Pain below rib cage center of chest. Upper Abdominal Pain: Causes, Symptoms, and Treatment Options

11.10.197513.10.2021 by alexxlab

What are the common causes of upper abdominal pain. How can you distinguish between mild and severe upper abdominal pain. When should you seek medical attention for upper abdominal pain. What are the self-care options for managing mild upper abdominal discomfort.

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Understanding Upper Abdominal Pain: Location and Characteristics

Upper abdominal pain refers to discomfort or pain experienced in the area below the rib cage and above the belly button. This region encompasses several vital organs, including the stomach, liver, gallbladder, and pancreas. The nature and intensity of the pain can vary greatly depending on the underlying cause.

To better understand upper abdominal pain, it’s essential to consider its characteristics:

Location: Precisely where in the upper abdomen is the pain felt?
Intensity: How severe is the pain on a scale of 0 to 10?
Duration: Is the pain constant or intermittent?
Triggers: Does the pain worsen after eating or during specific activities?
Associated symptoms: Are there other symptoms like nausea, vomiting, or fever?

Common Causes of Upper Abdominal Pain in Different Age Groups

The causes of upper abdominal pain can vary depending on a person’s age. Let’s examine the common causes for different age groups:

Common Causes in People Younger Than 50 Years of Age

Appendicitis
Gallbladder disease
Irritable bowel syndrome (IBS)
Peptic ulcer disease

Common Causes in People Older Than 50 Years of Age

Appendicitis
Bowel obstruction
Diverticulitis
Gallbladder disease
Pancreatitis
Peptic ulcer disease

It’s important to note that these are not exhaustive lists, and the causes can overlap between age groups. Other potential causes of upper abdominal pain include:

Angina and heart attack
Abdominal aortic aneurysm
Hepatitis
Herpes zoster
Pneumonia

Assessing the Severity of Upper Abdominal Pain

Understanding the severity of upper abdominal pain is crucial in determining the appropriate course of action. Healthcare professionals often use a pain scale to assess the intensity of discomfort:

None (Pain score 0): No pain whatsoever.
Mild (Pain score 1-3): The pain does not interfere with daily activities or work.
Moderate (Pain score 4-7): The pain disrupts normal activities and may wake you from sleep.
Severe (Pain score 8-10): The pain is intense, possibly the worst you’ve experienced, and prevents normal activities.

How can you differentiate between mild and severe upper abdominal pain? Mild pain typically doesn’t interfere with daily activities and may respond to over-the-counter remedies. Severe pain, on the other hand, is often debilitating and may be accompanied by other concerning symptoms like fever, vomiting, or changes in bowel habits.

When to Seek Immediate Medical Attention

While many cases of upper abdominal pain are not serious, there are situations where immediate medical attention is necessary. Call 911 or seek emergency care if you experience:

Loss of consciousness
Extreme weakness (inability to stand)
Profuse sweating, especially on the face
Pain lasting more than 5 minutes if you’re over 50 or have a history of heart problems
Pain accompanied by symptoms of a heart attack, especially if you’re over 35 and have risk factors like hypertension, diabetes, high cholesterol, obesity, or a family history of heart disease

Are there other scenarios where prompt medical attention is advised? Yes, you should contact a doctor or seek care promptly if you experience:

Fever over 103° F (39.4° C)
Fever in conjunction with diabetes or a weakened immune system
Yellowing of the eyes
Pregnancy
Severe weakness or illness

Self-Care Strategies for Mild Upper Abdominal Pain

If you’re experiencing mild upper abdominal pain, there are several self-care strategies you can employ at home:

Fluid intake: Sip clear fluids like water, broth, or diluted fruit juice until the pain subsides.
Diet modification: Start with clear liquids and gradually introduce bland foods. Avoid alcohol, caffeine, and greasy or fatty foods.
Smoking cessation: If you smoke, consider quitting as it can exacerbate heartburn and stomach problems.
Medication management: Avoid aspirin and NSAIDs like ibuprofen, which can irritate the stomach. Acetaminophen may be a better option for pain relief.
Antacids: Consider taking a liquid antacid for immediate relief, following package instructions carefully.

What dietary changes can help manage reflux disease (GERD)? For those suffering from GERD, it’s advisable to:

Eat smaller, more frequent meals
Avoid snacking for 2 hours before bedtime
Steer clear of trigger foods such as fatty or spicy foods, mints, chocolate, caffeine, and alcohol

Potential Complications and Long-Term Management

While many cases of upper abdominal pain resolve on their own or with simple home remedies, it’s important to be aware of potential complications and consider long-term management strategies.

What are some potential complications of untreated upper abdominal pain? Depending on the underlying cause, complications may include:

Chronic inflammation of the digestive tract
Malnutrition due to reduced food intake
Dehydration from persistent vomiting or diarrhea
Progression of underlying conditions like ulcers or gallbladder disease
Psychological distress and reduced quality of life

For those with recurring or chronic upper abdominal pain, long-term management strategies may include:

Dietary modifications: Identifying and avoiding trigger foods
Stress management techniques: Practicing relaxation methods like deep breathing or meditation
Regular exercise: Engaging in moderate physical activity to promote digestive health
Medication management: Working with a healthcare provider to find the right balance of medications for symptom control
Regular check-ups: Monitoring the condition and adjusting treatment plans as needed

Diagnostic Approaches for Persistent Upper Abdominal Pain

When upper abdominal pain persists or recurs frequently, healthcare providers may employ various diagnostic approaches to identify the underlying cause. These may include:

Physical examination: Assessing the abdomen for tenderness, swelling, or masses
Blood tests: Checking for signs of infection, inflammation, or organ dysfunction
Imaging studies: Utilizing ultrasound, CT scans, or MRI to visualize internal structures
Endoscopy: Examining the upper digestive tract using a flexible tube with a camera
Stool tests: Looking for signs of infection or bleeding in the digestive tract

How do healthcare providers determine which diagnostic tests are necessary? The choice of diagnostic approach depends on several factors, including:

The nature and severity of symptoms
The patient’s age and medical history
The presence of any red flag symptoms (e.g., unexplained weight loss, persistent vomiting)
The results of initial physical examinations and basic tests

Emerging Treatments and Research in Upper Abdominal Pain Management

The field of gastroenterology is continually evolving, with new treatments and research offering hope for improved management of upper abdominal pain. Some emerging areas of interest include:

Microbiome-based therapies: Exploring the role of gut bacteria in digestive health
Targeted drug delivery systems: Developing medications that act specifically on affected areas of the digestive tract
Neuromodulation techniques: Using electrical stimulation to manage pain signals
Personalized medicine approaches: Tailoring treatments based on an individual’s genetic profile and specific symptoms
Complementary and alternative therapies: Investigating the efficacy of treatments like acupuncture or herbal remedies

What promising research directions are scientists pursuing in the field of upper abdominal pain? Some areas of active investigation include:

The gut-brain axis: Studying the connection between digestive health and mental well-being
Biomarkers for digestive disorders: Identifying specific biological indicators to aid in diagnosis and treatment
Novel imaging techniques: Developing more accurate and less invasive ways to visualize the digestive system
Artificial intelligence in diagnosis: Using machine learning algorithms to improve diagnostic accuracy and speed

As research progresses, it’s likely that our understanding and management of upper abdominal pain will continue to improve, offering new hope for those who suffer from chronic digestive issues.

Lifestyle Modifications for Long-Term Upper Abdominal Health

While medical treatments play a crucial role in managing upper abdominal pain, lifestyle modifications can significantly contribute to long-term digestive health and pain prevention. Consider incorporating these strategies into your daily routine:

Balanced diet: Focus on a varied diet rich in fruits, vegetables, whole grains, and lean proteins
Mindful eating: Take time to chew food thoroughly and eat in a relaxed environment
Hydration: Drink adequate water throughout the day to support digestive function
Regular exercise: Engage in moderate physical activity to promote overall health and digestion
Stress management: Practice stress-reduction techniques like yoga, meditation, or deep breathing exercises
Sleep hygiene: Maintain a consistent sleep schedule and create a relaxing bedtime routine
Limit harmful substances: Reduce or eliminate alcohol consumption and quit smoking

How can these lifestyle changes impact upper abdominal health in the long term? By adopting these habits, you may experience:

Reduced frequency and severity of digestive symptoms
Improved overall digestive function and nutrient absorption
Enhanced immune function, potentially reducing the risk of digestive infections
Better stress management, which can positively influence digestive health
Improved sleep quality, contributing to overall well-being and pain management

Remember that consistency is key when implementing lifestyle changes. It may take time to see significant improvements, but the long-term benefits to your digestive health and overall well-being can be substantial.

Abdominal Pain – Upper | Advocare Broomall Pediatric Associates

Is this your symptom?

Pain or discomfort in the upper abdomen (stomach). This is the area below the rib cage and above the belly button.

Some Basics…

There are many things that can cause pain in the upper part of the stomach (abdomen). Most causes are not serious.
Pain in this area can be caused by eating too much. It can be caused by a food or a drug that upsets the stomach. It can also be caused by more serious problems like stomach ulcers or a gallbladder attack.
Reflux disease (GERD) causes a burning pain that goes into the chest. Laying down makes pain worse. Some people with reflux get a sour or bitter taste in their mouths.
Stomach pain is more likely to be serious in an older person.

Pain Scale

None: no pain. Pain score is 0 on a scale of 0 to 10.
Mild: the pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
Moderate: the pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
Severe: the pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

Common Causes of Upper Stomach Pain in People Younger Than 50 Years of Age

Appendicitis
Gallbladder disease
Irritable bowel syndrome (IBS)
Peptic ulcer disease

Common Causes of Upper Stomach Pain in People Older Than 50 Years of Age

Appendicitis
Bowel obstruction
Diverticulitis
Gallbladder disease
Pancreatitis
Peptic ulcer disease

Other Causes

Angina and heart attack
Abdominal aortic aneurysm
Hepatitis
Herpes zoster
Pneumonia

Warni

ng!

