Costochondritis – Physiopedia

Costochondritis is a self-limiting condition defined as painful chronic inflammation of the costochondral junctions of ribs or chondrosternal joints of the anterior chest wall.^[2]

• It is a clinical diagnosis and does not require specific diagnostic testing in the absence of concomitant cardiopulmonary symptoms or risk factors.
• Costochondritis is often confused with Tietze syndrome.
• Palpation of the affected chondrosternal joints of the chest wall elicits tenderness ^[2] and pain is reproduced by palpation of the affected cartilage segments which may radiate out into the chest wall.

Clinically Relevant Anatomy[edit | edit source]

The thoracic wall consists of the

• Sternum anteriorly,
• 12 thoracic vertebrae posteriorly,
• 12 paired ribs and associated costal cartilages.^[3]

Ribs consist of bone and cartilage, with cartilage serving as an elastic bridge between the bony portion of the rib and the sternum.

According to their attachment to the sternum, the ribs are classified into 3 groups: true, false, and floating ribs.

1. True ribs are the ribs that directly articulate with the sternum with their costal cartilages – ribs 1-7. They articulate with the sternum by the sternocostal joints. The first rib is an exception to that rule; it is a synarthrosis and the first rib could uniquely articulate with the clavicle by the costoclavicular joint
2. The false ribs (8,9,10) are the ribs that indirectly articulate with the sternum, as their costal cartilages connect with the seventh costal cartilage by the costochondral joint.
3. The floating ribs (11,12) do not articulate with the sternum at all (distal two ribs)^[4].

The ribs move with respiration and with truncal motion or movement of the upper extremities.^[3]

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions^[5].

Epidemiology[edit | edit source]

The epidemiology of costochondritis is not well established.

• In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics.
• In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%)^[5]
• Can affect children as well as adults. A study of chest pain in an outpatient adolescent clinic found that 31 percent of adolescents had musculoskeletal causes, with costochondritis accounting for 14 percent of adolescent patients with chest pain^[2].

Characteristics/Clinical Presentation[edit | edit source]

As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis.

Possible findings include

• Patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath.
• Pain quality is variable, but it may be described as a sharp or dull pain.
• Patients report a gradual or rapid onset of pain and swelling of the upper costal cartilage of the costochondral junction.
• Pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum (a pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible)^[5].
• Symptoms may occur gradually and can disappear spontaneously after a few days, but equally it may take years to disappear. ^[6][7] Even after the symptoms have resolved, they may return at the same location or at another rib level. ^[8]
• There may be hypomobility of the upper thoracic spine, costovertebral joints, and the lateral ribs.^[9]

Costochondritis is usually self-limited and benign – should be distinguished from other, more serious causes of chest pain.

• Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation.
• History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults.
• Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph.
• Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status^[10]

The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality. eg

Patient-specific functional scale ( PSFS): specific questionnaires for costochondritis have not yet been produced, but the PSFS is a valid, reproducable, and responsive outcome measure for patients with neck pain, back pain, and upper quarter complaints 19

The Global rating of change (GROC): to measure the patient’s subjective rate of improvement.improvement .^[2]

Measurement of thoracic and cervical mobility:^[13]

• Rotation of the thoracolumbar spine (TR): TR has high validity and sensitivity ranks and improvement of the measurement technology would probably result in a superior test for the follow-up.
• Finger to floor distance (FFD): high reliability and sensitivity, but poor correlation with spinal changes
• The Schober test
• Thoracolumbar flexion
• Occiput to wall distance ^[14]

Patients with Costochondritis will present with:

• Chest pain reproducible by palpation of the affected area, with ribs 2 to 5 mostly affected.
• Aggravating factors can be slouching or exercise.
• Often occurs after a recent illness with coughing or after intense exercise and it mostly of unilateral origin.^[2]
• May be an associated restriction of the corresponding costovertebral and costotransverse on examination.
• Loss of normal spinal movement associated with the chest pain.^[15]
• Palpation should be performed with 1 digit, on the anterior, posterior, and lateral side of the chest, the clavicle, the cervical and thoracic spine. When on the affected area it reveals a reproducible pain which might suggest Costochondritis, but it cannot entirely concluded.^[2]
• Motion palpation is a manual process of moving a joint into its maximal end range of motion, after which it is challenged with a light springing movement. This end point of joint movement forms the basis for determining the normal or abnormal joint movement. When motion palpation is reduced, the joint is considered fixated or hypokinetic.^[15]
• Cardiac causes should be ruled out in patients who present with a high risk.

Treatment consists of conservative management and is usually symptomatic, ^[16]

Management includes

• Reassurance
• Topical or oral analgesics.^[16]
• Local injections with steroid into the joint, tendon sheath or around the nerve, inhibits inflammation, reduces swelling and pain to improve movement. ^[17]
• If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis^[5]
• Alternative treatments may also include: ice, acupuncture, manual therapy, exercise, and other medications such as sulfasalazine which may have an additional long-term benefit in the management of costochondritis ^[18]

Physical Therapy Management[edit | edit source]

May Include:

• Education – reassure the patient by explaining the condition ^[19]

• Minimising activities that provoke the symptoms (e.g. reducing the frequency or intensity of exercise or work activities)
• A course of trigger point therapy to reduce pain – eg.cross fibre friction massage
• Use heat/ cold pads and massage to help against the overloading of muscles and to lessen the pain.[4][9] Heat and cold pads are both equally effective. So the patient can choose which one he likes the most. Instead of using cold pads, the patient can also use Vapocoolant spray on the involved areas. This spray can relief the pain on the chest.^[20]
• Postural exercises – Re-train proper posture in functional positions (Neuro-muscular control). Functional training is all about using the right muscles at the right time, to sustain the correct posture, in daily activities. Simple activities like eg. correct standing posture, sit to stand and walking up stairs all need be addressed to ensure correct technique and muscle recruitment.
• Thoracic manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility^[9]
• Exercises in the range of motion should be induced as soon as possible. The patient may not have pain when he is doing the exercises eg.rotation exercises for thoracic spine. Do not invoke pain.
• Progressive stretches. They can begin with simple mobility exercises as tolerated ^[20]eg ^[21] Stretching of the M. pectoralis major can be helpful (stretch the M. pectoralis major, stand in a corner for 10 sec with both of your hands against the wall (like when you do a push-up)repeat it a few times a day for 1 or 2 minutes).
• Mobilisation of the spine and ribs to improve thorax mobility and to reduce symptoms. ^[22]
• On the painful area they can use transcutaneous electrical stimulation and electroacupuncture. The acupuncture needle is placed within the involved spinal segment. Than low-frequency electrical currents are applied on the inserted needle.^[23]
• Dry needling : Musculoskeletal chest wall pain has traditionally been a difficult area to evaluate and treat. Dry needling in the hands of properly trained providers may aid in diagnosis and treatment of focal chest wall syndromes^[24]

Resources for pictures:

• Fig 1 & 2 : From THIEME Atlas of Anatomy, General Anatomy and Musculoskeletal System, © Thieme 2005, Illustration by Karl Wesker
• Fig 3 : Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71

Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality.

