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Muscle pain under breastbone: Sternal pain – different causes

Pain under the right breast: Causes, symptoms, and treatments

Pain under the right breast can result from injuries, infections, muscle strain, inflammation, and gastrointestinal issues. It can sometimes be a sign of an underlying health condition.

A strain or injury are common causes of pain under the right breast, and the pain usually gets better on its own. However, it can also result from conditions affecting the underlying tissues and organs, or the pain may be extending from another area of the body, such as the stomach.

In this article, we explore some potential causes of pain under the right breast, along with their main symptoms and treatments. We also describe when to see a doctor.

An injury or muscle strain can cause pain under the right breast.

Injuries to the ribs or chest area are common and can be very painful. Depending on where the injury occurs, this pain may manifest under one or both of the breasts.

Possible causes of chest injuries include:

  • knocks or blows to the chest area
  • falls
  • severe coughing

Other symptoms of an injury can include swelling and bruising. More forceful injuries can also result in bruised or fractured ribs.

People recovering from surgery to the breasts or chest area may also experience pain or discomfort under one or both breasts.

Treatment

A person can usually treat minor chest injuries at home with rest and over-the-counter (OTC) medications, such as acetaminophen and ibuprofen.

Applying ice to the affected area for up to 20 minutes at a time may also help reduce pain and swelling.

See a doctor for pain that results from a serious injury, such as a car accident. People with severe or worsening pain should also speak to a doctor.

It is possible to strain or overstretch the chest muscles, which can result in soreness and pain. Depending on which muscles a person strains, this pain may occur under a single breast.

Chest muscle strains can result, for example, from throwing, heavy lifting, and using heavy tools or equipment.

Treatment

Muscle strains usually get better with rest. OTC pain relievers and applying ice to the affected area for up 20 minutes at a time may help reduce chest discomfort.

Hormonal fluctuations that occur during the menstrual cycle can cause the breasts to become swollen and tender.

This tenderness usually occurs in the week or so before a person’s period, and it can affect one or both breasts.

Treatment

Taking OTC pain relievers and drinking plenty of water can help reduce breast tenderness from menstrual hormonal changes. The symptoms usually resolve before a person’s period is over.

Costochondritis is an inflammation of the cartilage in the costochondral joint, which is the area where the ribs meet the sternum, also called the breastbone.

The main symptom of costochondritis is chest pain, which can occur in one or both sides of the chest. This pain can be dull or sharp and may get worse when taking a deep breath or coughing. There may also be tenderness around the breastbone.

Costochondritis does not usually cause severe symptoms, such as shortness of breath, fever, or dizziness.

Doctors do not fully understand what causes costochondritis, but it may result from one or more of these issues:

  • chest injuries
  • intense physical activity
  • strenuous coughing
  • illness, such as a chest infection near the costochondral joint

Treatment

Costochondritis often gets better on its own, but it may last several weeks.

Some ways to relieve inflammation and pain from costochondritis:

  • avoiding activities that stress or aggravate the chest area
  • applying heat packs to the affected area
  • taking nonsteroidal anti-inflammatory drugs — NSAIDs — such as naproxen or ibuprofen

For pain that gets worse or does not go away, a doctor may recommend steroid injections or physical therapy.

A person who experiences a gallbladder attack should seek treatment.

The gallbladder is a small organ on the right side of the body that stores bile from the liver. If bile contains too much cholesterol or bilirubin, or if a person’s gallbladder does not empty properly, gallstones can form.

Most gallstones pass without causing problems. However, gallstones that block the flow of bile in the bile ducts can cause pain and inflammation. The episodes of pain resulting from these blockages are called gallbladder attacks or biliary colic.

The pain from a gallbladder attack usually occurs in the upper right abdomen and can last for several hours.

Attacks that last for more than a few hours can lead to complications. For instance:

  • jaundice, which is yellowing of the skin and eyes
  • nausea and vomiting
  • fever

Treatment

Anyone who has had a gallbladder attack should see a doctor, even if symptoms get better, because more attacks may follow. People who experience complications should receive prompt medical attention.

If gallstones continue to cause problems, doctors usually recommend surgery to remove the gallbladder. The gallbladder is not an essential organ, and removal reduces the risk of it becoming infected and causing further complications.

