrasound and also MRI of the joint are prescribed. A puncture of the joint may be needed.

Treatment includes medications that relieve pain, inflammation, muscle spasms, and repair pinched nerves.Physiotherapy and physiotherapy exercises are also prescribed, which improve blood circulation, metabolic processes, strengthen the muscles of the back and chest.

Prevention recommendations

• Warm up frequently, exercise, swim, yoga or fitness;
• Try to keep your back straight while walking and seated work;
• Avoid drafts, hypothermia, do not bathe for a long time, even in warm water;
• Avoid excessive physical exertion, do not lift heavy objects;
• Avoid sharp turns, bends;
• Avoid stressful situations, overwork;
• Watch your diet and weight;
• Give up bad habits: smoking and alcohol;
• Get a routine inspection annually.

Determine the true cause of the pain

Relieve pain, inflammation and muscle spasms

Repair pinched nerves

Prevent the development of complications

We will form a comprehensive treatment plan

90,000 Can a heart ache? | Health Blog “Ramsey Diagnostics”

Headache or heaviness in the back rarely frightens patients.And chest discomfort usually causes panic, and for good reason. Few can quickly distinguish between the symptoms of angina pectoris and neuralgia and correctly assess the risks. Can a heart ache in a young and healthy person? Maybe your heart is okay, and the pain causes pinched nerves or an attack of gastritis? There can be many reasons, and they, for our good luck, have different symptoms.

Probable causes of pain

There are many diseases that can cause painful sensations in the chest.A small part belongs to the heart, and it consists almost entirely of acute conditions:

• vascular pathologies: heart attack, angina pectoris, aortic dissection;
• inflammatory processes: myocarditis, pericarditis, endocarditis;
• congenital pathologies: valve prolapse, heart disease, cardiomyopathy, arrhythmias.

Pain from almost all organs of the abdominal cavity, spine, ribs, and lungs can spread to the upper part of the chest. Even stretched chest muscles can cause heaviness and pain that can easily be mistaken for heart problems.Discomfort in the chest can result from:

• pathologies of the spine and musculoskeletal system: osteochondrosis, scoliosis, neuralgia;
• lung diseases: pleurisy, pneumonia, abscess;
• diseases of the gastrointestinal tract: stomach ulcer, hernia of the esophagus, acute pancreatitis, gallbladder dyskinesia;
• psychological problems: heart neurosis, stress.

Can the heart hurt like the stomach and spine? Symptom Differences

Symptoms in diseases are similar: pulling pain, tingling, acute attacks.Pain can radiate to the shoulder, arm, back and lower abdomen. Heart problems should be suspected if the following occurs:

• feeling of heaviness and squeezing;
• burning in the region of the heart;
• manifestation of attacks and gradual worsening of symptoms;
• A sharp change in pressure or pulse in either direction (the main symptom of heart disease).

If we talk about diseases of internal organs, then the pressure and heart rate will not change with them.Only with perforation of the stomach ulcer will the pressure drop sharply due to internal bleeding. Usually, chest pain is caused by much less dangerous conditions. They can be distinguished by the following sensations:

• tingling,
• shooting,
• pain manifests itself with sudden movements or coughing,
• painful sensations do not subside and are constantly present.

Doctors advise taking nitroglycerin for any suspicion of heart pain. If he did not help, then this is either organ diseases or an acute heart attack, which can be distinguished from neuralgia and pneumonia by the intensity of the symptoms.

Possible heart disease

With chest pain, the very first thing that comes to mind is heart attack – necrosis of the heart muscle. This is a dangerous condition that requires immediate medical attention. Otherwise, it can even lead to death. The main symptoms are:

• chest pain radiating to the left arm, jaw, back and right side;
• weakness, feeling of panic fear;
• nausea, pallor, abdominal pain;
• in the case of an extensive area of ​​necrosis – loss of consciousness, blue color of the lips and nails, impaired breathing.

Ischemic disease , or angina – partial or complete blockage of the coronary arteries. It often develops against the background of high blood pressure, a sedentary lifestyle, and excess weight. In addition to pain, shortness of breath and weakness, the patient feels heaviness, as if a weight was placed on the chest.

Aortic rupture causes such an acute attack of pain that the person faints. Massive internal bleeding begins, and urgent medical attention is required to save life.