• Patients typically present with chest pain worse with breathing, and it is often positional.
• Costochondritis is a self-limited disease.
• It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal.
• Diagnosis is confirmed by a scan or bone scintigraphy and by a physical assessment of the affected costal cartilage.
• The treatment of costochondritis consists of conservative management and is usually symptomatic ^[20].
• Physiotherapy is often ordered if the condition does not respond to treatment (see physiotherapy section for details).

1. ↑ https://images.onhealth.com/images/slideshow/xl-sq-promos/chest-pain-costochondritis.jpg
2. ↑ ^{2.02.12.22.32.42.5} PROULX A and TERESA W.; Costochondritis: Diagnosis and Treatment; Am Fam Physician. 2009 Sep 15;80(6):617-620
3. ↑ ^3.03.1 Clemens WM. et al. ; Introduction to Chest Wall Reconstruction : Anatomy and Physiology of the Chest and Indications for Chest Wall Reconstruction ; Semin Plast Surg. ; 2011 ; 25(1) : 5-15
4. ↑ Safarini OA, Bordoni B. Anatomy, Thorax, Ribs. InStatPearls [Internet] 2019 Feb 19. StatPearls Publishing.Available from:https://www.ncbi.nlm.nih.gov/books/NBK538328/ (last accessed 14.4.2020)
5. ↑ ^5.05.15.25.3 Schumann JA, Parente JJ. Costochondritis.Available from:https://www.ncbi.nlm.nih.gov/books/NBK532931/ (last accessed 29.4.2020)
6. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389
7. ↑ Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.
8. ↑ Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze’s syndrome, Wiley-Blackwell, 2001, p23-29
9. ↑ ^9.09.1 Han J N et al.; Respiratory function of the rib cage muscles; European Respiratory Journal ISSN 0903 1993. 
10. ↑ Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American family physician. 2009 Sep 15;80(6):617-20.Available from:https://www.ncbi.nlm.nih.gov/pubmed/19817327 (last accessed 29.4.2020)
11. ↑ Brian E Udermann et al.; Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report; J Athl Train. 2005 Apr-Jun; 40(2): 120–122
12. ↑ Brenda M. Birmann et al.; Prediagnosis biomarkers of insulin-like growth factor-1, insulin, and interleukin-6 dysregulation and multiple myeloma risk in the Multiple Myeloma Cohort Consortium. Blood. 2012 Dec 13; 120(25): 4929–4937.
13. ↑ FREESTON J; Can Early Diagnosis and Management of Costochondritis Reduce Acute Chest Pain Admissions?; The Journal of Rheumatology November 2004, 31 (11) 2269-2271
14. ↑ Viitanena J, H. Kautiainena, J. Sunia, M. L. Kokkoa & K. Lehtinena; The Relative Value of Spinal and Thoracic Mobility Measurements in Ankylosing Spondylitis; Scandinavian Journal of Rheumatology; Volume 24, 1995 – Issue 2
15. ↑ ^15.015.1 Aspegren D; Conservative Treatment of a Female Collegiate Volleyball Player with Costochondritis ; Journal of Manipulative and Physiological Therapeutics ; May 2007 Volume 30, Issue 4, Pages 321–325 
16. ↑ ^16.016.1 Grindstaff L.T. et al. ; Treatment of a female collegiate rower with costochondritis : a case report ; J Man Manip Ther. ;2010 ;18(2) : 64-68 
17. ↑ Kamel M. et al. ; Ultrasonographic assessement of local steroid injection in Tietze’s syndrome ; Br J Rheumatol ; 1997 ;36(5) : 547-50 
18. ↑ Freeston J. et al. ; Can early diagnosis and management of costochondritis reduce acute chest pain admissions ?; J Rheumatol ; 2004 ; 31(11)-2269-71 
19. ↑ Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr 2004;43(3):231-238
20. ↑ ^20.020.120.2 Hudes K, Low-tech rehabilitation and management of a 64 year old male patient with acute idiopathic onset of costochondritis. J Can Chiropr Assoc. 2008 December; 52(4): 224–228
21. ↑ Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71 
22. ↑ Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18(6):586-589.
23. ↑ Imamura ST., et al., syndrome de tietze, Cossermeli W., Terapêutica em reumatologia, Sao Paulo, lemos editorial, p773-777, 2000.
24. ↑ Richard B, Westrick P., Evaluation and treatment of musculoskeletal chest wall pain in military athlete. The International Journal of Sports Physical Therapy, 2012, Volume 7(3) Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362990/ (last accessed 30.4.2020)

Hernia – Physiopedia

A hernia occurs when there is a weakness or hole in the peritoneum, the muscular wall that usually keeps abdominal organs in place.

This defect in the peritoneum allows organs and tissues to push through, or herniate, producing a bulge.

The lump may disappear when the person lies down, and sometimes it can be pushed back into. Coughing may make it reappear^[1].

The most common types of hernia are^[2]:

• Inguinal (inner groin) see R image
• Incisional (resulting from an incision)
• Femoral (outer groin)
• Umbilical (belly button) see image R second down.
• Hiatal (upper stomach).

All hernias are caused by a combination of pressure and an opening/weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.

Anything that causes an increase in pressure in the abdomen can cause a hernia, including:

• Lifting heavy objects without stabilizing the abdominal muscles
• Diarrhea or constipation
• Family History—Although family history may not guarantee a hernia, research shows it is a reliable predictor of one occurring.
• Persistent coughing or sneezing
• Obesity, poor nutrition, and smoking (all weaken muscles and make hernias more likely).
• Pregnancy—The risk is small, but studies show that pregnancy is associated with an increase in the risk of hernia recurrence.
• Injury—Most sports-related hernias occur in the groin and don’t appear as a bulge. But if left untreated, it can evolve into an inguinal hernia^[3].