For people who cannot undergo gallbladder removal, doctors may recommend some of the following nonsurgical treatments:

  • endoscopic retrograde cholangiopancreatography
  • oral dissolution therapy
  • shock wave lithotripsy

A hiatal hernia occurs when part of the stomach slides up through the hiatus, which is an opening in the diaphragm. The diaphragm is a large, thin sheet of muscle that separates the chest cavity from the abdomen.

Hiatal hernias do not always cause noticeable symptoms, but they can increase a person’s risk of gastroesophageal reflux disease (GERD). Some examples of symptoms:

  • chest pain
  • heartburn
  • problems swallowing
  • shortness of breath
  • nausea and vomiting

Treatment

Treatment is usually necessary if the hiatal hernia is causing problems. For people with symptoms of GERD, treatment options include:

  • lifestyle and dietary changes, such as maintaining a healthy weight and avoiding foods that make symptoms worse
  • medications that reduce stomach acid, such as antacids, h3 receptor blockers, and proton pump inhibitors

If these treatments are unsuccessful, a doctor may recommend surgery to correct the hernia.

Irritable bowel syndrome (IBS) causes gastrointestinal symptoms, such as abdominal pain and changes to a person’s bowel movements. These symptoms tend to vary in type and severity from person to person.

Some symptoms of IBS:

  • bloating and gas
  • constipation or diarrhea
  • a feeling of incomplete evacuation after having a bowel movement
  • stools containing a whitish mucus

IBS can sometimes also cause referred pain, including right-sided chest pain.

Treatment

Treatment for IBS typically includes some of the following lifestyle and dietary changes:

  • increasing fiber intake
  • exercising regularly
  • reducing and managing stress
  • getting enough sleep
  • following a specific diet, such as the low-FODMAP diet.

FODMAP is an acronym for oligo-, di-, monosaccharides, and polyols, which are groups of carbs that can cause digestive symptoms, including bloating, gas, and pain.

Doctors may also prescribe specific medications to reduce constipation, diarrhea, and abdominal pain.

Shortness of breath and chest tightness are potential symptoms of pleural disorders.

The pleurae make up a large, thin membrane that is folded over to form two layers. One layer wraps around the lungs, and the other lines the inside of the chest cavity. The space between these two layers is called the pleural space.

Inflammation of the pleura is called pleurisy, and it can cause the two layers to rub against each other. This friction can lead to sharp chest pain when coughing or breathing deeply.

In different pleural disorders, air, gas, fluid, or blood collects in the pleural space, which can also cause sharp chest pain.

Other symptoms of pleural disorders:

  • coughing
  • fever and chills
  • shortness of breath
  • fatigue
  • chest tightness
  • weight loss
  • a bluish tint to the skin

Treatment

Treatment for a pleural disorder depends on the underlying cause and the severity of a person’s symptoms.

For example, if a bacterial infection is causing the condition, a doctor may prescribe antibiotics. They may also recommend anti-inflammatory medications or pain relievers to help reduce a person’s discomfort.

Some people require a procedure to drain gas or fluids from the pleural space.

Pneumonia is infectious inflammation of the tiny air sacs in the lungs, which causes them to fill up with fluid. It can lead to a range of symptoms, including sharp chest pain that typically gets worse with deep breathing or coughing.

Other symptoms of pneumonia:

  • fever and chills
  • a persistent cough that produces green, yellow, or bloody mucus
  • a loss of appetite
  • fatigue and low energy levels
  • confusion
  • nausea
  • shortness of breath or other breathing difficulties

Early symptoms of pneumonia can be similar to a common cold or the flu and may come on suddenly or gradually worsen over a few days. Symptoms can vary from mild to severe.

The most common cause of pneumonia is a bacterial infection, but pneumonia can also result from viral or fungal infections.

Treatment

People with symptoms of pneumonia should see a doctor. Seek urgent medical attention if symptoms are severe.

Pneumonia can sometimes lead to life-threatening complications, and some people require hospitalization.

Treatment depends on the type of pneumonia and the severity of symptoms. Doctors may prescribe antibiotics for bacterial pneumonia or antiviral medications for viral pneumonia.

To treat mild pneumonia at home, a doctor may recommend the following:

  • getting plenty of rest
  • drinking lots of fluids
  • taking OTC pain relievers
  • avoiding tobacco smoke and other lung irritants
  • taking oral antibiotic or oral antiviral therapy, as prescribed

See a doctor if the pain under the right breast gets worse, does not go away, or is interfering with daily activities. Also, seek medical attention if the pain accompanies other concerning symptoms.