A person can have a heart attack and think that it is just “heartburn. ” If you are over 40 years old or have any of these risk factors, you could be having a heart attack:

Diabetes
Hypertension
High cholesterol
Obesity
Smoking
Someone in your family (like a parent, brother or sister) has had a heart attack

When to Call for Abdominal Pain – Upper

Call 911 Now

Passed out (fainted)
Very weak (can’t stand)
Sweat on or dripping down face
More than 50 years old and pain lasts more than 5 minutes
History of a heart problem and pain lasts more than 5 minutes
More than 35 years old and have at least one heart risk factor, including:
- Hypertension
- Diabetes
- High cholesterol
- Obesity
- Smoker
- Family member has had a heart attack
You think you have a life-threatening emergency

Call Doctor or Seek Care Now

Fever over 103° F (39. 4° C)
Fever and have diabetes
Fever and have a weak immune system (such as HIV, cancer chemo, long-term steroids, splenectomy, transplant)
Fever and are bedridden (nursing home patient, stroke, chronic illness, or recovering from surgery)
Whites of the eyes have turned yellow
Pregnant
You feel weak or very sick
You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Stomach pains come and go (cramps), and last more than 24 hours
More than 60 years old
You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

Stomach pains off and on for weeks or months (are frequent, come and go)
Burning pains in chest with a sour taste in mouth
Stomach pains often occur 1 hour after meals
You have other questions or concerns

Self Care at Home

Care Advice for Mild Upper Abdominal Pain

What You Should Know:
- Mild stomach pain can be caused by an upset stomach, gas pains, or eating too much. It can also be caused by reflux disease (GERD). Sometimes mild stomach pain is the first sign of a vomiting illness like stomach flu.
- You can treat mild stomach pain at home.
- Here is some care advice that should help.
Fluids: Sip only clear fluids until the pain is gone for more than 2 hours. Clear fluids include water, broth, and water mixed with fruit juice. Then slowly return to a normal diet.
Diet:
- Start with clear liquids. When you feel better, you can begin eating a bland diet.
- Avoid alcohol or drinks with caffeine in them.
- Avoid greasy or fatty foods.
Stop Smoking: Smoking can make heartburn and stomach problems worse.
Avoid Aspirin: Avoid aspirin and drugs such as Motrin, Advil, and Aleve. These drugs can bother your stomach. Try taking Tylenol.
Antacid:
- If you are having pain now, try taking a liquid antacid.
- Read and follow all the instructions and warnings on the package insert of all medicines you take.
Reflux Disease (GERD):
- Eat smaller meals and avoid snacks for 2 hours before sleeping.
- Avoid foods that tend to cause heartburn and stomach problems. These include fatty/greasy foods, spicy foods, mints, chocolate, drinks with caffeine, and alcohol.
What to Expect: With harmless causes, the pain most often goes away within 2 hours. With stomach flu, the pain may come and go for 2 to 3 days. You may have belly cramps before you vomit or have diarrhea. If your pain does not stop and gets worse, it may be more serious.
Call Your Doctor If:
- Severe stomach pain occurs
- Stomach pain is constant and lasts more than 2 hours
- You think you need to be seen
- You get worse

And remember, contact your doctor if you develop any of the ‘Call Your Doctor’ symptoms.

Last Reviewed:	10/13/2021 1:00:40 AM
Last Updated:	9/30/2021 1:00:37 AM
Copyright 2021 Amazon.com, Inc., or its affiliates.

Sudden Sharp Pain Under Right Rib Cage

Your abdomen is made up of 4 quadrants. The part of your body under your right rib cage is called the upper right quadrant, and sudden sharp pain in this area can impact the nearby organs such as the kidney, liver, and gallbladder.
You shouldn’t worry too much about this pain, but it’s good to know what is causing it and when to visit your physician.

Causes of sudden sharp pain under your right rib cage

Gallbladder problems

An excruciating pain under the right rib cage can indicate the presence of gallstones. These are tiny balls in the gallbladder made of cholesterol or bile. It’s common for an adult to have gallstones, and usually, there are no symptoms.
But, a blocked stone in a duct in the gallbladder can cause sharp stabbing pain under the right rib cage. This condition is called gallstones disease, and the pain can last around 5-6 hours.
Leaving gallstones disease untreated can cause inflammation of the gallbladder. Moreover, it can result in fever, pale skin, and persistent pain.
Book an appointment with your doctor if your gallbladder area is hurting. Your doctor can diagnose the actual cause of pain and advise appropriate treatment.

Kidney problems

Another cause of pain under the right rib cage is a kidney stone. It is a hard formation of minerals in the urine found in the right kidney.
The formation of kidney stones is a common problem, and 1 out of every 11 individuals are affected by this issue.
Similar to gallstones, kidney stones don’t always cause painful sensations. But, if a kidney stone gets stuck in the urinary tract or results in an infection, it can cause sharp pain in the groin or lower back.
You may experience frequent urination and pain while doing so. In severe cases, blood can pass with urine.

Digestive problems

Indigestion can often cause a sudden sharp pain under your right rib cage as well as:

chest pain
slight stomach pain after eating
bloating
heartburn
sickness

If you suspect that your discomfort is due to indigestion, you can simply change your diet and see what suits you better. However, it’s best to consult if indigestion keeps coming back and you’re experiencing:

sickness
anemia
blood in your stool or vomit
weight loss
are aged 55 or older

The above symptoms can indicate heartburn. But if indigestion keeps coming back, it can cause severe complications.

Shingles

Shingles often cause pain and itchy rashes. The pain can be slight, sharp, or excruciating, and you may also have a headache or fever. Sometimes shingles can also cause sudden sharp pain under your right rib cage.
See your doctor if you have pain under the right rib and rash that you suspect to be shingles. This becomes more important if you are expecting or have a weaker immune system.

What to do

If you’re experiencing minor pain under your right rib cage, there’s nothing much to worry about, but if the pain is sharp or continuous, see your doctor. Schedule an appointment with the experts at Rheumatology Care of North Houston by calling 832.532.9779.

Rib Cage Pain symptoms and causes

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Slipping rib syndrome

Definition

adam.com”>Slipping rib syndrome refers to pain in your lower chest or upper abdomen which may be present when your lower ribs move a little more than normal.

Your ribs are the bones in your chest that wrap around your upper body. They connect your breastbone to your spine.

Alternative Names

Interchondral subluxation; Clicking rib syndrome; Slipping-rib-cartilage syndrome; Painful rib syndrome; Twelfth rib syndrome; Displaced ribs; Rib-tip syndrome; Rib subluxation; Chest pain-slipping rib

Causes

This syndrome usually occurs in 8th to 10th ribs (also known are false ribs) at the lower part of your rib cage. These ribs are not connected to the chest bone (sternum). Fibrous tissue (ligaments), connect these ribs to each other to help keep them stable. The relative weakness in the ligaments can allow the ribs to move a little more than normal and cause pain.

adam.com”>The condition can occur as a result of:

Injury to the chest while playing contact sports such as football, ice hockey, wrestling, and rugby
A fall or direct trauma to your chest
Rapid twisting, pushing, or lifting motions, such as throwing a ball or swimming

When the ribs shift, they press on the surrounding muscles, nerves, and other tissues. This causes pain and inflammation in the area.

Slipping rib syndrome can occur at any age, but it is more common in middle-aged adults. Females may be more affected than males.

Symptoms

The condition usually occurs on one side. Rarely, it may occur on both sides. Symptoms include:

Severe pain in the lower chest or upper abdomen. The pain may come and go and get better with time.
A popping, clicking, or slipping sensation.
Pain when applying pressure to the affected area.
Coughing, laughing, lifting, twisting, and bending may make the pain worse.

Exams and tests

The symptoms of slipping rib syndrome are similar to other medical conditions. This makes the condition difficult to diagnose.

Your health care provider will take your medical history and ask about your symptoms. You will be asked questions such as:

How did the pain start? Was there an injury?
What makes your pain worse?
Does anything help relieve the pain?

Your provider will perform a physical exam. The hooking maneuver test may be done to confirm the diagnosis. In this test:

You will be asked to lie on your back.
Your provider will hook their fingers under the lower ribs and pull them outward.
Pain and a clicking sensation confirms the condition.

On the basis of your exam, an x-ray, ultrasound, MRI or blood tests may be done to rule out other conditions.

Treatment

The pain usually goes away in few weeks.

Treatment focuses on relieving the pain. If the pain is mild, you can use ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) for pain relief. You can buy these pain medicines at the store.

Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
Take the dose as advised by the provider. DO NOT take more than the amount recommended on the bottle. Carefully read the warnings on the label before taking any medicine.

Your provider may also prescribe pain medicines to relieve pain.

adam.com”>You may be asked to:

Apply heat or ice at the site of pain
Avoid activities that makes the pain worse, such as heavy lifting, twisting, pushing, and pulling
Wear a chest binder to stabilize the ribs
Consult a physical therapist

For severe pain, your provider may give you a corticosteroid injection at the site of pain.

If the pain persists, surgery may be done to remove the cartilage and lower ribs, although it is not a commonly performed procedure.

Outlook (prognosis)

The pain often goes away completely over time, although the pain may become chronic. Injection or surgery may be required in some cases.

Possible Complications

Complications may include:

Difficulty breathing.
Injury during an injection may cause pneumothorax.

There are usually no long-term complications.

When to Contact a Medical Professional

You should call your provider right away if you have:

An injury to your chest
Pain in your lower chest or upper abdomen
Difficulty breathing or shortness of breath
Pain during daily activities

Call 911 if:

You have sudden crushing, squeezing, tightening, or pressure in your chest.
Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.
You have nausea, dizziness, sweating, a racing heart, or shortness of breath.