Pericarditis , endocarditis , myocarditis – inflammation of different parts of the heart: the shell, valves and the muscle itself. They are caused by infectious diseases such as tuberculosis, syphilis, or fungal infections. Symptoms are similar to angina pectoris – pain, heaviness in the chest, shortness of breath. The patient is more comfortable in a semi-sitting position, his temperature rises and noticeable edema appears.

Arrhythmia rarely brings significant discomfort.With her, pain is felt only in the heart, without leaving it. It is often so weak that you may not even be aware of its presence until you have had a planned EKG.

How to recognize non-heart diseases?

They can be divided into three main groups: diseases of the musculoskeletal or nervous system and the gastrointestinal tract.

• among the pathologies of the musculoskeletal system can cause chest pain osteochondrosis, hernia, tendonitis, arthritis.In the first case, the pain is caused by pinching of the nerve endings by the curved spine. The sensations will be unpleasant, but weak. They may be accompanied by tingling and numbness in one or both arms, shoulders, and chest. Hernias in advanced stages cause severe pain that subside if the patient assumes a comfortable, relaxed position. Despite the reflection of pain in the chest and abdomen, the focus is felt in the region of the spine. Joint diseases are easily distinguished by reduced mobility.
• Chronic diseases of the gastrointestinal tract (for example, an attack of gastritis) cause mild aching pain.Acute conditions – stomach ulcers, pancreatitis, blockage of the bile ducts – cause unbearable pain, localized in the middle or side of the abdominal cavity, but which is reflected in the heart, back and even shoulders. With problems with the gastrointestinal tract, the patient feels nausea, weakness, sweating. For any acute pain in the abdominal cavity, you should immediately call an ambulance!
• diseases of the nervous system are not only neuralgia with acute pain during sudden movements, but also a neurosis of the heart.Neuralgia is easy to distinguish by its point localization. With stress, fatigue and lack of sleep, the pain is weak, aching and constant, intensifying after nervous tension.

Unpleasant sensations can cause diseases of the respiratory system. However, they can be easily distinguished by coughing, fever and noises in the bronchi.

Diagnostics of possible diseases

In an acute condition, you need to go to an ambulance – due to necrosis of the heart tissue or internal bleeding, the count goes for minutes.But you should start examining the body even with mild chest pain – if you detect the disease in time, you can prevent it from developing into a severe form.

For the diagnosis of the heart, the following are usually used:

• ECG – the simplest and most famous examination,
• Coronary angiography of the heart – the study of the state of the arteries and heart valves,
• Ultrasound of the heart – according to its results, the state of the entire heart muscle and its individual structures can be seen.

If heart disease has been excluded due to symptoms or tests, other tests may help:

• Fluorography or CT of the chest to assess the state of the respiratory system,
• CT of the thoracic spine for a detailed examination of the spine,
• MRI of the thoracic spine will allow to examine the bone and nerve structures in more detail,
• Ultrasound of the abdominal organs – pathologies will be visible on it gallbladder and pancreas,
• Gastroscopy to examine the walls of the esophagus and stomach.

Do not delay research on chest pain, as you can miss the treatment period. If you try to diagnose yourself, you can make a mistake and aggravate the problem. Only a specialist will be able to direct you to the necessary examinations, draw the correct conclusions from the examination and be able to suggest treatment. And do not forget that for any attacks of severe chest pain, you should go to an ambulance – you can underestimate the symptoms and miss a serious pathology.

90,000 possible causes and when to sound the alarm

What to do when you feel discomfort or chest pain? Perhaps it’s a heart attack, or maybe another, less serious problem? In this article, we will look at the most common causes of chest pain, as well as the typical signs of the diseases in which they appear.

By the nature of the manifestation, the pain is different: from sharp and piercing – to dull, but not strong. It is sometimes described as squeezing or burning. In some cases, the pain radiates to the neck, then to the jaw, and then moves to the back or down one or two arms.

The causes of chest pain can vary, but the most dangerous are those related to the heart or lungs. Although in many cases the cause of pain has nothing to do with these organs.

Chest pain comes from:

• The organs that are located in it are the heart, lungs and esophagus.
• Components of the chest wall – skin, muscles and bones.
• Organs located next to the chest – liver, gallbladder, stomach, pancreas.

Sometimes chest pain is caused by pain in the neck that spreads to the chest. This is called reflected or repercussion pain.