Some symptoms that require immediate medical attention:

  • severe, sharp, or sudden chest pain
  • chest pain that radiates to other parts of the body, such as the jaw, arms, or shoulders
  • a bluish tint to the lips or skin
  • difficulty breathing
  • coughing up blood
  • confusion, dizziness, or loss of consciousness

Pain under the right breast is rarely a cause for concern and often results from muscles strains or minor injuries.

However, it can indicate a more serious condition, such as an infection, chest inflammation, or a gastrointestinal issue.

If the pain gets worse, does not go away, or occurs with other concerning symptoms, see a doctor. Seek immediate medical attention for severe chest pain or pain that accompanies breathing difficulties.

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What to Know About Strained Chest Muscles

Sharp pain and tightness in your chest. Difficulty breathing. These are just a few of the symptoms of a potential heart attack, but they can also mirror a pulled chest muscle.

A strained or pulled chest muscle is much less serious than a heart attack, but it can be quite painful.   

Read on to learn more about the causes and symptoms of muscle strains in the chest, how they are diagnosed and treated and how the symptoms differ from a heart attack.

The muscles of the chest

Your chest is made up primarily of two muscles, the pectoralis major and the pectoralis minor, as well as your intercostal muscles.

  • The pectoralis major muscles are the fan-shaped muscles that go from your armpits to the center of your breastbone, or sternum. 
  • The pectoralis minor muscles are smaller muscles under the pectoralis major that run along your ribs, just under your collarbone. 
  • The intercostal muscles run between the ribs and form the chest wall.

While it’s possible to strain the pectoralis major or pectoralis minor muscles, nearly half of all chest muscle strains occur in the intercostal muscles.

“Your intercostal muscles are responsible for helping you breathe, so straining them can feel scary, especially if you’re having trouble breathing,” said Sarah Chapman, DPT, an orthopedic clinical specialist at Banner Health in Gilbert, AZ. “Thankfully, usually all these strains are minor.”

What causes a strained chest muscle?

A pulled chest muscle can occur due to overstretching or pressure or strain on the muscles. These can be caused by a number of different situations, but are most commonly seen in athletes. 

“Many people pull their chest muscles in contact sports and other athletics that require forceful or repetitive motion, like tennis, golf, gymnastics and rowing,” Chapman said. “Similarly, if your arm is pulled back and overhead quickly or for prolonged periods of time, such as during weightlifting, it can cause a chest strain.”

The other common causes of chest muscle strains include:

  • Skipping warm-ups before sporting activities
  • Accident or injury, such as a car accident or fall
  • Lifting the wrong weight
  • Lifting while twisting, such as lifting heavy boxes off of shelves or moving furniture 
  • Hard coughing or sneezing during illness, such as bronchitis or a bad cold

What are the symptoms of strained chest muscle?

A strained chest muscle usually causes pain in the chest area that gets worse with movement or coughing.  

“You may notice pain or tenderness along the chest, tenderness when touching the injured muscle, pain with arm movements and difficulty moving the arm,” Chapman said. “There may also be bruising, swelling or muscle twitching or spasms.”

As mentioned earlier, this pain may be confused with a heart attack. However, in the case of a heart attack, there are usually other symptoms that will occur.

“With a heart attack, the pain will radiate down your arm and you may also experience nausea or vomiting, shortness of breath, dizziness, fainting, sweating, fatigue and an irregular heart rate,” Chapman said. 

Call 911 if you are experiencing symptoms of a heart attack. Do not drive yourself to the emergency room.

How is a muscle strain diagnosed?

Avoid trying to self-diagnose and treat without seeing your health care provider first. Although strains are often minor, it’s important for your provider to evaluate your symptoms and rule out something more serious, such as a broken bone.

If your pain is caused by a pulled muscle, your provider with determine if its acute (due to an injury or trauma) or chronic (due to repetitive use) and will assign a grade based on the severity of the injury.

  • Grade 1 strains (mild strains) describe mild damage to the chest that affects less than 5% of the muscle fibers.
  • Grade 2 strains describe a moderate tear to the chest that affects a higher amount of muscle fibers. This may affect mobility and strength, but the muscle isn’t fully ruptured.
  • Grade 3 strains describe a complete muscle rupture, which may require surgery to reattach the affected tendon to the bone.

What are the best ways to treat a strained chest muscle?

Most of the time, a pulled muscle is a minor injury and with proper care can heal on its own within a few weeks. 