References

Dixit S, Chang CJ. Thorax and abdominal injuries. In: Madden CC, Putukian M, McCarty EC, Young CC, eds. Netter’s Sports Medicine. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Kolinski JM. Chest pain. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 7.

McMahon, LE. Slipping rib syndrome: A review of evaluation, diagnosis and treatment. Seminars in Pediatric Surgery. 2018;27(3):183-188.

Waldmann SD. Slipping rib syndrome. In: Waldmann SD, ed. Atlas of Uncommon Pain Syndromes. 3rd ed. Philadelphia, PA: Elsevier; 2020:chap 72.

Waldmann SD. The hooking maneuver test for slipping rib syndrome. In: Waldmann SD, ed. Physical Diagnosis of Pain: An Atlas of Signs and Symptoms. 3rd ed. St Louis, MO: Elsevier; 2016:chap 133.

Hiatal Hernia, Diaphragmatic Breathing, What Is the Diaphragm

Overview

What is the diaphragm?

The diaphragm is a muscle that helps you inhale and exhale (breathe in and out). This thin, dome-shaped muscle sits below your lungs and heart. It’s attached to your sternum (a bone in the middle of your chest), the bottom of your rib cage and your spine. Your diaphragm separates your chest from your abdominal cavity (belly).

In addition to helping you breathe, your diaphragm increases pressure inside your abdomen. This helps with other important functions, such as getting rid of your urine (pee) and feces (poop). It helps prevent acid reflux by putting pressure on your esophagus (food tube in your throat). Your esophagus and several nerves and blood vessels run through openings in the diaphragm.

Many different conditions can affect how the diaphragm works. The most common conditions include hernias and nerve damage from surgery or an accident. Neuromuscular disorders such as amyotrophic lateral sclerosis (ALS) can also weaken the diaphragm. These conditions can cause difficulty breathing, heartburn and pain in the chest and belly.

Function

What does the diaphragm do?

The diaphragm plays a critical role in the respiratory system. When you breathe in, your diaphragm contracts (tightens) and flattens, moving down towards your abdomen. This movement creates a vacuum in your chest, allowing your chest to expand (get bigger) and pull in air. When you breathe out, your diaphragm relaxes and curves back up as your lungs push the air out.

Several nerves, soft tissues and blood vessels pass through the diaphragm. These include the:

Aorta, a big artery that carries your blood away from your heart to the rest of your body.
Esophagus, a hollow tube that connects the throat to the stomach. Food and liquids move through the esophagus to the stomach.
Inferior vena cava, a vein that carries blood to your heart.
Phrenic nerve, which controls the diaphragm’s movement.
Thoracic duct, a vessel that carries a fluid called lymph through the body as part of the lymphatic system.
Vagus nerve, which has many important jobs, including helping to control the digestive system.

Conditions and Disorders

What conditions and disorders affect this system?

Many conditions, diseases and injuries can affect the diaphragm, including:

Hernias: A hiatal hernia happens when the top part of your stomach bulges through an opening in the diaphragm. A diaphragmatic hernia occurs when an organ in your abdomen bulges into the chest cavity. These hernias can be present at birth or they can result from trauma, age and obesity. Hernias may require surgical repair.
Phrenic nerve damage: Nerve damage can result from cancer, autoimmune diseases or trauma. It can also happen during surgery including heart bypass surgery and lung transplants. A tumor, aortic aneurysm or cervical spondylosis can compress or damage the nerve. Conditions such as HIV and diseases like West Nile virus and Lyme disease can cause the nerve to become inflamed (swollen).
Spasms: During a diaphragm muscle spasm, the diaphragm doesn’t relax and curve back up when you exhale. It contracts (tightens), causing a cramp in the abdomen. Strenuous exercise can cause this type of spasm, which some people call a “side stitch.” It usually gets better with rest.
Weakness or paralysis: Neuromuscular disorders can cause diaphragmatic palsy (weakness of the diaphragm muscle). These may include multiple sclerosis (MS) and ALS. The diaphragm can also weaken as a result of diabetic neuropathy, spinal cord injuries or lung issues like chronic obstructive pulmonary disease (COPD).

What are the symptoms of diaphragm problems?

Symptoms of diaphragm problems may only last a short time, or they may be permanent. They include:

Acid reflux, heartburn, cough and difficulty swallowing.
Changes in skin color (skin may turn blue).
Fast heart rate, chest pain and tightness or trouble breathing (especially when lying down).
Headaches.
Hiccups that don’t go away or come back often.
Pain or pressure in the chest, back, side, shoulder or abdomen (usually under the lower rib cage). Belly, chest and back pain might be worse after eating.
Pulsing or fluttering in the belly under your ribs.

Some signs of diaphragm problems are similar to symptoms of a heart attack. If you have shortness of breath, chest tightness or chest pain, get immediate medical help.

How common are these conditions?

Phrenic nerve damage from trauma (either through surgery or an accident) is the most common cause of diaphragm problems. The risk of phrenic nerve damage (and muscle weakness) after cardiac bypass surgery may be as high as 20%.

Hiatal hernias are common, especially in people over 50 who are obese. About 55% of people over 50 have a hiatal hernia.

Care

How can I keep my diaphragm healthy?

Your diaphragm is a muscle. Just like any other muscle in your body, you can strengthen it with exercises. Diaphragmatic breathing exercises can help your diaphragm work more efficiently. They also reduce stress and help you feel better.

To keep your diaphragm healthy, you should:

Eat smaller meals and avoid foods that cause heartburn.
Get regular checkups if you have a condition that puts you at a higher risk of diaphragm problems.
Maintain a healthy weight.
Warm up before you exercise to allow your diaphragm time to stretch. Don’t overdo it when exercising.

Frequently Asked Questions

When should I call my doctor?

If you have any symptoms of diaphragm problems, see your provider. Some symptoms are similar to signs of a heart attack. Get immediate medical help if you have chest pain or pressure or shortness of breath.

Symptoms of diaphragm problems may also be signs of other conditions. It’s essential to see your provider for an evaluation.

How do I know if I’m at risk for diaphragm problems?

You have a higher risk of developing problems with your diaphragm if you have:

Autoimmune disorders such as lupus.
COPD, lung cancer or other lung problems.
Heart disease that requires surgery.
Lyme disease.
Neuromuscular disorders such as MS.
Obesity.
Viruses, including HIV.

A note from Cleveland Clinic

Your diaphragm plays a critical role in helping you breathe and keeping you healthy. Several conditions, diseases and injuries can damage the diaphragm. If you have a condition that puts you at a higher risk of diaphragm problems, talk to your provider about getting regular checkups. Get help right away if you have shortness of breath, chest pain or difficulty swallowing. You can strengthen this important muscle with special breathing exercises. These exercises help your diaphragm work as it should.

Abdominal Pain, Age 12 and Older

Do you have pain or cramping in your belly?

This also includes injuries to the belly.

How old are you?

11 years or younger

12 to 55 years

56 years or older

Are you male or female?

Why do we ask this question?

If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had surgery on your chest, belly, or pelvic area in the past 2 weeks?

Yes

Recent abdominal surgery

Are you pregnant?

Yes, you know that you’re pregnant.

Pregnancy

No, you’re not pregnant, or you’re not sure if you’re pregnant.

Pregnancy

Have you had a baby in the past 3 months?

Yes

Had baby within past 3 months

Are you having trouble drinking enough to replace the fluids you’ve lost?

Little sips of fluid usually are not enough. You need to be able to take in and keep down plenty of fluids.

Yes

Unable to maintain fluid intake

Able to maintain fluid intake

Do you have pain in your belly?

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Has the pain:

Gotten worse?

Pain is getting worse

Stayed about the same (not better or worse)?

Pain is unchanged

Gotten better?

Pain is getting better

How long have you had pain?

Less than 4 hours

Pain for less than 4 hours

At least 4 hours but less than 1 full day (24 hours)

Pain for 4 to 24 hours

At least 1 full day but less than 2 days (48 hours)

Pain for more than 24 hours

At least 2 days but less than 1 week

Pain for more than 48 hours

1 week or more

Pain for more than 1 week

Does the belly hurt all over or mostly in one area?

Pain that is most intense in just one area is likely to be more serious than a bellyache that hurts all over.

Mostly in one area

Localized pain

Do you have pain with a new bulge in your belly button or groin?

Yes

Pain with bulge at the navel or groin

Is there any chance that you could be pregnant?

Yes

Possibility of pregnancy

Within the past week, have you had an injury to the abdomen, like a blow to the belly or a hard fall?

Yes

Abdominal injury within past week

Since the injury, have you had any new bleeding from the rectum, urethra, or vagina?

Yes

Bleeding from rectum, vagina, or urethra since injury

Is there a belly wound that is deeper than a scratch?

Have you vomited since the injury?

Yes

Has vomited since the injury

Is there pain just below the ribs?

Pain just below the ribs after an injury can be a symptom of serious damage to the liver or spleen.

Have you had any new shoulder pain since the injury?

A belly injury sometimes can cause pain in the shoulder.

Yes

Shoulder pain since injury

Did you hurt your shoulder in the injury?

Do you suspect that the injury may have been caused by abuse?

This is a standard question that we ask in certain topics. It may not apply to you. But asking it of everyone helps us to get people the help they need.

Yes

Injury may have been caused by abuse

Have you had:

At least 1 stool that is mostly black or bloody?

At least 1 stool mostly black or bloody

At least 1 stool that is partly black or bloody?

At least 1 stool partly black or bloody

Streaks of blood in your stool?

Streaks of blood in stool

Do you think you may have a fever?

Did you take your temperature?

How high is the fever? The answer may depend on how you took the temperature.