What are the most common causes of chest pain?

Causes related to the heart

All organs and tissues of our body need oxygen and nutrients, which are carried through the blood.The heart pumps oxygen-rich blood through a vast network of arteries. This network includes vessels that supply blood to the heart muscle itself. These vessels are located on the surface of the heart and are called coronary arteries. They branch out into smaller vessels located inside the heart muscle.

In people with coronary heart disease, the coronary arteries become clogged with fatty deposits – plaques. These deposits cause the arteries to narrow and prevent oxygenated blood from reaching the heart.Angina is the term for ischemic chest pain.

When the heart has to work harder, it needs more blood and oxygen. If the extra oxygen-rich blood cannot pass through the narrowed coronary arteries, the heart begins to ache. That is why angina pectoris is especially evident during physical activity.

Chest pain caused by angina pectoris manifests itself as discomfort or squeezing behind the sternum during exertion.Sometimes it gives into the arms, neck, jaw, or stomach area. Angina pain is usually mild and diminishes after 10 minutes of rest.

• Myocardial infarction (heart attack)

During a heart attack, a plaque is damaged or ruptured. Subsequently, the blood coagulation mechanism is triggered, during which a blood clot forms at the site of damage. The latter completely blocks the coronary artery or one of its small branches. This means that part of the heart muscle is left without blood and oxygen.If an artery is not quickly relieved of the blockage, the portion of the heart muscle that is left without oxygen is damaged or dies. This is myocardial infarction.

The most common symptom of a heart attack is severe chest pain at rest. However, scientists at Harvard Medical School warn that pain is just one possible symptom of an attack. Seek medical attention immediately if a person notices one or more of the following symptoms:

• Compressive, burning pain in the center of the chest.Sometimes, heart attack patients feel as if a belt is tightly tightened around their chest.
• Pain, numbness, tingling, or other discomfort in one or both arms, back, neck, jaw, or stomach.
• Shortness of breath or shortness of breath.
• Sudden nausea or vomiting.
• Dizziness or lightheadedness.
• Unusual tiredness and a feeling of heaviness.
• Heat or cold sweat.

Sometimes chest pain in a heart attack resembles angina pectoris, but in most cases it is more severe and prolonged.

Certain heart problems that are not related to blood flow in the coronary arteries can also cause chest pain.

• Variant angina

This type of angina occurs due to a temporary spasm of the coronary arteries. Usually, in this case, the arteries do not have narrowing or blockages.

This inflammation of the sac (pericardium) causes acute pain that is worse when the person takes a deep breath or lies down.

This is an inflammation of the heart muscle itself, which causes chest pain. Myocarditis feels very similar to angina pectoris. Often, myocardial inflammation is triggered by a viral infection.

• Hypertrophic cardiomyopathy

In this condition, the heart muscle (myocardium) thickens, making it harder for the heart to pump blood. In a small number of patients, this disease manifests itself in the form of shortness of breath and chest pain. Sometimes the work of the electrical system of the heart is disrupted, resulting in arrhythmias.

• Aortic dissection

This rare but life-threatening condition affects the main artery that leaves the heart, the aorta. This vessel is made up of layers of muscle cells that can separate and rupture. Subsequently, blood flows out to an area of ​​the body outside the circulatory system. This is an extremely serious condition that requires the intervention of a vascular surgeon. With aortic dissection, the pain is very severe and appears suddenly, radiating to the back or to the area between the shoulder blades.

Causes related to the lungs

A number of problems related to the lungs cause chest pain:

• Pulmonary embolism

With an embolism, a blood clot forms in the pulmonary artery that blocks blood flow to lungs. The pain comes on suddenly, is accompanied by shortness of breath, and may worsen when the person breathes deeply.

An infection in the lungs causes not only cough and high fever, but also chest pain.

If the membrane that covers the lungs becomes inflamed, it causes pain. They usually get worse during inhalation and coughing. Pleurisy can appear due to a viral infection, as well as as a complication of pneumonia, pulmonary embolism, or chest trauma.

With pneumothorax, air enters the space between the chest wall and the lung – the pleural cavity. Chest pain comes on suddenly and can last for hours.

• Pulmonary hypertension

If pressure rises in the arteries that carry blood to the lungs, the person may develop chest pain.