In most mild to moderate chest muscle strains, as with all muscle strains, RICE (rest, ice, compression and elevation) is the best first line of treatment.  

Rest: Stop activity, especially those that cause you to pull your chest muscle. 
Ice: Apply ice packs or heat to the injured area to help reduce pain.
Compression: If necessary, wrap an elastic bandage to help reduce swelling. It’s important to not make the bandage too tight, as this can cause additional pain. 
Elevation: Keep your chest elevated, especially at night. You can use pillows or a wedge to help.

You may also want to consider taking over-the-counter pain relievers such as ibuprofen or acetaminophen to help with inflammation and pain.

As your pain lessens, you may slowly return to previous sports and physical activity.

For chronic muscle strains that don’t improve with rest, your provider may recommend physical therapy or changing your exercise routine to build strength in the surrounding areas. 

How can I prevent muscle strains and pulled chest muscles?

It’s important to keep the muscles in your chest stretched and strong in order to avoid injury.   

“Remember to properly warm up before performing any sport or exercise, lift heavy objects with care and avoid lifting heavy weight without proper training or practice,” Chapman said. “As well, stretch after exercise to maintain flexibility in your chest.”

Some exercises to try are a pec stretch and a doorway stretch:

  • To do a pec stretch, stand with your arms at your side and then clasp your hands together behind your back. Slowly push arms up until you feel a stretch in your chest and hold for 10 to 30 seconds.
  • To do a doorway stretch, stand by an open doorway with your arms at a 90-degree angle and palms flat on the doorframe. Slowly step forward with one foot and lean forward until you feel a stretch in the chest. Hold this for 10 to 30 seconds.

Takeaway

A strained chest muscle can be painful but it’s often a minor condition that, with some rest and proper care, can get better. 

Experiencing chest pain?

Call 911 if you have symptoms of a heart attack.

For all other chest pain:

Save your spot for a virtual or in-person urgent care visit.
Schedule an appointment with a primary care provider.

Other useful articles:

  • What’s Best for Your Fitness, Static or Dynamic Stretching?
  • How to Strengthen Your Muscles with Resistance Bands
  • How to Keep Your Muscles Strong as You Get Older
  • Everything to Know About Blood Clots in Your Veins, Heart and Lungs



Sports Medicine
Physical Therapy
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Diseases of the thoracic spine that we treat in Khimki

Vital organ systems are located in the chest. Any discomfort in the chest area that occurs on the left, right, in the sternum, when inhaling, turning to the side, bending over is a sign for immediate medical attention.

Most often, pain occurs in front of the sternum and is sharp, pressing, stabbing, squeezing in nature, a person feels a burning sensation in the sternum. The pain radiates to the back, arm, shoulder blade, collarbone. All these symptoms may indicate the presence of pathology in the musculoskeletal system, the neuromuscular apparatus, and the system of internal organs.

It is a mistake to believe that if pain occurs in the sternum, it is associated only with diseases of the cardiovascular system.

There are a number of causes, not related to cardiovascular and pulmonary pathology, leading to pain in the chest on the left, right and in the sternum. let’s consider them:

  • osteochondrosis of the thoracic or cervical spine – these are degenerative-dystrophic changes in the intervertebral discs. The pain is dull, paroxysmal, localized in the region of the sternum, may radiate to the region of the shoulder blades. Often confused with cardiac pathology (angina pectoris). Often occurs at night and does not go away after taking cardiovascular drugs. The disease can begin in middle age and lead to permanent disability;
  • Tietze’s syndrome – costal chondritis, inflammation of the cartilage in the articulation of the ribs and sternum. Occurs after trauma, surgery in the chest area, metabolic disorders. It is manifested by acute pain when turning, tilting, inhaling, coughing and sneezing. As a rule, one-sided, can give to the right or left hand;
  • intercostal neuralgia – damage to the intercostal nerves, when they are irritated, pinched, various toxins enter the body, etc. There is a strong, sharp, sharp pain in the area from the spine to the sternum;
  • violation of posture, scoliosis – the disease begins in early adolescence and progressing, leads to a change in body geometry, displacement of internal organs, persistent pain in the chest;
  • injury – bruises, fractures, cracks in the musculoskeletal structure of the chest.

It is important to identify the causes of chest pain and prescribe effective step-by-step treatment. Do not self-medicate, you can harm yourself and aggravate the course of the disease.