1. Inguinal hernia (found in groin) – the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin may reach the scrotum.

• About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.
• Risk factors: older adults; people with close relatives who have had inguinal hernias; people who have had inguinal hernias previously; males; smokers, as chemicals in tobacco weaken tissues, making a hernia more likely; people with chronic constipation; premature birth and low birth weight; pregnancy.^[1]

2. Incisional hernia – the intestine pushes through the abdominal wall at the site of previous abdominal surgery. Image R – Post-thoracotomy lung herniation in emaciated patient

• This type is most common in elderly or overweight people who are inactive after abdominal surgery.
• Because an incisional hernia is the result of surgery, the clearest risk factor is a recent surgical procedure on the abdomen.
• People are most susceptible 3-6 months after the procedure, especially if: they are involved in strenuous activity; have gained additional weight; become pregnant. These factors all put extra stress on tissue as it heals.^[1]

3. Femoral hernia (found in groin) – occurs when the intestine enters the canal carrying the femoral artery into the upper thigh.

• Femoral hernias are most common in women, especially those who are pregnant or obese.

4. Umbilical hernia – part of the small intestine passes through the abdominal wall near the navel.

• Common in newborns.
• Umbilical hernias are most common in babies with a low birth weight and premature babies.
• In adults, the risk factors include:being overweight; having multiple pregnancies; being female.

5. Hiatal hernia – a hiatal or hiatus hernia is caused by the upper part of the stomach pushing out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.^[1].

• The risk of hiatal hernia is higher in people who: are aged 50 years or over; have obesity.^[1]

Image on R Schematic diagram of different types of Hiatal Hernias – Green is the esophagus, red is the diaphragm, blue is the HIS-angle. A is the normal anatomy B is a pre-stage C is a sliding hiatal hernia D is a paraesophageal type

Tips to Decrease the Risk of a Hernia

• Maintain a healthy weight. Rapid weight loss and weight gain place pressure on the abdominal wall.
• Don’t smoke.
• Change lifting stance. Lift with the legs, not the back.
• Change your diet to improve bowel movements. Increasing fiber intake may help to relieve constipation that can cause straining during bowel movements, which can aggravate a hernia. Some examples of high-fiber foods include whole grains, fruits, and vegetables.
• Dietary changes can also help with the symptoms of a hiatal hernia. Try to avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.
• To prevent acid reflux, avoid foods that may cause it, such as spicy foods and tomato-based foods.^[2]

Whether or not surgery is performed depends on the size of the hernia and the severity of symptoms.

• The doctor may want to simply monitor your hernia for possible complications ie watchful waiting.
• In some cases, wearing a truss may help to ease the symptoms of a hernia (supportive undergarment that helps to hold the hernia in place).
• If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.^[4]

If the hernia is growing larger or causing pain surgeons may decide it’s best to operate. Repair may be by sewing the hole in the abdominal wall closed during surgery. This is commonly done by patching the hole with surgical mesh.

Hernias can be repaired with either open or laparoscopic surgery.

• Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions. It’s also less damaging to the surrounding tissue.
• Open surgery, the surgeon makes an incision close to the site of the hernia, and then pushes the bulging tissue back into the abdomen. They then sew the area shut, sometimes reinforcing it with surgical mesh. Finally, they close the incision^[4].

Can include ( after medical history taken)

• abdominal ultrasound – high-frequency sound waves to create an image of the structures inside the body
• CT scan, which combines X-rays with computer technology to produce an image
• MRI scan

If a hiatal hernia is suspected other tests that allow them to assess the internal location of your stomach may be ordered:

Gastrografin or barium X-ray, which is a series of X-ray pictures of your digestive tract. The pictures are recorded drinking a liquid containing diatrizoate meglumine and diatrizoate sodium (Gastrografin) or a liquid barium solution. Both show up well on the X-ray images.

Endoscopy, which involves threading a small camera attached to a tube down the throat and into esophagus and stomach.^[4]

Physical Therapy Management[edit | edit source]

The main goal of physiotherapy is to:

Reduce pressure off the tissue (e.g. addressing poor breathing mechanics)

Strengthen the supporting tissue (e.g. deep core strengthening)

Apply compression support to assist

Reduce aggravating activities and gradually re-introduce eg Avoid eg weight lifting or exercises that strain the abdomen, may increase pressure at the area of the hernia (cause the hernia to bulge more). The same is true for exercises that are done improperly.

• Exercise may work to strengthen muscles around the hernia and promote weight loss, helping reduce some symptoms.
• A study from 2018^[4]investigated the effects of an exercise program on obese individuals who were to undergo ventral hernia repair surgery. It was observed that people who completed the exercise program had less complications following surgery.

Hernias can happen at any age, but this medical condition is very common among the elderly.

• When a hernia is left untreated, it can result in serious health complications, including debilitating pain, infections, and blood loss.
• One of the biggest risk factors for hernias is an individual’s age. Older adults tend to have much weaker core muscles, and it doesn’t take much for soft tissue to push through the abdominal wall. Many older adults also undergo procedures that weaken the midsection and tear some of the nearby connective tissue. Seniors who have a family history of hernias must keep an eye out f or lingering discomfort in the midsection and unusual protrusions.^[5]
• Frail seniors who have hernias should not exert themselves and consider professional in-home care when managing daily activities.

• Hernias are usually straightforward to diagnose, simply by feeling and looking for the bulge.
• Treatment is a choice between watchful waiting and corrective surgery, either via an open or keyhole operation.
• For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias.
• Within 2 years of a femoral hernia being diagnosed, 40 percent result in bowel strangulation.
• It remains unclear whether non-emergency surgery is worthwhile for hernia repair in cases of an inguinal hernia without symptoms that can be pushed back into the abdomen.
• Education re prevention and appropriate exercises is key.^[6]

R image Hernia Locations

Costochondritis – causes, symptoms, treatment

Costochondritis is a condition that causes pain in the front of the chest.  It is the result of inflammation at the point where the upper ribs attach to the breastbone (sternum).

Costochondritis is a relatively harmless condition that will usually go away without treatment.  However, it can cause anxiety as its symptoms may be mistaken for a heart attack. The sudden onset of chest pain should be assessed immediately by emergency services or a doctor. 