Causes related to the digestive system

• Heartburn (acid reflux)

This is a painful, burning sensation behind the breastbone that occurs when gastric juice enters the esophagus.

• Problems with the gallbladder or pancreas

Gallstones or inflammation of the pancreas cause abdominal pain that spreads to the chest.

• Stomach or duodenal ulcer

With an ulcer, it hurts in the upper abdomen – just under the sternum. The pain that is characteristic of the ulcer appears and disappears, and sometimes it is felt as chest pain. The accompanying symptoms of peptic ulcer disease are bloating, vomiting, feeling unwell, and a feeling of full stomach after eating.

Esophagitis is an inflammation of the esophagus that sometimes occurs due to medication.

Other causes of chest pain include:

• Panic attacks

If you have periods of intense anxiety accompanied by increased heart rate, profuse sweating, nausea, chest pain, dizziness and fear of death, you may be suffering from panic attacks.

• Shingles

This is an infection that affects the nerve and the area of ​​the skin that it innervates. If lichen attacks the nerve that innervates the skin in the chest area, the person develops chest pain. In most cases, a rash appears in the area of ​​nerve damage 2-3 days after the first painful sensations appear.

What to do if chest hurts?

For any new, severe or prolonged pain, see a doctor as soon as possible.This is especially true for people who have previously experienced heart or lung disease. If you are worried about very severe pain in the chest, which gives to the hands or jaw, you feel unwell, sweat a lot or are short of breath, call an ambulance immediately. These symptoms may indicate a heart attack.

If the pain is mild and does not bother often, it is necessary to conduct an examination. Its main goal is to eliminate heart and lung problems that can pose a danger to human life.The main diagnostic procedures for chest pain:

• electrocardiogram,
• blood test,
• chest x-ray,
• endoscopy and other research methods.

If you are concerned about chest pain and want to find out the source of its origin, contact your physician.

How to recognize a “silent heart attack”? And is it possible not to notice it at all?

October 30, 2019

Photo author, Getty Images

Acute chest pain, sudden pressure surge, sudden onset of shortness of breath. This is approximately how we imagine the symptoms of a heart attack – and often this is exactly what happens.

Other signs that can identify an acute heart attack include cutting pain in the arm or neck, dizziness, and profuse sweating.

But what if the attack passes without such obvious symptoms – so that the patient himself does not even know that he has experienced a heart attack?

According to a Harvard University study, this happens much more often than doctors expected. Almost half of all cases of acute heart attack (45%) occur in the so-called silent or imperceptible infarction (SMI – silent myocardial infarction), which often affects men.

“Symptoms of SMI can be so mild and so short-lived that they are often mistaken for ordinary discomfort or other less serious problem – so they are often ignored by men,” explains George Platzky, professor of hospitals at Harvard University.

For example, men can often attribute fatigue or physical discomfort to overwork, poor sleep, or even just age-related changes in the body. And a mild sore throat or chest area will be mistaken for symptoms of heartburn or indigestion.

In addition, it is often difficult to determine exactly where the pain is coming from. For example, a sharp pain in the left side of your chest is likely to make you suspect a heart attack, but a “silent heart attack” can cause only slight chest discomfort in general.

Warning signs and reasons for concern:

• discomfort in the center of the chest (slight sensation of pressing pain), which does not go away for several minutes or quickly disappears, but comes back again;
• General discomfort in the upper body in general – for example, discomfort in one or both arms, in the back, abdomen, neck or lower jaw;
• Difficulty breathing before or after chest discomfort;
• Sudden cold sweat, dizziness, or nausea.

“Sometimes a person generally feels completely normal – both during and after SMI – which only increases the risk that alarms will not be noticed,” – warns Professor Platzky.

This is why the results of the Harvard Medical Study published in the Journal of the American Medical Association are particularly alarming.

Men at risk

Doctors examined almost 2000 men and women aged 45 to 84 who did not have cardiovascular diseases, and 10 years later they made another MRI of the heart in the same patients.

In 8% of them, scars were found on the heart, indicating a previous myocardial infarction – while 78% of patients who survived the attack did not even know about it.

Photo by Science Photo Library

Men experienced a “silent heart attack” five times more often than women.

Judging by the results of the study, the risk factors for SMI are exactly the same as for a regular heart attack: smoking, excess weight, lack of exercise, high blood pressure, cholesterol and diabetes.