Doctors of the Medical Center “Freedom of Movement” are highly qualified specialists in the treatment of diseases of the musculoskeletal system and neurological pathology.

The doctor will conduct an external examination, collect an anamnesis, find out the nature, intensity and localization of the pain attack. He will prescribe all the necessary diagnostic tests.

Diagnostic examination:

  • chest x-ray;
  • computed tomography;
  • magnetic resonance imaging;
  • ultrasound diagnostics;
  • electromyography;
  • general and biochemical blood test.

Under the strict guidance of our specialists, you will effectively and comfortably go through all stages of treatment, eliminate chest pain and return to normal life. An individual treatment method is selected for each patient.

Methods of treatment:

  • therapeutic massage;
  • physiotherapy exercises;
  • reflexology, kinesiotherapy;
  • shock wave therapy;
  • kinesiotherapy;
  • drug treatment.

We will take into account your wishes and draw up a schedule of treatment procedures without compromising your life and work. Our clinic is open Mon-Sat: from 9:00 to 21:00, Sun: from 09:00 to 19:00.

We are waiting for you at the address: Moscow, Kurkinskoe highway, 30

You can make an appointment by phone: +7(495) 212-08-81

Differential diagnosis of chest pain

Chest pain can indicate diseases of many organs and systems: cardiovascular, nervous , digestive, respiratory, musculoskeletal, endocrine.

Diagnosis of chest pain should have a clear algorithm.

I Evaluation of complaints
When a patient is admitted with complaints of chest pain, it is first necessary to exclude a number of urgent conditions that threaten the patient’s life: ACS, PE, dissecting aortic aneurysm, spontaneous pneumothorax. . All these diseases have an acute onset and are typically characterized by burning pain behind the sternum lasting more than 30 minutes, not relieved by nitrates. The pain is often accompanied by shortness of breath, cyanosis, and arterial hypotension up to the development of shock.

In case of myocardial infarction pain has irradiation characteristic of angina pectoris. Lasts more than 15-20 minutes, does not pass against the background of taking nitrates. Moryt observed pallor, cold clammy sweat, nausea, vomiting, arterial hypotension. Myocardial ischemia often causes the appearance of a III or IV tone.

In case of massive massive PE , as in myocardial infarction, the pain is localized behind the sternum, but does not have a typical irradiation. In cases of occlusion of small branches of the pulmonary artery with the development of a lung segment infarction, it is associated with irritation of the pleura and appears several hours and even days after the onset of the disease. The hallmark clinical features are a combination of pain with cyanosis and dyspnea, an increase in CVP in the absence of orthopnea, and signs of pulmonary venous congestion. Arterial hypotension is often determined, sometimes shortness of breath is accompanied by hemoptysis, although its absence does not exclude the diagnosis of PE. The anamnesis is often preceded by thrombophlebitis, surgery, bed rest. The diagnosis can be confirmed by characteristic electrocardiographic (sign Q III-S I), radiological changes (atelectasis, subpleurally located infiltrates that have a cone-shaped shape), ECHO-KG data (dilatation and decreased contractility of the right ventricle, pulmonary hypertension), coagulogram data (increased D-Dimer ). Diagnosis of PE is especially difficult when the only symptom is sudden onset of shortness of breath.

At dissection of the thoracic aorta retrosternal localization of pain with irradiation to the back, sometimes the neck, head, abdomen and legs is typical. In its intensity, it usually exceeds the pain of a heart attack, the pain is not accompanied by heart or respiratory failure. An important diagnostic sign is an unequal pulse on the carotid, radial and femoral arteries. BP is often elevated and, like the pulse, is not the same in both arms. Important differential diagnostic value are signs of aortic insufficiency, primarily auscultatory (noise at the 2nd point of auscultation of the heart, decreasing character and occupies the entire diastole). Changes in the ECG and enzyme activity are not typical. The diagnosis is established by revealing the expansion of the aorta on the radiograph and visualization of its dissection on EchoCG, preferably transesophageal. In unclear cases, MRI can confirm the diagnosis

Spontaneous pneumothorax is often suspected in patients with bronchial asthma and emphysema. However, it sometimes develops in the absence of any lung disease. This is especially true for young thin men. With spontaneous pneumothorax, the connection of pain with breathing and coughing is usually noted only at the onset of the disease. In the future, the displacement of the mediastinal organs can cause dull constant pain in the sternum and neck. The pain syndrome is accompanied by shortness of breath, which usually worries more than pain, sometimes with a dry cough. Characteristic: pronounced cyanosis, pale face covered with cold sweat, soft, thready pulse, blood pressure is low, the affected half lags behind in the act of breathing, swells, smoothed intercostal spaces, breathing is weakened or not heard at all, voice trembling on the affected side is not carried out, with R- the study – the absence of a pulmonary pattern, the edge of the sleeping lung is determined, the shadow of the heart and blood vessels is deviated in the opposite direction, increased shortness of breath and pain indicates a tension pneumothorax, with which an emergency pleural puncture is indicated, the combination of a boxed percussion tone with a sharp weakening of breathing allows you to make a diagnosis.