Causes

There is often no definitive cause for costochondritis. It can be associated with an injury to the rib cage or with unusual physical activity or strain (eg: heavy lifting or severe coughing). Costochondritis can occur after a respiratory illness such as a cold or flu and in people with underlying conditions including fibromyalgia, systemic lupus erythematosus and ankylosing spondylitis.   

Costochondritis affects females more often than males, and more commonly occurs in adolescents and young adults. 

Symptoms

The main symptoms of costochondritis are pain and tenderness at the junction of the ribs and the breastbone as a result of cartilage tissue between the bones becoming inflamed. The pain increases with movement and deep breathing and decreases with rest and quiet breathing. Pressure placed directly on the affected area will also cause significant pain.

The pain can vary in intensity but is often severe. It may be described as pressure, aching or sharp pain. It is usually located on the front of the chest, but can radiate to the back, abdomen, arm or shoulder. 

The pain usually occurs on only one side of the chest, most commonly the left, but can affect both sides of the chest at the same time. Symptoms of costochondritis usually last for between one and three weeks.

Costochondritis symptoms can be mistaken for a heart attack. However, the pain of a heart attack covers the whole chest and is often accompanied by shortness of breath, nausea and sweating.  If the onset of pain is sudden, contact emergency services or a doctor.

Diagnosis

A diagnosis of costochondritis can usually be made by assessing the nature of the symptoms and by the fact the pain can be reproduced by pressing on the affected area. Sometimes tests to rule out other more serious conditions may be recommended: 

• A chest X-ray
• An electrocardiogram (ECG), which is a tracing of the heart’s electrical activity
• Blood tests.

Treatment

Often the symptoms of costochondritis resolve without treatment. Where treatment is required, the aim is to reduce inflammation and control pain. Treatment usually consists of: 

• Rest and avoiding activities that worsen the pain
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and pain-relieving medications such as paracetamol
• Ice and/or heat packs applied to the area
• Gentle stretching of the upper chest (pectoral) muscles two or three times a day.

If the pain is extreme and/or prolonged, a corticosteroid medication such as hydrocortisone may be injected into the affected area to help reduce pain and inflammation. In rare cases, where the condition does not respond to medical treatment, surgery to remove the inflamed cartilage may be required. 

References

Flowers, L.K. (2020). Costochondritis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/808554-overview#a4 [Accessed: 20/08/20]
NHS (2029). Costochondritis (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/costochondritis/ [Accessed: 20/08/20]
O’Toole, M.T. (Ed) (2017). Costochondritis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed). St Louis, MI: Elsevier.

Last Reviewed: August 2020

Chest pain – Better Health Channel

Chest pain can be serious. It may be caused by temporary poor blood flow to the heart (angina), or by a sudden blockage in the coronary arteries resulting in a heart attack. 

If you have chest pain, seek urgent medical help. Call 000 for an ambulance.

There are other possible causes of chest pain such as indigestion and muscle strain. Aside from the heart, many parts of the chest that can cause chest pain include the lungs, oesophagus (gullet), muscle, bone and skin.

Because of the complex system of nerves in the body, the cause of the chest pain may come from elsewhere in your body, such as your stomach (abdomen). This is known as ‘referred pain’.

In a heart attack, every minute counts. Urgent treatment is needed to prevent damage to the heart.

If you think you are having a heart attack, or you are in doubt about the cause of your chest pain, call 000 for an ambulance.

Chest pain – symptoms of a heart attack

Chest pain can be a warning sign of a heart attack. A heart attack happens when the blood supply to your heart becomes blocked and damages the heart muscle. 

The longer a heart attack is left untreated more damage occurs. In some cases, a heart attack can be fatal. Many Australians die of heart attack, or suffer permanent damage to the heart because they don’t know the signs or wait too long to act.

Symptoms of a heart attack may include:

• Severe crushing pain in the centre of your chest or behind the breastbone. You may feel this as a squeezing, tightening, choking or heavy pressure feeling.
• Pain spreading to the shoulders, arms, neck, throat, jaw or back.
• Sweating.
• Feeling anxious, dizzy or unwell.
• A sick feeling in the stomach.
• Shortness of breath.
• Symptoms that often last 10 to 15 minutes or more.

Symptoms of a heart attack may vary from person to person, and some people have few symptoms or none at all.

Chest pain – angina

Angina is a short-lived chest pain that occurs when the heart muscle does not receive enough blood or oxygen – often when it has to work harder than usual. This can occur with exercise, stress, cold weather or after eating a large meal. 

Angina pain eases with rest, or with the use of angina medicines. 

Angina is usually caused by underlying coronary artery disease, where the arteries of the heart become narrow due to the buildup of plaque (fatty deposits) in the artery walls. This narrowing means that blood supply to the heart is reduced, causing chest pain (angina). Angina does not usually cause damage to the heart.

Angina and heart attack – risk factors

Angina and heart attack are usually caused by underlying coronary artery disease, which has certain risk factors – some you can change, others you can’t. 

Risk factors you can change:

Risk factors you can’t change:

• getting older – risk increases as we age
• being a post-menopausal woman
• being male
• family history of heart disease
• ethnicity – Aboriginal Torres Strait Islander and certain other populations are at higher risk 

It is important to remember that people without these risk factors can also experience angina or a heart attack. 

Other common causes of chest pain

The symptoms of a heart attack are similar to other conditions, so your chest pain may have nothing to do with your heart.

Other common causes of chest pain include: 

• Indigestion or stomach acid coming up the oesophagus (reflux). This common problem can be made worse by smoking, drinking alcohol or coffee, eating fatty foods and taking some drugs. You may feel this as a burning pain in the chest. It often goes away quickly after taking antacid or milk.
• Chest infection.
• Chest trauma (rib fractures).
• Blood clots in your lungs (pulmonary embolism).
• Chest muscle strains – these can be caused by vigorous exercise, physically active work, playing contact sport or lifting weights at the gym. 
• Inflammation in the rib joints near the breastbone (costochondritis).
• Shingles (or herpes zoster) or can cause chest pain before a rash forms.

Seek urgent medical help for chest pain

With chest pain, every minute counts. The faster you get to hospital for treatment, the better.

If any activity brings on chest pain, follow these steps:

1.Stop what you are doing and rest immediately.

2.Talk – tell someone how you feel.