High: 104°F (40°C) or higher, oral

High fever: 104°F (40°C) or higher, oral

Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Mild: 100.3°F (37.9°C) or lower, oral

Mild fever: 100.3°F (37.9°C) or lower, oral

How high do you think the fever is?

Moderate

Feels fever is moderate

Mild or low

Feels fever is mild

How long have you had a fever?

Less than 2 days (48 hours)

Fever for less than 2 days

At least 2 days but less than 1 week

Fever for at least 2 days but less than 1 week

1 week or more

Fever for 1 week or more

Do you have a health problem or take medicine that weakens your immune system?

Yes

Disease or medicine that causes immune system problems

Do you have shaking chills or very heavy sweating?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off you or soaking through your clothes.

Yes

Shaking chills or heavy sweating

Are you nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Have you vomited blood or what looks like coffee grounds?

If there is only a streak or two of blood that you are sure came from your nose or mouth, you are not vomiting blood.

Yes

Has vomited blood or what looks like coffee grounds

How much blood have you vomited?

Two or more streaks of blood, or any amount of material that looks like coffee grounds

Has vomited material that looks like coffee grounds or at least 2 streaks of blood

One streak of blood or less

Has vomited 1 streak of blood or less

Have you felt nauseated for more than 2 full days (48 hours)?

Yes

Nausea for more than 2 days

Nausea for no more than 2 days

Is your diabetes getting out of control because you are sick?

Yes

Diabetes is affected by illness

Is the plan helping get your blood sugar under control?

Yes

Diabetes illness plan working

Diabetes illness plan not working

How fast is it getting out of control?

Quickly (over several hours)

Blood sugar quickly worsening

Slowly (over days)

Blood sugar slowly worsening

Did the pain start after you took a new medicine?

Yes

Abdominal pain started after taking a medicine

In the past few weeks, have you been losing weight without trying?

Yes

Has been losing weight without trying

Have your symptoms lasted longer than 1 week?

Yes

Symptoms have lasted longer than 1 week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

With cramping pain in the belly:

The pain may hurt a little or a lot.
The amount of pain may change from minute to minute. Cramps often get better when you pass gas or have a bowel movement.
The pain may feel like a tightness or pinching in your belly.
The pain may be in one specific area or be over a larger area. It may move around.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or lightheaded, like you may pass out.
Feeling very weak or having trouble standing.
Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

If you’re not sure if a fever is high, moderate, or mild, think about these issues:

With a high fever:

You feel very hot.
It is likely one of the highest fevers you’ve ever had. High fevers are not that common, especially in adults.

With a moderate fever:

You feel warm or hot.
You know you have a fever.

With a mild fever:

You may feel a little warm.
You think you might have a fever, but you’re not sure.

Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.

Oral (by mouth) temperature

High: 104°F (40°C) and higher
Moderate: 100.4°F (38°C) to 103.9°F (39.9°C)
Mild: 100.3°F (37.9°C) and lower

A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.

Ear temperature

High: 105°F (40.6°C) and higher
Moderate: 101.4°F (38.6°C) to 104.9°F (40.5°C)
Mild: 101.3°F (38.5°C) and lower

Armpit (axillary) temperature

High: 103°F (39.5°C) and higher
Moderate: 99.4°F (37.4°C) to 102.9°F (39.4°C)
Mild: 99.3°F (37.3°C) and lower

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

It is easy for your diabetes to become out of control when you are sick. Because of an illness:

Your blood sugar may be too high or too low.
You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
You may not know how to adjust the timing or dose of your diabetes medicine.
You may not be eating enough or drinking enough fluids.

An illness plan for people with diabetes usually covers things like:

How often to test blood sugar and what the target range is.
Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
What to do if you have trouble keeping food or fluids down.
When to call your doctor.

The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.

You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.

Symptoms of dehydration can range from mild to severe. For example:

You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).

Severe dehydration means:

Your mouth and eyes may be extremely dry.
You may pass little or no urine for 12 or more hours.
You may not feel alert or be able to think clearly.
You may be too weak or dizzy to stand.
You may pass out.

Moderate dehydration means:

You may be a lot more thirsty than usual.
Your mouth and eyes may be drier than usual.
You may pass little or no urine for 8 or more hours.
You may feel dizzy when you stand or sit up.

Mild dehydration means:

You may be more thirsty than usual.
You may pass less urine than usual.

Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.

A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.

A large amount of blood in the stool may mean a more serious problem is present. For example, if there is a lot of blood in the stool, not just on the surface, you may need to call your doctor right away. If there are just a few drops on the stool or in the diaper, you may need to let your doctor know today to discuss your symptoms. Black stools may mean you have blood in the digestive tract that may need treatment right away, or may go away on its own.

Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.

If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Symptoms of a heart attack may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Many prescription and nonprescription medicines can cause belly pain or cramping. A few examples are:

Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
Antibiotics.
Antidiarrheals.
Laxatives.
Iron supplements.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Postoperative Problems

Pregnancy-Related Problems

Abdominal Pain, Age 11 and Younger

Problems After Delivery of Your Baby

Slipping Rib Syndrome in a Female Adult with Longstanding Intractable Upper Abdominal Pain

Slipping rib syndrome is a rare cause of abdominal or lower chest pain that can remain undiagnosed for many years. Awareness among health care personnel of this rare but significant disorder is necessary for early recognition. Prompt treatment can avoid unnecessary testing, radiographic exposure, and years of debilitating pain. A 52-year-old female was evaluated for a 3-year history of recurrent abdominal and lower chest pain. Pain was sharp, primarily located in the lower chest and subcostal region left more than right, waxing and waning, nonradiating, and aggravates with specific movements. She underwent frequent physical therapies, treated with multiple muscle relaxants and analgesics with minimal improvement. Imaging modalities including CT scan, MRI, and X-rays performed on multiple occasions failed to signify any underlying abnormality. Complete physical examination was unremarkable except for positive hooking maneuver. Dynamic flow ultrasound of lower chest was performed which showed slipping of the lowest rib over the next lowest rib bilaterally left worse than right, findings consistent with slipping rib syndrome. Slipping rib syndrome is caused by hypermobility of the floating ribs (8 to 12) which are not connected to the sternum but attached to each other with ligaments. Diagnosis is mostly clinical, and radiographic tests are rarely necessary. Hooking maneuver is a simple clinical test to reproduce pain and can aid in the diagnosis. Reassurance and avoiding postures that worsen pain are usually helpful. In refractory cases, nerve block and surgical intervention may be required.

1. Introduction

Slipping rib syndrome is a rare cause of abdominal and lower chest pain that is often undiagnosed, overlooked, or misdiagnosed for many years. Many health care personnel are unaware of this rare entity, and failure of diagnosis may lead to unnecessary diagnostic interventions and extensive radiation exposure. We describe a case of a 52-year-old female who presented with 3 years of lower chest/upper abdominal pain and was later diagnosed as bilateral slipping rib syndrome.

2. Case Presentation

2.1. History

A 52-year-old female with no known past medical history was evaluated for a 3-year history of abdominal pain. Pain was sharp, primarily located in the lower chest and subcostal region left more than right, waxing and waning, nonradiating, and aggravates with certain nonspecific movements including forward lean. She was an accountant by profession and was never involved in any athletic activities. Her medications included over-the-counter acetaminophen and cyclobenzaprine. She underwent frequent physical therapy sessions and was treated with different analgesics with minimal improvement.

2.2. Physical Examination

Complete physical examination was unremarkable except for mild to moderate tenderness in the left more than the right subcostal area which was reproduced on hooking maneuver.

2.3. Diagnostic Workup

(1)Prior to presentation, she underwent frequent imaging modalities on multiple occasions including CT chest, CT abdomen and pelvis, MRI abdomen and pelvis, and plain X-rays. All these modalities failed to identify any significant underlying abnormality.(2)EGD was also performed twice and was unremarkable on both occasions.(3)Dynamic flow ultrasound of the lower chest was performed to potentiate the diagnosis and revealed slipping of the lowest rib over the next lowest rib bilaterally left worse than right, findings consistent with bilateral slipping rib syndrome.

2.4. Course

Reassurance about the benign nature of disease was provided, and avoidance of pain-inciting postures was recommended. Her symptoms persisted despite conservative management, and intercostal nerve block was planned. Patient’s symptoms remarkably improved with nerve block without requiring any surgical intervention.

3. Discussion

3.1. Introduction

Slipping rib syndrome also named as costal margin syndrome, clicking rib and rib-tip syndrome, was first identified in 1922 by Davies-Colley as a cause of severe abdominal pain due to overriding of the ninth and tenth rib [1]. The pathophysiology of slipping rib syndrome is uncertain.

Rib hypermobility caused by weakness of costochondral, sternocostal, or costovertebral ligaments is considered the primary underlying mechanism of slipping rib syndrome [2]. Holmes in 1943 proposed that pain in slipping rib syndrome is caused by recurrent subluxation of the costal margins of the 8th, 9th and 10th ribs making these ribs in close contact and cause irritation of the intercostal nerves.

3.2. Clinical Presentation and Diagnosis

Slipping rib syndrome often presents as the lower chest, flank, or upper abdominal pain. It is usually a clinical diagnosis while imaging studies are often required to rule out other potential causes including rib fractures, costochondritis, and cholecystitis or hepatobiliary pathologies [2]. Pain is reproduced by performing hooking maneuver [3], first described in 1977. It is a simple test where the clinician places his fingers in the subcostal area and pulls in the anterior direction (Figure 1).

Pain or clicking indicates a positive test. The positive hooking maneuver test is usually followed by a nerve block. Relief of pain on the nerve block after positive hooking maneuver is highly suggestive of slipping rib syndrome. Dynamic flow ultrasound, as performed in our patient, is sometimes helpful in visualization of the ribs slipping against each other potentiating the diagnosis [4].