In differential diagnosis, first of all, it is necessary to distinguish between coronary pain, i.e. angina pectoris, and non-coronary pain – cardialgia, and clarify its genesis.

Cardiac pains:

1. Localization behind the sternum or in the region of the heart;

2. Nature of pain: aching, pressing, squeezing;

3. Connection of pain with physical or psycho-emotional stress;

4. Radiation to the left arm and shoulder blade;

5. Concomitant symptoms: feeling short of breath, palpitations, weakness, sweating, fear of death;

6. Can be stopped with nitroglycerin if analgesics are ineffective.

Differences between coronary pain and non-coronary pain:

– occurrence during physical exertion;

– termination at rest;

– cupping with nitroglycerin.

Non-coronary heart diseases: pericarditis, myocarditis, cardiomyopathies, mitral valve prolapse.

In case of myocarditis the nature of pain is the most diverse, from short-term stabbing to fairly intense long-term pain. Past medical history (usually viral) infection 2-3 weeks prior to clinic appearances. In the diagnosis, an increase in CPK-VM, LDH, a positive effect from taking NSAIDs and GCS are important. On the ECG, rhythm disturbances and conduction, decreased voltage, negative T waves, but in mild cases there may not be changes. Echo-KG shows either normal or diffuse hypokinesis in severe myocarditis.

With pericarditis localization in the lower part of the sternum and left shoulder due to irritation of a small number of phrenic nerve receptors, the absence of irradiation, the pain is dull, monotonous and, unlike anginal, lasts for hours and even days; due to its pleuritic component, it increases with deep breathing, swallowing, coughing, movements and lying down, decreasing in a sitting position with an anterior inclination of the torso. During ascultation, a pericardial friction noise (during systole and diastole) is heard in the zone of absolute dullness of the heart, aggravated by pressure with a phonendoscope; pleuropericardial murmur (with inflammation of the pleura immediately adjacent to the heart) – increases at the height of the deep entrance. On the ECG, there is a concordant ST rise in many ECG leads, a significant decrease in voltage (with the appearance of exudate in the pericardial cavity), T wave inversion in many leads.

In cardiomyopathies localization in the region of the heart, duration and undulating character with periods of amplification without connection with physical activity. ; pain occurs for no reason or is associated with emotional factors and is accompanied by characteristic autonomic crises and hot flashes. Deep negative T waves are often found on the ECG.

Pain with mitral valve prolapse are functional in nature and are caused by disruption of the nervous system. Often, pain in the heart area occurs after stress, emotional stress, and sometimes at rest. The pains may be tingling or aching and last from a few seconds to tens of minutes, several hours or days; the pain is not aggravated by physical exertion, is not combined with shortness of breath, dizziness or fainting.

Pulmonary-pleural pains:

1. Occur or intensify with deep inspiration and coughing;

2. They are acute, short-term, do not radiate;

3. Concomitant symptoms: cough, shortness of breath, sputum;

4. History of acute or chronic lung disease, auscultation data – pleural friction noise, dry or wet rales, percussion data – signs of pulmonary emphysema, cavity or compaction of lung tissue.

Respiratory diseases accompanied by chest pain: pleurisy, pleuropneumonia, mediastinitis, spontaneous pneumothorax, tracheobronchitis

Acute tracheobronchitis may cause a burning sensation behind the sternum, which is associated with coughing and disappears when it is relieved.

With pleurisy and pleuropneumonia pain may increase during palpation, accompanied by shortness of breath, fever, and in some patients – signs of intoxication. The friction noise of the pleura is also characteristic in pneumonia – the corresponding physical and radiological changes, as well as inflammatory changes in the blood.