If you take angina medication:

• Wait 5 minutes. If you still have symptoms – take another dose of your medicine.
• Wait 5 minutes. If your symptoms don’t go away…

3.Call 000 and chew on 300mg aspirin  (if available). 

• Ask for an ambulance.
• Don’t hang up. 
• Wait for the operator’s instructions. 

Do not take aspirin if you have an allergy to aspirin, or your doctor has told you not to take it.

Remember, if you have any doubt about your pain, call an ambulance anyway. 

Do not drive yourself to hospital. Wait for the ambulance. It has specialised staff and equipment that may save your life.

Diagnosis of chest pain

Before medical treatment can begin, the cause of the pain must be found. You may a have a lot of tests done including:

If your healthcare professional thinks you may have angina, they may order further tests to check the state of the blood vessels that supply your heart. They may also arrange an exercise stress test (on an exercise bike or treadmill) or other tests – such as an angiogram or CT scan of your chest.

It is not always easy to diagnose the cause of chest pain. Your doctor may need to see you more than once to be sure, and further tests may be needed, or you may be referred to a cardiologist (heart doctor). 

Recovering from chest pain 

If your doctor has ruled out serious causes of chest pain, it is likely you will make a full recovery. General self-care suggestions include: 

• Follow your doctor’s advice about treatment.
• In the first few days at home, try to take it easy. 
• Rest if you feel tired.
• Slowly increase your activity, as you are able.
• There is no need to limit work or strenuous activity (including sex) if you feel well.
• Follow up with your local doctor (GP) when recommended by your treating doctor.

Reduce your risk of heart attack

Ways to reduce your risk of heart attack include: 

Where to get help

What You Need to Know

1. CareNotes
2. Costochondritis

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is costochondritis?

Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones.

What causes costochondritis?

The cause of costochondritis may be unknown, or it may be caused by any of the following:

• Chest injury: An injury to your chest may cause costochondritis.
• Strain: Activities that strain your chest wall muscles can lead to costochondritis. This includes hard coughing. Strain can also occur while you are playing sports with repeated arm movements, such as rowing, weightlifting, and volleyball.
• Infection: Lung or chest infections can increase your risk of costochondritis.
• Inflammatory diseases: Diseases that cause swelling around your joints, such as rheumatoid arthritis, increase your risk of costochondritis.

What are the signs and symptoms of costochondritis?

Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.

How is costochondritis diagnosed?

Your healthcare provider will ask you about your signs and symptoms. He will also do a physical exam. He will touch your chest and may move your arms to see if this causes pain.

How is costochondritis treated?

Costochondritis pain may go away without treatment, usually within a year. Your treatment depends on the cause of your costochondritis. You may need any of the following:

• Acetaminophen: This medicine decreases pain. Acetaminophen is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
• NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.

What can I do to help decrease the pain caused by costochondritis?

• Rest: You may need to rest and avoid painful movements and activities. Do not carry objects, such as a purse or backpack, if this causes pain. Avoid activities such as weightlifting until your pain decreases or goes away. Ask your healthcare provider which activities are best for you to do while you recover.
• Heat: Heat helps decrease pain in some patients. Apply heat on the area for 20 to 30 minutes every 2 hours for as many days as directed.
• Ice: Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on the painful area for 15 to 20 minutes every hour or as directed.
• Stretching exercises: Gentle stretching may help your symptoms. Stand in a doorway and put your hands on the door frame at the level of your ears or shoulders. Take 1 step forward and gently stretch your chest. Try this with your hands higher up on the doorway.

When should I contact my healthcare provider?

• You have a fever.
• The painful areas of your chest look swollen, red, and feel warm to the touch.
• You cannot sleep because of the pain.
• You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

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Pericarditis | Johns Hopkins Medicine

What is pericarditis?

Pericarditis is inflammation of the pericardium, the thin sac (membrane) that surrounds the heart.

The pericardium holds the heart in place and helps it work properly. There is a small amount of fluid between the inner and outer layers of the pericardium. This fluid keeps the layers from rubbing as the heart moves to pump blood.

What causes pericarditis?

Usually, the cause of pericarditis is unknown, but may include:

• Infection (by viruses, bacteria, a fungus, or parasites)

• Autoimmune disorders (such as lupus, rheumatoid arthritis, or scleroderma)

• Inflammation after a heart attack

• Chest injury

• Cancer

• HIV/AIDS

• Tuberculosis (TB)

• Kidney failure

• Medical treatments (such as certain medicines or radiation therapy to the chest)

• Heart surgery

What are the symptoms of pericarditis?

The following are the most common signs of pericarditis:

The symptoms of pericarditis may look like other conditions. See a healthcare provider for a diagnosis.

How is pericarditis diagnosed?

If your healthcare provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may also be heard.

Along with a complete medical history and physical exam, tests used to diagnose pericarditis may include:

• Echocardiogram. This test uses sound waves to check your heart’s size and shape. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin over the heart. Echo can show how well your heart is working and whether fluid has built up around your heart.

• Electrocardiogram. This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.

• Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.

• Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to look for thickening or other changes in the pericardium.

• Cardiac CT. This type of X-ray takes a clear, detailed picture of your heart and pericardium. It may be used to help rule out other causes of chest pain.

• Blood tests. Certain blood tests can help rule out other heart problems, such as heart attack, and can tell the doctor how much inflammation there is in your pericardium.

How is pericarditis treated?

Your healthcare provider will figure out the best treatment based on:

• How old you are

• Your overall health and medical history

• How sick you are

• How well you can handle specific medicines, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medicines, such as pain medicines, anti-inflammatory drugs, or antibiotics.

If serious heart problems develop, treatment may include:

Pericarditis may last from 2 to 6 weeks, and it may come back.

What are the complications of pericarditis?

There is a small amount of fluid between the inner and outer layers of the pericardium. Often, when the pericardium becomes inflamed, the amount of fluid between these layers increases. This is called a pericardial effusion. If the amount of fluid increases quickly, the effusion can keep the heart from working properly. This complication of pericarditis is called cardiac tamponade and is a serious emergency. A thin needle or tube (called a catheter) is put into the chest to remove the fluid in the pericardium and relieve pressure on the heart.

Chronic constrictive pericarditis occurs when scar-like tissue forms throughout the pericardium. It’s a rare disease that can develop over time in people with pericarditis. The scar tissue causes pericardial sac to stiffen and not move properly. In time, the scar tissue squeezes the heart and keeps it from working well. The only way to treat this is to remove the pericardium with a special type of heart surgery.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare provider.