3.3. Management

Reassuring patients about the benign nature of this disease helps in relieving their anxiety and fear of having serious underlying illness. Reassurance and conservative measures are the key management options for patients having mild symptoms [5]. Avoidance of specific movements or postures triggering or aggravating pain is associated with favorable outcome [2, 6]. In more refractory and severe cases, nerve blocks should be performed. Our patient is currently being managed with nerve blocks repeated every 2 to 3 months. In very severe cases, resection of the slipping rib and accompanying cartilage is performed to alleviate symptoms [7].

3.4. Prognosis

The outcomes of both conservative and surgical management are quite favorable. Three case-series have been published explaining the satisfactory outcomes of simple reassurance, reassurance with local anesthetic injections, and surgical management, respectively [6, 8, 9].

4. Conclusion

Increased awareness of slipping rib syndrome as a potential cause of lower chest and abdominal pain can spare patients with years of pain and prevent unnecessary interventions and radiographic exposures. A simple clinical test like hooking maneuver is often enough to establish the diagnosis. Reassurance and avoidance of pain-triggering postures are often helpful. Refractory cases can be treated with nerve blocks and surgery.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Copyright

Copyright © 2018 Noman Ahmed Jang Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Chest pain | FBUZ Treatment and Rehabilitation Center of the Ministry of Economic Development of Russia. Official site

Chest pain is one of the most frequent complaints of patients when they visit a doctor. There are many reasons leading to this problem. We will only talk about the most common ones.

Reasons

To make it easier to understand the causes of chest pain, we divide them into four main groups:

Respiratory diseases
Musculoskeletal diseases
Diseases of the heart and large vessels
Diseases of the digestive system

Look at how many different specialists a person with chest pain should look at in order to identify its cause: pulmonologist, cardiologist, neurologist and gastroenterologist.Therefore, it would seem to me wiser and more correct, when this complaint appears, to first turn to a competent therapist so that he understands which organ system is the cause of the pain, and then advised which specialist to contact.

Since I am a pulmonologist, I will try to answer the question:

When does chest pain occur in bronchopulmonary diseases?

Why the lungs “do not hurt”

There are no pain receptors in the lung tissue, therefore pain in diseases of the bronchopulmonary system occurs only if the leaves covering the lungs – the pleura – are affected.No wonder the pain in these diseases is called “pleural pain”.
Another cause of chest pain in bronchopulmonary diseases can be tracheobronchitis.

Mechanism of “pleural pain”

In a healthy state, during breathing, two sheets of pleura (one covers the lung, the other lines the chest wall from the inside) slide along the surfaces of each other, which allows the lungs to freely and painlessly fall down and expand when breathing. When these sheets become inflamed or growths appear on them, during breathing, they rub against each other due to the resulting “irregularities” (roughness).As a result, pain with deep breathing and coughing.

Causes of “pleural pain”

The first and most common cause of “pleural pain” is inflammation of the pleura itself and / or its covered lung. It is not for nothing that some types of pneumonia are called pleuropneumonia, that is, inflammation of the lungs and pleura.
Neoplastic diseases of the pleura and lungs can also become the cause of “pleural pain”.
Pneumothorax (air entering the pleural space) can also cause pain.

Features of “pleural pain”

“Pleural pain” is most often one-sided, acute, aggravated by deep inspiration and coughing. The pain is sometimes so severe that it makes the person take only shallow breaths.
A person assumes the so-called “forced position”, that is, he tries not to breathe on the side of the chest where the source of pain is located. To do this, he lies on the sore side or presses it with his hands, thus limiting the mobility of the chest.
Please note that in some cases, when fluid begins to accumulate between the pleural layers, pushing the pleura apart and preventing them from “rubbing” against each other, chest pain decreases, but shortness of breath appears.

What to do?

First of all, consult a doctor. The doctor can hear the rubbing noise of the pleural sheets, make an x-ray of the chest, ultrasound of the pleural cavity, CT scan of the chest to assess the damage to the lungs and pleura.

Therapy will be prescribed depending on the cause of the pleural pain.

Tracheobronchitis is another cause of chest pain associated with bronchopulmonary pathology.

In case of inflammation or swelling of the trachea and large bronchi, unpleasant sensations may occur behind the breastbone, having an aching or sore character. They occur mainly when inhaling air, especially cold air, aggravated in the supine position, often accompanied by a strong cough.
If these pains have arisen against the background of a cold, then most likely it is an inflammation of the trachea – tracheitis. Against the background of anti-inflammatory therapy prescribed by the doctor, these pains, along with the cough, quickly go away.
If the pain persists and there was no apparent reason for their appearance, then to clarify the diagnosis, the doctor may prescribe a computed tomography of the chest organs, and, if necessary, bronchoscopy.

90,000 Chest pain in children

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, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Chest pain in children: causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment.

Definition

The physiological significance of any pain is associated with the protection of the body from destruction, i.e. with a warning system about real or potential danger of damage.The pain signal ensures the timely mobilization of the body’s defenses.

When it comes to a child, his complaints of pain should be treated with special care, since children cannot always accurately characterize its specifics and even localization.

Chest pain can cause both intense physical activity and serious diseases of the organs located in the chest.

The sensation of pain significantly limits the activity of a small child, which can affect his psychomotor development.At an older age, pain can cause problems with the socialization and adaptation of the child in the children’s team.

Varieties of chest pain in children

Distinguish between acute and chronic pain, and depending on its nature – stabbing, pressing, squeezing, aching.

Possible causes of chest pain in children

Often, children complain of chest pain after intense physical activity. If such complaints are rare, then the appearance of pain can be explained by overstrain of the ligamentous apparatus – in this case, after a short rest, the pain disappears on its own and is not considered pathological.

Chest pain can result from injury (such as broken ribs).

The pain that occurs after eating should alert parents, since it can be a symptom of a gastrointestinal tract disease, for example, gastroesophageal reflux, gastritis or gastric ulcer, both alone and combined with manifestations such as belching, sour taste in the mouth, heaviness in the abdomen, impaired bowel movements.

Various respiratory diseases (eg whooping cough) associated with a debilitating cough often cause chest pain in children.This is due to excessive tension in the intercostal muscles. Chest pain with pneumonia may be associated with the spread of the inflammatory process to the pleura. In this case, the child usually takes a forced position, sparing the affected side, a superficial cough and a rise in body temperature are observed.

Some diseases (lung abscess, tuberculosis) are fraught with the development of pneumothorax (accumulation of air in the pleural cavity, leading to collapse of the lung tissue and compression of the blood vessels of the mediastinum).

Chest pain that occurs or worsens during movement is often a symptom of damage to the roots of the spinal nerves due to poor posture, scoliosis, or spinal hernia.

In adolescence, chest pain is associated with intense growth of the musculoskeletal system and delayed development of the cardiovascular and nervous systems. Such pain can be accompanied by a rapid heartbeat, dizziness and other unpleasant subjective sensations in the chest.

Infectious diseases such as herpes zoster caused by herpes simplex can cause long-term chest pain. The disease is characterized by the appearance of fine bubbly, profuse rashes along the affected nerve – often in the chest area. This rash is very itchy and causes significant discomfort.

Among the heart diseases that cause chest pain in children, myocarditis should be distinguished. It often develops against the background of an acute respiratory viral infection or intestinal infection (caused, for example, by the Coxsackie virus) or within two weeks after it.Young children with an unfavorable perinatal history are most susceptible to the development of myocarditis. An increase in body temperature is often the first symptom of the development of myocarditis. In the future, shortness of breath and pain in the chest area appear, the child becomes restless, tearful, reflex vomiting may be observed.

Myocardial infarction (violation of oxygen delivery to the myocardium, leading to necrosis of the heart muscle) is an extremely rare disease in children.

A heart attack can occur as a result of atherosclerosis in familial forms of hyperlipidemia, abnormal discharge of the left coronary artery, in Kawasaki disease, coronary artery vasculitis, infective endocarditis.The disease is characterized by burning pain behind the sternum, as well as respiratory failure, sweating, shortness of breath, and decreased blood pressure. In isolated cases, abdominal pain, vomiting, diarrhea are noted.

With the exclusion of all somatic (bodily) pathologies and persistence of chest pain, attention should be paid to the mental state of the child. Children and adolescents with anxiety and depressive disorders often complain of chest pain, palpitations, and difficulty breathing.

Which doctor should i contact if children have chest pain?

If a child develops chest pain, contact
pediatrician.After examining and collecting anamnesis, the doctor will prescribe a set of laboratory and instrumental studies and consultations of narrow specialists.

An examination by a pediatric cardiologist, orthopedist, rheumatologist, neurologist, gastroenterologist, psychiatrist may be required.

Diagnostics and examinations for chest pain in children

In most cases, for a diagnosis, a complex of laboratory and instrumental studies is required, a list of which is made by the doctor, focusing on the patient’s condition and the existing symptoms.

Clinical blood test: general analysis with platelet count, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes).

Chest deformities – treatment, symptoms, causes, diagnosis

Chest deformities occur in 2% of people. Changes (defects) in bone and cartilage tissues reduce both the supporting function of the chest and the required amount of mobility. Deformities of the chest (sternum and ribs) are not only a cosmetic defect and cause not only psychological problems, but also quite often lead to dysfunction of the chest organs (cardiovascular system and respiratory system).

Reasons

The causes of chest deformity can be both congenital and acquired. The main reasons are as follows:

In clinical practice, funnel chest deformity and keeled deformity are most common.

Funnel chest deformity (sunken chest)

Funnel chest deformity (sunken chest) is by far the most common chest deformity and occurs in 1 in 400 newborns.Keel deformity, as the second most common form of deformity, occurs 5 times less frequently than the funnel chest.