Pain in diseases of the musculoskeletal and nervous structures:

intercostal neuralgia – pain is localized along the intercostal space, tenderness is noted during palpation, movements of the trunk and left arm;

radicular syndrome due to osteochondrosis or spondylarthrosis, pain often radiates to the left shoulder or arm and is accompanied by disturbances in its sensitivity; there is also pain in the paravertebral points in the projection of the exit of the roots;

Tietze’s syndrome – is characterized by local palpation of the chest in the projection of the sternocostal joints, the pain is occasionally accompanied by pronounced local signs of aseptic inflammation of the costal cartilages in the places of their attachment to the sternum – swelling, redness of the skin and hyperthermia;

syndrome of the pectoralis major muscle – local palpation tenderness is typical in the places of attachment of this muscle to the sternum, increased pain in the entire muscle when pressing on the trigger points in the region of the II – V ribs along the parasternal line;

herpes zoster – pain may precede the rash by several days, making it difficult to determine its cause early; more often it is one-sided and is located in the zone of innervation of the intercostal nerves.

Pain in diseases of the esophagus :

1. Connection with the passage of food through the esophagus

2. Dysphagia, belching, heartburn;

3. Relief of pain after belching or vomiting, sometimes when the body is upright.

– peptic esophagitis and reflux esophagitis – pain resembles anginal pain, is located behind the sternum and in the epigastrium, radiates to the lower jaw, can be stopped with nitroglycerin. Recognize these diseases allows the relationship of pain with food intake and its reduction after a few sips of water or taking antacids, as well as the presence of dysphagia;

Mallory-Weiss syndrome – intense retrosternal pain occurs after prolonged vomiting and is accompanied by the appearance of blood in the vomit;

peptic ulcer of the stomach typical Appears approximately 1 hour after eating and is relieved by taking antacids;

cholecystitis and cholangitis pain in the lower part of the sternum and epigastric region
appearing 1-2 hours after eating;

hiatal hernia – pain or discomfort behind the sternum occurs or worsens immediately after eating, especially when moving to a horizontal position, weakening in a standing position, after belching, vomiting, taking antacids

II Evaluation of physical examination findings :

Physical examination pays special attention to the presence of the following symptoms :
General symptoms :
– fever
– respiratory rate over 30 per minute
– tachycardia
– profuse sweating

– knees pulled up to the chest, torso tilted forward;

Cardiovascular symptoms :
– arterial hypertension or hypotension (dissecting aortic aneurysm);
– absence of a pulse (or a decrease in its amplitude) in the peripheral arteries (dissecting aortic aneurysm);
– the appearance of the III heart sound (MI).

– increase in the area of ​​cardiac dullness;

– a sharp decrease in heart sounds

Symptoms of the respiratory system :
– cough;
– uneven participation of the chest in the act of breathing
– dullness of percussion sound
– weakening of respiratory sounds
– bronchial breathing
– wheezing
– pleural friction noise

When examining a patient, it is important to assess the constitutional features. In asthenic people with a flat chest, mitral valve prolapse is more common. In a patient with Marfan’s syndrome, chest pain may be associated with aortic dissection or pneumothorax, to which these patients are predisposed.

III Instrumental research methods for differential diagnosis of chest pain:

1. Electrocardiography (ECG)

2. Echocardiography (ECHO CG)

noah cells;

4. Computed tomography (CT) of the chest

5. Magnetic resonance imaging (MRI)

6. Angiopulmonography

7. Ultrasound examination of the abdominal organs

8. Esophagogastroduodenoscopy

Diagnostic search in some cases can be limited in the presence of a characteristic symptom accompanying pain:

  1. shortness of breath and cyanosis pneumothorax, pleuropneumonia, heart defects
  2. With an increase in body temperature, one should think about inflammatory diseases of the respiratory organs, as well as pulmonary infarction, mediastinitis, pericarditis
  3. Difficulty swallowing is typical for diseases of the esophagus, but can also be observed with aortic aneurysm

Physical examination data that help in the differential diagnosis of thoracalgia:

  1. Pleural friction noise, pericardium – pleurisy, pericarditis 9001 4
  2. When blood pressure is not the same on both arms dissecting aortic aneurysm should be considered
  3. Presence of rashes on the skin along the nerve sac roots may indicate herpetic neuralgia
  4. Swelling of the neck, face and upper body, subcutaneous emphysema, saphenous vein dilatation, severe tachycardia, arrhythmia, decreased blood pressure, forced position – half-sitting with the head bowed to the chest may indicate the presence of mediastinitis.