Key points

• Pericarditis is inflammation of the pericardium, the thin sac that surrounds the heart.

• Pericarditis may be caused by infection, autoimmune disorders, inflammation after a heart attack, chest injury, cancer, HIV/AIDS, tuberculosis (TB), kidney failure, medical treatments (such as certain medicines or radiation therapy to the chest), or heart surgery.

• The most common signs of pericarditis include chest pain, fever, weakness and tiredness, coughing, trouble breathing, pain when swallowing, and palpitations (irregular heartbeats).

• If pericarditis is suspected, the healthcare provider will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub — the sound of the pericardium rubbing against the outer layer of your heart.

• The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medicines, such as pain medicines, anti-inflammatory drugs, or antibiotics. If serious heart problems develop, treatment may include removal of excess fluid around the heart or surgery.

• Pericarditis may last from 2 to 6 weeks, and it may come back.

• Pericarditis can lead to complications such pericardial effusion (a buildup of fluid around the heart that can keep it from working properly) and chronic constrictive pericarditis (scar-like tissue forms throughout the pericardium which squeezes the heart and keeps it from working well).

Right Side Chest Pain: 7 Causes & What To Do

In most cases, pain on the right side of the chest is a temporary symptom that happens due to conditions that are not serious, such as too much stress, muscle strain or acid reflux.

However, chest pain, whether on the right or the left side, can have several causes, including problems in the digestive system, in the lungs, and even the heart, and these need to be diagnosed and treated.

If the pain happens frequently, is very intense, worsens with time, or comes with other symptoms such as a tingling feeling in the arm and face, difficulty breathing, or fainting, it’s important to go to a hospital or call for a doctor, as it can be a sign of a life-threatening problem. 

The most common causes of pain on the right side of the chest include:

1. Stress and anxiety

Excess stress and anxiety are two conditions that can lead to a panic attack and cause very similar symptoms to a heart attack, including sudden chest pain. Usually the pain is felt more in the middle of the chest, but many times it can radiate to the right side of the body.

Added to the chest pain, there are other common symptoms such as shallow breathing, breathlessness, tingling in the hands and feet, and sweating. Unlike a heart attack, a panic attack is more common after a very stressful situation and the chest pain tends to disappear in a few minutes.

What to do: the best way to alleviate the discomfort caused by a panic attack is to try to calm down, to allow breathing to become regular and the muscles to become less tense. Another thing you can do is go somewhere quiet and drink a cup of valerian or chamomile tea. If the pain is still strong or if you suspect a heart attack, go to hospital or call for medical help.

2. Muscle strain

A strained muscle is another common cause of chest pain and it usually happens one or two days after an activity that uses the chest muscles more intensively. This increased use of the muscles can be intentional, from doing exercise in the gym, for instance, but it can also be involuntary, for example, from painting a ceiling. 

In addition, strong pangs in the chest region can also cause lesions in the muscle fibers, and this may not cause pain immediately, but they may become painful after a few days. In these cases, other common symptoms are an increase in pain when touching a muscle, slight swelling, and difficulty moving the arms.

What to do: applying ice to the region for 15 to 20 minutes, three to four times a day will help with pain relief. Also, you can do a light massage on the region with an anti-inflammatory lotion. If the pain does not improve in three days, we recommend you go to a general physician or a physiotherapist, as more specific treatment may be needed.

3. Acid reflux (GERD)

Acid reflux is a common condition that affects many people and it happens when the acid in the stomach goes up to the esophagus causing a sensation of heartburn, especially after eating. This discomfort can sometimes be felt in the form of pain, which ends up radiating to the chest and it can affect the right side.  

Gastroesophageal reflux disease (GERD) is generally accompanied by other symptoms such as a frequent need to burp, a sour taste in the mouth, feeling like there’s a lump in the throat, and a dry cough.

What to do: depending on the gravity, the reflux symptoms can be relieved through simple diet changes, such as avoiding eating too much at once and avoiding fatty and spicy foods. However, there are cases where medication to block the stomach acid may be necessary. Therefore, if the discomfort does not improve with diet changes, we recommend you visit a gastroenterologist to start adequate treatment.

4. Costochondritis

Costochondritis is a less common problem but it can cause intense pain in the chest, usually in the middle of the chest, but it can radiate to the right or the left side.

This condition happens when the cartilages that connect the sternum bone to the ribs get inflamed after the chest undergoes strong pressure, periods of intense coughing, or  bad posture. Costochondritis causes sensitivity in the mid-chest area and pain that gets worse when you take a deep breath or cough. 

What to do: costochondritis is a temporary problem that tends to improve after a few days, without requiring specific treatment. However, stretching exercises and applying ice to the region for 15 to 20 minutes, three to four times a day can decrease inflammation and relieve discomfort, and anti-inflammatory medication may also help.

5. Gallbladder or liver inflammation

The gallbladder and the liver are two organs of the abdominal cavity that are located on the right side of the body and so, when they get inflamed or suffer alterations they can cause pain in that area. Although it is more common for the pain to be in the abdominal region, in some cases it can radiate to the chest too. 

When there is a problem with the gallbladder or the liver there can be other symptoms besides the chest pain and these include vomiting, loss of appetite, general feeling of being unwell, and jaundice. 

What to do: if you suspect you have gallbladder inflammation or a liver problem, it’s important to visit a gastroenterologist to confirm the diagnosis and start adequate treatment. Gallbladder inflammation is usually quite serious, especially if the gallbladder is obstructed by a stone. In these cases, the pain is very strong and there can be fever and acute vomiting. If this happens, go to the hospital immediately.

6. Lung problems

Various problems in the lungs can cause pain in the chest region, especially when breathing. In addition to the pain, there may also be coughing, shortness of breath, shallow breathing and fever.

Lung problems are more common after accidents or in people who have chronic heart diseases or pulmonary diseases. 

What to do: chest pain due to problems with the lungs can be a sign of serious problems such as pleurisy, pneumonia, pneumothorax, or even pulmonary embolism. If you suspect you have a lung problem please go to the hospital to get exams done, such as an x-ray to the thorax so that a doctor can identify the cause and start adequate treatment, which can vary according to the cause.

7. Heart problems

When you get chest pain, one of the main concerns is that it may be a sign of a heart problem. However, this isn’t common. That being said, heart problems can be the cause of chest pain, including the pain that radiates to the right side, especially if the heart muscle is inflamed.