Etiology of development of funnel-shaped deformity

There are several theories explaining the development of this deformity, but the etiology remains unclear until the end. Some authors believe that the development of funnel-shaped deformity may be associated with an excessively rapid growth of costal cartilage, which displaces the sternum posteriorly. Diaphragm abnormalities, rickets, or increased intrauterine pressure are also thought to contribute to the displacement of the posterior sternum.The frequent association of funnel deformity with other diseases of the musculoskeletal system, such as Marfan’s syndrome, suggests that, to a certain extent, the deformities are due to connective tissue abnormalities. Genetic determinism also occurs in 40% of patients with keeled deformity.

Clinical manifestations

The funnel chest can appear as a small defect or a pronounced defect in which the sternum reaches almost to the vertebrae.The appearance of the defect is the result of 2 factors: (1) the degree of posterior angulation of the sternum and the degree of posterior angulation of the costal cartilage in the area of attachment of the ribs to the sternum. If, in addition, there are additional asymmetries of the sternum or cartilaginous asymmetries, then surgical treatment becomes more technically difficult.

Funnel deformity usually occurs at birth or shortly after birth. The deformity often progresses and the indentation depth increases as the child grows.Sunken breasts are more common in men than women in a 6: 1 ratio. Sunken breasts can be associated with other congenital anomalies, including diaphragm abnormalities. In 2% of patients, sunken breasts are associated with congenital heart anomalies. In patients with a characteristic body habit, a diagnosis of Marfan syndrome can be assumed.

There are several methods for quantifying the severity of pectus crater deformity, which usually include measuring the distance from the sternum to the spine.Perhaps the most commonly used method is the Haller method, which uses the ratio of lateral distance to anteroposterior distance obtained from CT. In the Haller system, a score of 3.25 or higher indicates a severe defect that requires surgery.

Funnel breasts have no particular physiological effect on infants or children at all. Some children experience pain in the sternum or rib cartilage, especially after intense exertion.Other children may have palpitations, which may be due to mitral valve prolapse, which usually occurs in patients with sunken breasts. Some patients may feel a murmur of blood movement, which is due to the fact that the pulmonary artery is close to the sternum and during systole, the patient may notice a murmur of blood ejection.

Asthma is sometimes found in patients with a funnel chest, but it has been noted that the deformity does not have a clear effect on the clinical course of asthma.Funnel-shaped deformity affects the cardiovascular system and observations have shown that after surgical correction of the deformity there is a significant improvement in the functions of the cardiovascular system.

Keel deformation

Keel deformity is the second most common congenital deformity of the chest wall. Pectus carinatum accounts for approximately 7% of all deformities of the anterior chest wall. It is more common in boys than girls (4: 1 ratio).As a rule, this deformity is already present at birth and tends to progress as the child grows. A keel deformity is a bulging of the chest and is actually a spectrum of deformities that include costochondral cartilage and sternum. Changes in osteochondral cartilage can be both unilateral and bilateral. In addition, the bulging of the sternum can be large or slight. The defect can be asymmetric, causing the sternum to rotate with depression on one side and bulging on the other.

Etiology

The pathogenesis of keeled deformity, as well as funnel-shaped deformity, is not clear. It has been suggested that this is the result of excessive proliferation of ribs or osteochondral cartilage. There is a certain genetic determinism of the keeled deformity. So in 26% of cases, a family history of this form of deformity was noted. In addition, in 15% of cases, keeled deformity is combined with scoliosis, congenital heart defects, Marfan’s syndrome or other connective tissue diseases.

Clinical manifestations

Keel deformations can be divided into 3 different types of deformations.

Type 1. It is characterized by a symmetrical protrusion of the sternum and costal cartilage. With this type of deformity of the sternum, the xiphoid process is displaced downward
Type 2. Corporocosteal type, with this type of deformity there is a displacement of the sternum downward and forward, or arching of the middle or lower third of the chest. This type of deformity is usually accompanied by curvature of the ribs.
Type 3. Costal type. In this type of deformity, the costal cartilage is mainly involved, which bends forward. Curvature of the sternum is usually not significant.

Symptoms of keeled deformity are more common in adolescents and can be severe shortness of breath that occurs with minimal exertion, decreased endurance and the appearance of asthma. This is due to the fact that the chest wall excursion is limited due to the fixed anteroposterior chest diameter, which leads to an increase in residual volume, tachypnea, and compensatory diaphragmatic excursion.

Poland’s syndrome

Poland’s syndrome is named after Albert Poland, who first described this type of chest deformity as a result of observations at school and belongs to the spectrum of diseases that are associated with underdevelopment of the chest wall. This syndrome includes abnormalities in the development of the pectoralis major, pectoralis minor, serratus anterior, ribs, and soft tissue. In addition, deformity of the hand and hand can be observed.

The incidence of Poland’s syndrome is approximately 1 in 32,000 children born.This syndrome is 3 times more common in boys than in girls, and the right side is affected in 75% of patients. There are several theories regarding the etiology of this syndrome, which include abnormal migration of embryonic tissue, hypoplasia of the subclavian artery, or intrauterine trauma. However, none of these theories have proven their worth. Poland’s syndrome is rarely associated with other medical conditions. Some patients with Poland syndrome have leukemia. There is a definite association of this syndrome with Moebius syndrome (unilateral or bilateral paralysis of the facial nerve, which takes the optic nerve).

Symptoms of Poland’s syndrome depend on the degree of the defect and in most cases they are cosmetic complaints. Patients with significant bone defects may have lung swelling, especially when coughing or crying. In some patients, functional and respiratory impairments are possible. The lungs themselves do not suffer from this syndrome. In patients with significant muscle and soft tissue defects, a decrease in exercise tolerance may become apparent.

Wife Syndrome

Wife’s syndrome or progressive dystrophy of the chest, which is caused by intrauterine growth disorder of the chest and hypoplasia of the lungs.This syndrome was first described in 1954 by Zhen in newborns. And although in most cases such patients do not survive, in some cases, surgical methods of treatment allow such patients to live. Wife syndrome is inherited in an autosomal recessive manner and no association with other chromosomal abnormalities has been noted.

Sternum defects

Sternal defects can be divided into 4 types and all are rare: thoracic ectopia of the heart, cervical ectopia of the heart, thoracoabdominal ectopia of the heart, and cleft sternum.Thoracic ectopia of the heart is an abnormality of the location of the heart outside the chest, and the heart is completely unprotected by dense bone tissue. The survival rate of patients with thoracic ectopia of the heart is very low. Only three successful cases of surgical treatment out of 29 operations with this anomaly have been described.

Cervical ectopia of the heart differs from the thoracic only in the localization of the abnormal location of the heart. Typically, these patients have no chance of survival. In patients with thoracoabdominal ectopia, the heart is located down the sternum.The heart is covered with a membrane or thin skin. The downward displacement of the heart is the result of a lunate pericardial defect and a diaphragm defect. Abdominal wall defects are also common.

Cleft sternum is the least serious of the 4 abnormalities because the heart is nearly closed and in its normal position. There is partial or complete cleavage of the sternum over the heart, with partial cleavage more common than complete cleavage. Associations with heart defects in this anomaly are rare.In most children, cleft sternum usually does not cause any very noticeable symptoms. In some cases, respiratory symptoms are possible as a result of paradoxical movement of the sternum defect. The main indication for surgical treatment is the need to protect the heart.

Diagnostics

Diagnosis of chest deformities, as a rule, does not present great difficulties. In the foreground of the instrumental research methods is radiography, which allows you to assess both the form of deformity and its degree.CT scan of the chest allows you to determine not only bone defects and the degree of deformity of the sternum, but also the presence of displacement of the mediastinum, heart, the presence of compression of the lung. MRI allows you to get more advanced information about the state of bone tissue and soft tissue and, moreover, does not have ionizing radiation.

Functional studies of the activity of the heart and lungs, such as ECG, ECHO-cardiography, spirography, allow us to assess the presence of functional disorders and the dynamics of changes after surgery.

Laboratory research methods are prescribed if it is necessary to differentiate with other possible conditions.

Treatment

The tactics of treatment for chest deformities is determined by the degree of deformity and the presence of dysfunctions of the respiratory and heart organs. With a slight deformation with a funnel chest or keeled deformity, conservative treatment is possible – exercise therapy, massage, physiotherapy, breathing exercises, swimming, the use of corsets.Conservative treatment is not able to correct the deformity, but it can stop the progression of the deformity and preserve the functionality of the chest organs.

In case of moderate and severe deformity, only surgical treatment can restore the normal function of the chest organs.

90,000 Colds are coming, but the heart wants warmth …

Weather & Health

Forecasters scare us, warning that the coming winter will be the worst in 120 years.Time will show how correct these predictions are, but it is probably worth worrying about your health before the onset of the cold season.

With the arrival of frost, diseases of the heart and blood vessels are most often exacerbated. What’s more, scientists say the chances of dying from myocardial infarction, stroke, sudden cardiac arrest and other cardiovascular diseases are 36% higher in the fall and winter months than in summer. What is the reason and how to help your body adapt to the unfavorable surprises of nature? Let’s talk about this with Natalia Zaplavnaya, a cardiologist at the Rostov Regional Consultative and Diagnostic Center.

– Natalya Alexandrovna, many people believe that cold is the best means of hardening. Why are we so afraid of him? Is our heart more comfortable in warmth?

– Constriction of blood vessels under the influence of cold leads to the occurrence of winter exacerbations, which causes obstructed blood circulation. At this time of the year, our body, in comparison with summer, receives less vitamins, minerals and amino acids from food, which are abundant in fresh vegetables and fruits. He is guilty of a sharp manifestation of chronic diseases and a sedentary lifestyle, which, as a rule, accompanies us in cold autumn and winter, as a result of which there is excess weight and blood pressure rises.

vExacerbation of vascular diseases also occurs due to a decrease in immunity, which can be caused by frequent colds, respiratory viruses and bacterial infections. Doctors – practitioners in the winter period note that patients have a failure in taking medications due to the reduction in daylight hours and the drowsy state of people who sometimes simply forget to take the next dose of the necessary drugs. This is also fraught with increased blood pressure and heart attack.Therefore, it is so important that relatives of people suffering from chronic vascular and heart diseases pay attention to these risk factors and prevent possible exacerbations.

– Everyone wants to protect themselves from heart ailments. But, alas … The number of heart attacks continues to grow, in terms of the number of deaths, it surpasses cancer, infectious diseases and serious injuries. How to avoid a heart attack and how to recognize the threat of its development?

– Most patients believe that simply controlling their cholesterol levels is enough to correct this problem, but the reality is not so simple.For example, the same indicator of 5 mmol / l in a young 30-year-old woman and in a 70-year-old smoking man who suffers from arterial hypertension indicates a different degree of likelihood of a heart attack. Despite the same cholesterol levels, the treatment for these people will be different, recommendations for the prevention of the disease are also developed individually, taking into account genetic risks, the results of special tests and laboratory studies. There are certain indicators that help cardiologists to identify signs of the development of cardiovascular pathology at the earliest stage, when the body is still able to cope with disorders and put a barrier to ailments.Carrying out the so-called primary prevention allows you to reduce the risk of stroke or heart attack in an absolutely healthy person, without any complaints and suspicious symptoms, but with risk factors. Repeated preventive measures are to reduce the complications of the disease in those already suffering from it.

– What symptoms can become a SOS signal and a reason for immediate referral to a specialist?

If your pressure rises above 140/90 mm.Hg, if you have discomfort in the chest when going out into the cold or when walking, if you have burning pains behind the breastbone, if you have high cholesterol or do not know its level – do not pull, do not expect trouble – go to the appointment to a cardiologist.

The main cause of myocardial infarction is atherosclerosis, blockage of blood vessels by plaques containing cholesterol. Few people know that atherosclerosis begins as early as adolescence. Therefore, you need to think about keeping your arteries “clean” as early as possible.Better late than never, though. Most people switch to a healthy lifestyle only after they have had a heart attack or stroke. It is wise to develop good habits in advance. Try to keep other family members healthy with you.

It is advisable to undergo a preventive medical examination annually. During which it is necessary to pass blood tests not only for cholesterol, but also C-reactive protein, homocysteine, fibrinogen, low and high density lipoproteins, triglycerides.It is also recommended to include in the list of mandatory examinations ultrasound of the heart and blood vessels, and not just the usual cardiogram. At OKDC, the screening program for identifying the risks of cardiovascular pathology is developed on the basis of European standards, and includes many additional parameters. If you work out or plan to work out in the gym, to assess the capabilities of your heart and blood vessels, it is advisable to perform an ECG under stress (VEM or treadmill test). If you are worried about palpitations or interruptions in the work of the heart, the most information will be given by a daily ECG (Holter ECG) – after all, serious rhythm disturbances on a regular ECG may not be recorded at all.If you are tormented by headaches, 24-hour blood pressure monitoring (ABPM) is necessary to detect latent hypertension.

Highly qualified specialists, modern expert-class equipment and the principle of complete diagnostics have allowed our doctors to save hundreds of lives and prevent the occurrence of serious vascular pathology at the “early approaches” of the disease. But success in the fight against ailments depends not only on the literacy of doctors, but also on the responsibility of each patient for their health, on the degree of readiness to clearly follow all the recommendations of doctors and lead a healthy lifestyle.

90,000 Treatment of angina pectoris (angina pectoris, angina pectoris) in the St. Petersburg hospital of the Russian Academy of Sciences

area of the heart.

Pain can appear suddenly during physical exertion or emotional stress, can radiate (give) to the left shoulder, arms, neck, lower jaw, between the shoulder blades, left subscapularis and lasts no more than 10-15 minutes.The pain disappears when you stop exercising or take a short-acting nitrate (for example, nitroglycerin under the tongue).

The posture and reflex gesture of a person who has felt such pain are characteristic.

The main cause of angina pectoris is atherosclerosis – narrowing of the coronary (coronary) arteries supplying the heart with blood by atherosclerotic plaque, or spasm of the artery of the heart. Sometimes angina attacks can occur with damage to the microvessels of the heart, which most often occurs in people suffering from metabolic disorders, for example, type II diabetes mellitus.

If you do not pay due attention to the occurrence or worsening of angina pectoris, then at some point, as a result of complete cessation of blood circulation in the vessel, myocardial infarction may occur.

Often so-called “painless forms of ischemia” are also encountered, especially often in the elderly, when the patient does not feel pain subjectively, but “equivalents” of angina pectoris can occur – shortness of breath, attacks of general weakness, but at the same time, the same processes occur in the vessels of the heart , as in those experiencing angina pectoris.

The appearance of paroxysmal chest pain or other sensations behind the sternum is a reason to contact a cardiologist, who will conduct a comprehensive diagnosis of angina pectoris and other manifestations of coronary heart disease.

It is important to remember that a single electrocardiogram (ECG) is not proof of the absence of coronary artery disease, angina pectoris!

With an increase in the frequency of angina attacks, it is necessary to immediately consult a doctor, and if an intense and protracted attack occurs for more than 10-15 minutes, call an ambulance and carry out further treatment in a cardiological hospital.

The purpose of hospitalization is examination, selection and development of basic therapy, solution of the issue of restoring blood flow in the affected vessels of the heart, for which diagnostics is carried out, including in the conditions of of the department of endovascular surgery coronary angiography is performed and the method of surgical correction of the disease – angioplasty, stenting of the coronary arteries or coronary artery bypass grafting.

90,000 Burning in the chest – the cause of what disease? – Clinic “Doctor near”

Most often, a symptom of a burning sensation behind the sternum manifests itself in the following diseases:

Pain and burning in the chest are quite common symptoms that can occur after heavy physical exertion, after eating, against the background of stressful situations. This phenomenon may indicate both rather harmless processes and pathological conditions that threaten human life.In addition to the heart, the lungs, stomach, esophagus, pancreas, large vessels, musculoskeletal system are located in the chest cavity, and the mammary glands are located on top of women.

The cause of the burning sensation in the chest, if it is not episodic, but regular or constant, must be clarified by a specialist in order to determine the correct methods of treatment.

Why do chest pains occur?

Unpleasant sensations and burning sensations in the chest in men and women can cause a number of diseases.Let’s consider the most common ones.

Diseases of the gastrointestinal tract

Heartburn is one of the most popular causes of chest burning. It usually appears after an excessively plentiful meal, as well as from spicy, smoked, overcooked food (especially at night). Heartburn can also occur after drinking alcohol, strong coffee and tea. Burning and pain behind the breastbone can occur along the entire esophagus line and spread from the throat to the stomach.The duration of the pain syndrome most often ranges from 5-10 minutes to one and a half hours or longer, often it is accompanied by a belching with a sour taste. You may also experience a mild dry cough and a feeling as if the person choked on something. About half an hour after eating, a symptom such as a sore throat is likely to appear, aggravated when a person bends over or takes a horizontal position. To prevent the onset of symptoms of heartburn, the first step is to stop overeating.If seizures occur intermittently or frequently, it is necessary to consult a doctor to prescribe adequate treatment.

A burning sensation in the chest also often means the presence of an inflammatory process on the esophageal mucosa – esophagitis reflux. When gastric juice enters the esophagus, its mucous membrane and walls are corroded. For this reason, inflammation forms and a burning sensation occurs in the chest. The appearance of such signs as nausea, vomiting, belching, discomfort in the process of swallowing food is possible.In such a situation, a burning sensation is constantly felt in the lower chest region. To alleviate the symptoms, it is recommended to give up fried, spicy, fatty foods, fast food, alcoholic beverages, do not overeat or eat at night, do not bend over or lie down for two hours after completing a meal.

Heart disease

Burning, painful sensations and a feeling of squeezing in the chest in the region of the heart may indicate pathologies of the cardiovascular system.In this case, you should put a nitroglycerin tablet under the tongue, the onset of relief will mean a problem associated with cardiac activity.

One of the most common syndromes that provoke a burning sensation in the chest is angina pectoris. This is due to the violation of blood circulation in the coronary arteries, which provide the heart with oxygen and essential nutrients, as a result of the formation of atherosclerotic plaques on the walls of blood vessels. Usually painful sensations are short-lived (about two to five minutes) and appear in the morning.A person has a feeling that inside the chest cavity on the left it seems to bake, while it can be combined with discomfort in the neck, jaw, shoulder blades, spine. Attacks occur regularly and especially often after physical exertion.

Another pathology is myocardial infarction. It is characterized by the occurrence of sharp severe pain in the heart area due to physical exertion or severe stress, which does not disappear at rest and after taking nitroglycerin, even repeated.Pain sensations accumulate in the side of the body on the left – they can be given under the scapula, in the arm, in the jaw. They are often accompanied by shortness of breath, cold sweat, heart rhythm disturbances, and dizziness. If you have these symptoms, you need to urgently call an ambulance.

Pulmonary diseases

A burning sensation in the chest also manifests its symptoms in the presence of diseases such as bronchitis, flu, tonsillitis, bilateral pneumonia or pleurisy of the lungs.An inflammatory process in the lungs with concomitant cough and fever is usually accompanied by a burning sensation in the chest on a constant basis or when inhaling, after coughing fits. Pain in the chest can be localized in the middle, left or right, depending on which side the inflamed lung is on. A burning sensation with bilateral pneumonia covers the entire chest. Flu and sore throat are also characterized by the appearance of cough, body aches, fever, pain in the throat and chest.

Intercostal neuralgia

A condition in which nerves are pinched towards the intercostal muscles. Most often, the appearance of neuralgia is provoked by herpes zoster (there is a rash in the form of bubbles on the skin between the ribs) or osteochondrosis. It is characterized by strong painful sensations in a strictly defined place, aggravated by inhalation, brisk walking, bending and other sudden movements.