Usually heart problems are more common in elderly people, people with other chronic problems or patients who are hospitalized due to serious infections. Heart pain is usually very intense and causes a sensation of something tightening the heart. Additionally, there can also be other symptoms such as palpitations, cough, difficulty breathing and fainting. 

What to do: if you suspect that the pain could be caused by a heart problem, it’s important to go to the hospital quickly or call for medical help, so that the cause can be diagnosed and treatment started.

When to go to the doctor

Many times, chest pain disappears after a few minutes and so, there’s no reason to worry. However, being examined by a doctor is the only way of identifying the correct cause. Therefore, it’s best to go to hospital if:

• The pain is very intense or gets worse with time;
• The pain lasts more than 15 minutes;
• Other symptoms appear such as difficulty breathing, high temperature or fainting.

In addition, elderly people and those with chronic problems, especially of the respiratory system or the heart, should be examined by a doctor, as the pain may indicate that the condition got worse, and treatment may need to be adjusted.

90,000 Perhaps you have Fibromyalgia!

You are often ignored by doctors and family members because they think you are always “complaining of pain”. Most of you went through multiple consultations with various doctors and many tests, but the diagnosis was never made. Perhaps you have Fibromyalgia!

Fibromyalgia is a disorder that causes widespread muscle and joint pain throughout the body, sleep deprivation, memory loss, mood problems, and chronic fatigue.Many people with fibromyalgia may also experience persistent headaches, depression, anxiety, tension, and irritable bowel syndrome.

It is believed that women are much more vulnerable to this disease than men.

Fibromyalgia Symptoms:

• Extensive pain: Pain associated with fibromyalgia is often described as a dull pain that lasts at least three months. The pain can affect any part of the body, such as the back, neck, chest, arms, legs.You may experience pain in many areas of the body, and painful areas change over time.
• Fatigue: You may feel tired even after a long sleep. Your sleep is often interrupted by restless legs syndrome.
• Cognitive Difficulty: Difficulty concentrating on work. You suffer from memory deficits in your daily activities.
• Depression and Anxiety Disorders: You are prone to frequent depression, which is exacerbated by the rejection of the “invisible disease” by others.
• Other symptoms: You may also have symptoms such as burning sensation when urinating, numbness, loss of appetite, tingling sensation, diarrhea, constipation, tinnitus, depression, etc.

Do you want to know if your thyroid is okay? Take the test

Diagnosis of fibromyalgia

There are no specific tests for the diagnosis of fibromyalgia. Diagnosis is made by a neurologist using clinical methods based on symptoms and examination.Blood tests and other clinical studies are done to rule out other conditions that may be causing similar symptoms.

Guidelines for Fibromyalgia Treatment:

1. Medication is used to relieve pain, muscle spasms, sleep disorders and symptoms of depression. It includes antidepressants, local anesthetics, anticonvulsants.
2. Lifestyle changes. Relief of the syndrome can be achieved with regular swimming, yoga, Pilates, long walks, cycling, meditation, and gentle muscle massage.
3. Normalization of sleep. A good quality night’s sleep is essential.
4. Treatment of asthenic conditions, depression. Consulting a psychologist. Hypnosis

The main steps in the treatment of fibromyalgia are the establishment of the diagnosis and possible causes of pain, as well as the selection of an appropriate treatment regimen.

Correctly selected comprehensive approach in the treatment of fibromyalgia will significantly affect the improvement of your condition and quality of life.

Timoshenko Anna Sergeevna, neurologist of the International Innovation Clinic.

Back and joint problems? Don’t restrict your movement because of the pain! Read more… ..

90,000 Treatment of pain under the ribs – OSTEOMED network of clinics

Pain in the ribs or under the ribs often leads people to seek help from doctors of various specialties, since it mimics angina pectoris, pleural pain, and the consequences of trauma.But often the pain in the ribs is a consequence of problems with the spine.

Doctors of the Osteomed Clinic in St. Petersburg very often observe in their practice patients with pain in the ribs or intercostal neuralgia. Simultaneously with the pain syndrome, other manifestations are determined in patients, which require detailed consideration and exclusion of other pathologies. To do this, you need to make an appointment with an experienced specialist and undergo a full examination.

Causes of rib pain

Among the causes of pain in the ribs or under the ribs, the following can be noted:

• Traumatic injury to the chest – rib fractures, bruises, hematomas.In this case, the pain intensifies when bending, turning, and you can easily determine its source by feeling. Fractures are especially common in older people with advanced osteoporosis, where even a slight movement, such as a cough, can break the ribs.
• Diseases of the respiratory system – pneumonia, pleurisy, bronchitis, as well as a strong cough can also give pain in the ribs associated with overstrain of the muscles of the diaphragm and chest.
• Cardialgia – pain in the heart – often radiates throughout the chest, accompanies heart defects, hypertension, heart attacks, coronary heart disease, etc.d.
• Oncological diseases of the mediastinal organs and the chest itself;
• Tuberculosis of the lungs, spine, musculoskeletal tissues of the chest;
• Osteochondrosis in the cervical and thoracic spine;
• Polyneuritis, myositis, arthritis, etc.

Diagnostics of the pathological condition

With osteochondrosis, the pain in the ribs is of a periodic nature, sometimes worsens – usually in the evening and at night, and after a night’s rest it subsides.Since the thoracic part of the spine is its most inactive part, the pain is not as pronounced as with degenerative changes in other areas. It can intensify with breathing, coughing, sighing, but nevertheless the blur of its manifestations makes patients suspect that they have completely different diseases.

Therefore, it is very important to conduct a thorough differential diagnosis with other pathologies using various types of research:

• X-ray of the chest and lungs, heart, spine – in several projections;
• Computed tomography or nuclear magnetic resonance imaging of the organs of the mediastinum and the entire chest, including the structures of the spine;
• Electrocardiography;
• Electromyography;
• Echocardiography;
• Examination of the vital capacity of the lungs, listening to breathing, sputum analysis and other methods for detecting pathology of the respiratory system;
• Dopplerography of the mediastinal vessels;
• General and biochemical analyzes, etc.d.

Step by step, in a clinic, it is necessary to exclude the most life-threatening conditions, while at the same time alleviating the patient’s condition with symptomatic means.