Intercostal myositis

The appearance of a burning sensation and pain can be facilitated by bruises and fractures of the ribs, suffered earlier, active physical activity and inflammation of the intercostal muscle – myositis.At the same time, unpleasant sensations are concentrated in a specific place. The pain occurs when moving, coughing, taking deep breaths and is absent when the person is at rest.

Premenstrual syndrome

During the period of PMS against the background of mastopathy, a woman may experience a burning sensation in the breast – in both mammary glands or in one. In this case, a feeling of discomfort appears only before the onset of menstruation, nodules can be found in the chest on palpation, and it swells a little.

Vegeto-vascular dystonia

With VSD, painful sensations arise on the left or in the middle of the chest as a result of overwork of the body. Also, a person’s skin turns pale or reddens, sweating increases, he gets hot.

Thoracic osteochondrosis, scoliosis

A burning sensation in the chest is provoked by physical activity and active movement. Feelings of numbness, tingling in the hand, squeezing of the chest, pain in the area of the shoulder blades, cold feet are also felt.

Mental disorders

A strong surge of emotions, stressful situations, emotional disturbances, chronic fatigue syndrome in men and women can cause a feeling of heaviness and pressure inside the chest. Usually, the discomfort is localized to the right. At the same time, other symptoms of malaise – high fever, cough, joint aches, difficulty breathing or eating – are absent, and diagnostic tests do not reveal any pathologies.In this case, the patient is advised to consult a psychiatrist.

When help is needed immediately

The following pathological conditions require an early start of treatment:

mitral valve prolapse, atrial fibrillation – a burning sensation behind the breastbone is implicitly expressed and is not associated with physical activity and breathing;
aortic dissection – characterized by strong sharp pain sensations, there is a burning sensation in the chest on the left or in the middle, as well as the feeling that it is being torn apart.In the absence of emergency care, the risk of death is high;
pulmonary embolism – severe pain, intense burning sensation in the chest (top), feeling that there is not enough air, cough with rusty phlegm.

Call our contact center at 8 (495) 230 03 09 and we will help you make an appointment with a specialist!

Conversations about pain. Topic number 1 – chest pain

Maslov Sergey Vyacheslavovich

Therapist, Cardiologist

April 26, 2021

What does pain in different parts of the body say? How to decipher these signals that the body gives us for a reason? Let’s talk in a series of materials on pain and its causes.

It is often not customary for us to go to the doctor immediately when something is ill. First, pain relievers, ointments, and warming up are used. There remains the hope that “it will pass by itself”, “I will endure”. Sometimes this happens, but, unfortunately, much more often postponing a visit to the doctor leads to the fact that the disease develops, the risk of complications and life-threatening conditions increases.

This article series is not intended to help patients self-diagnose.We want to give an idea of how multifaceted this problem is. What a huge number of different reasons can cause at first glance similar pain sensations.

It is not always possible to establish the cause immediately. Outlining the range of problems, the doctor first checks the most probable ones. In this he is assisted by laboratory tests, diagnostic examinations, examination and conversation with the patient. If first-round problems are excluded, the rarer ones are considered. You need to be prepared for the fact that treatment of pain may require several visits to the doctor and stages of diagnosis.

For a doctor, pain, especially when a patient first appears, is primarily a symptom – something in the body is not working properly. And there are two main tasks, and they are interrelated: to alleviate the patient’s condition and figure out what is happening.

Our first conversation was about CHEST PAIN

The area related to the chest is defined from the end of the neck (from the collarbones) to the edge of the ribs (where the belly begins, which we will talk about in the next conversation). We chose chest pains for the first topic of the cycle, since they can be called the most terrible in terms of the likelihood of developing life-threatening conditions.

Baseline surveys are available to help confirm or rule out the most common causes. In case of complaints of chest pain, even if the symptoms are more suitable for other diseases, ECG is necessarily done to exclude disturbances in the work of the heart. The doctor needs to check this direction, since the most dangerous conditions are associated with it. Another important step in the examination for chest pain is x-rays of the lungs. Clinical blood test is prescribed to detect inflammation, biochemical blood test – determines markers of damage to the stomach and gastrointestinal tract.This is the main primary diagnosis, the rest of the tests and examinations are prescribed by the doctor based on specific symptoms, according to indications.

Due to the location of the organs in the chest, it is not always possible to understand what exactly hurts, and the list of diseases that can cause chest pain is quite extensive. Even the liver, gallbladder, and stomach located below can give off painful sensations to the chest area. This is explained by both proximity and innervation that occurs through the solar plexus.Innervation is the impulses that go from the organs to the brain and vice versa. If you try to simplify this process, the brain gives a command, the organ responds with an action, the signal about this action goes back to the brain. If there is a problem in this organ, a painful impulse arises, which can be given not in the organ itself, but in the nerve center.

NOT SIMPLE OSTEOCHONDROSIS

Similar mechanisms are observed in osteochondrosis. Almost everyone has this disease, and it is constantly “getting younger”. Therefore, osteochondrosis takes a significant place in the number of patients who come with complaints of chest pains.When the roots of the spinal nerves are pinched due to changes in the spine in this disease, signals from various internal organs pass through the diseased nerve. And one may get the impression that it is not this nerve root that hurts, but the internal organs are hurting, although there are no pathologies in them. Depending on the lesion of different roots, echoes can occur in different areas. The most frightening for patients are the sensations of malfunctioning of the heart, when, due to the increased sensitivity of the chest, the heart rhythm is perceived differently and the impression of too strong blows arises.

When receiving signals about pain, the brain tends to reduce movements in this area. With osteochondrosis, there is a decrease in mobility in the places of attachment of the ribs, the amplitude of movement of the chest is limited, and if a person needs to breathe more intensively, rather intense pain in the chest and a feeling of lack of air may occur.

Muscle pains in the chest area may also occur, more often they are associated with sudden movements, overexertion, hypothermia, as is the case with other muscles in our body.

HEART PAIN

Angina pectoris

Angina pectoris occurs very often, this disease is associated with atherosclerosis. Atherosclerosis is the accumulation of cholesterol deposits in the walls and on the walls of blood vessels, which impair their permeability. Angina pectoris occurs when atherosclerosis affects the vessels of the heart. It is characterized by severe, compressive pain in the region of the heart during physical exertion, the load usually ends – the pain passes.

Heart attack

The most famous, frightening and dangerous cause of acute chest pain is heart attack.With the development of a heart attack, the heart vessel is sharply clogged, blood immediately stops flowing into one of its sections, it ceases to be supplied with oxygen, experiences shock and tissues in this place begin to die off. In this case, acute pain occurs, one of the most intense in intensity possible in the chest. This pain has a huge number of epithets: tearing, piercing, “like a knife blow”, fire in the chest, etc.

There are several conditions where the pain of a heart attack can be “erased”.For example, in diabetes mellitus, when the nerves that conduct pain impulses to the brain change, taking certain medications and in a number of other cases. But this is an exception, most often the pain is very strong.

A heart attack rarely occurs at rest, in order for an atherosclerotic plaque to rupture, something must provoke a load on the heart, an increase in its contractions, an increase in pressure.

Myocarditis

Inflammation of the heart muscle of an infectious nature, for example, as a complication of influenza, sore throat, can cause very different intensity chest pains from small pulling to severe.Usually accompanied by general intoxication, deterioration of health.

AORTIC DISEASE

Chest pain may be associated with dissection or inflammation of the central vessel, the aorta. Acute aortic dissection is fatal in a large percentage of cases. Unfortunately, rarely, when they manage to get to the hospital and operate safely, everything happens too quickly. The pain is comparable in strength to a heart attack. It can also occur in a less acute form if the dissection occurs in the abdominal region, but in any case it is a dangerous condition that requires immediate medical attention.

LUNGS DO NOT HURT

It is necessary to exclude pneumonia, which can occur without severe cough and other diseases. By itself, pneumonia practically does not cause pain, there are no pain receptors in the tissues of the lungs. Pain in pneumonia is associated either with muscle tension due to coughing, or with the addition of pleural lesions (pleurisy), or an abscess in the lung.

In viral diseases, there is such a complication as inflammation of the cartilage of the sternum, with which the ribs are in contact – perehandritis.Like any joint, these joints can become inflamed and painful.

NEIGHBORHOOD INFLUENCE

Returning to osteochondrosis, non-steroidal anti-inflammatory drugs, sometimes hormone therapy, are often used in the treatment of this disease. All this can worsen the condition of the digestive system, leading to the formation of stomach and esophageal ulcers. This is a rather painful condition, the pain can begin both suddenly and increase gradually. And it is localized just exactly in the middle of the chest, sometimes rising higher.May be accompanied by a burning sensation. Combined with increased sensitivity of nerve endings due to osteochondrosis, it can cover the entire chest in front. More often occurs after eating and when lying down, at night. There is a frightening condition for patients, sometimes it is even mistaken for a heart attack, especially the elderly.

In case of disturbances in the work of the stomach, a condition may occur when, instead of pushing food down, it begins to contract in the opposite direction, causing food to be thrown into the esophagus and even prolapse (pushing) a part of the stomach into the opening of the esophagus.Prolapse is characterized by a sharp pressing pain in the chest. Interestingly, this pain can go away when drinking ordinary water, acidity decreases, the stomach returns to its place and the situation is normalized for a while. Osteochondrosis as a concomitant disease causes an increase in these pains.

If the peristalsis of the stomach and duodenum is disturbed, the contents may be thrown into the pancreatic ducts. In this case, acid production is activated, and the pancreas begins to digest itself.In this case, inflammation occurs, cysts can form, pain radiates in different directions, including in the area of the diaphragm.