Treatment of pain under the ribs

As a rule, with severe pain syndrome, the doctor uses various pain relievers – they can be taken in pill form or parenterally administered. Unbearable pain, which can also occur with intercostal neuralgia, is stopped by novocaine blockade in the compression zone of the nerve roots.

Each identified pathology has its own specific treatment. In vertebrology, chest pain caused by thoracic or cervicothoracic osteochondrosis has its own characteristics of therapy:

• Drug treatment – these are analgesics, anti-inflammatory drugs, muscle relaxants, mild diuretics, drugs to improve peripheral circulation, chondroprotectors, vitamin and mineral complexes;
• Manual therapy, remedial gymnastics, physiotherapy act directly on the causative factor of pathology, helping to release musculo-articular blocks, strengthen and develop muscles around the spine, improve blood supply and trophism of the thoracic spine;
• Among other types of treatment – the appointment of rest in the acute period, a diet with a predominance of proteins, dairy products, vegetables, fruits with the exception of grapes, sorrel, coffee, carbonated drinks, sweets, fatty foods.In addition, patients can use acupuncture, stone therapy and other methods in complex treatment.

Chest, chest pain :: Clinician

Chest pain may be associated with an unhealthy state of internal organs, damage to the osteochondral structures of the chest, diseases of the spine and peripheral nervous system, or psychogenic diseases. Pain in the chest can be a manifestation of diseases of the heart and cardiovascular system , lung pathology , as well as diseases of the gastrointestinal tract .

Only a weak relationship was noted between the severity of chest pain and the severity of the underlying cause.

Characteristics of symptoms in various diseases:

• In case of heart disease : a feeling of pressure behind the breastbone, gives to the left hand. Pressing, aching, or stabbing pain, most often in the region of the heart. The connection with physical activity is not traced, sometimes there is an increase in pain in the days following the load.Pain with high blood pressure is also possible. Usually it is a prolonged aching pain or a feeling of heaviness in the region of the heart.
• Diseases of the cardiovascular system : shortness of breath appears or increases, moderate chest pain associated with the act of breathing, cough, which may be accompanied by hemoptysis. In case of complications – sudden severe shortness of breath, very severe pain behind the sternum, loss of consciousness, decrease in blood pressure.
• Diseases of the respiratory system : the onset or intensification of pain with deep breathing or coughing, acute short-term pain, specific cough, sputum production, shortness of breath, hemoptysis, fever, signs of intoxication.
• Diseases of the abdominal organs : there is a constant burning sensation behind the sternum, pain along the esophagus, aggravated by swallowing, associated with the intake of cold or hot, solid food.
• Chest pain associated with neurological diseases : predominant localization of pain in the area of ​​the corresponding nerve root, a clear connection with movements of the spine (with radicular pain) or trunk (with neuralgia), sharp local pain in the places where the intercostal nerves exit.

Which doctor should I contact if there is a chest pain:

Which studies will help determine the cause of chest pain:

If you have previously undergone any research or have already been with a specialist, be sure to take their results for a consultation with a doctor. If you have not had experience attending studies or seeing a doctor, we will do everything necessary in our centers.

You must be very careful about your health.People do not pay enough attention to the symptoms of diseases and do not realize that they can develop into a life-threatening condition. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that it is too late to treat them. Therefore, identifying symptoms is the first step in diagnosing diseases in general. To do this, it is necessary at least once a year to be examined by a doctor , in order not only to prevent a terrible disease, but also to maintain a healthy state of all internal organs and systems.

If you want to ask a question to our specialists – use the section of the online consultation. You will also find answers to frequently asked questions there. If you are interested in reviews about visiting our centers, there is a special Reviews section for you, where you can also help other patients and leave your message after visiting our centers. We will be grateful to you!

Chest pain treatment in St. Petersburg – Rossimed Clinic

An experienced cardiologist is attending the Rossimed clinic.We use modern diagnostic methods and effective treatments for heart disease.

Men and women over 30 may complain of discomfort, heaviness in the chest and shortness of breath, and stiffness of movements. If similar symptoms are observed in a child, then doctors suspect a tuberculosis infection or traumatic injury to internal organs.

Chest pain in medicine is called thoracolgia. This ailment can be provoked by various reasons.The danger of the syndrome is that it mainly manifests itself as a result of pathologies of the cardiovascular or respiratory system. This symptom may indicate a heart attack or aortic dissection. In addition, chest pains are noted in patients suffering from neuralgia and trauma in the spine or sternum.

Symptoms

Since heaviness in the chest area can cause various pathologies, including malfunctions of the gastrointestinal tract, heart, lungs, it is necessary to identify the causes before prescribing therapy.The nature of the complaints, the place of localization of unpleasant sensations and their intensity, as well as the accompanying symptoms, will help to determine what kind of disease provoked thoracolgia.

Dull pain, aching in the chest, may be accompanied by:

• Fever, fever.
• A cough that occurs for unknown reasons.
• Shortness of breath.
• Sweating.
• Confusion of consciousness.
• Migraine headaches.
• Weakness and fatigue.

However, signs such as:

• Unbearable pain, concentrated in the middle of the sternum above the solar plexus or on the left, indicate a specific pathology. It irides into the arm, subscapularis of the back or neck, which indicates a heart attack or ischemia of the heart. Therefore, it is impossible to postpone a visit to a cardiologist.

• About exertional angina is indicated by discomfort on the right, which occurs as a result of physical exertion, and disappears when the patient is at rest.
• Pain, concentrated on the left and radiating to the back, is a sign of aortic dissection.

However, when a patient complains of thoracolgia, which is accompanied by chest discomfort arising from a cough or deep breath, then most likely the cause lies in upper respiratory tract diseases. In this situation, concomitant symptoms will be high fever, weakness, sweating. Characteristic signs are coughing, shortness of breath.

If thoracolgia is caused by osteochondrosis, then patients complain of pain in the hypochondrium.The skin of patients becomes pale, its sensitivity is disturbed, and muscle tone decreases. In addition, pain that occurs during physical activity is a characteristic feature.

Such symptoms cannot be ignored, since their appearance indicates a serious illness, and the lack of timely therapy is fraught with the development of a heart attack and even death.

It is especially dangerous to ignore pressing pains that radiate to the back, left forearm and neck, in which shortness of breath is observed, unconscious fear and anxiety appear, and blood pressure drops.These symptoms are characteristic of a heart attack. Therefore, when they appear, it is necessary to immediately call an ambulance, to ensure complete rest for the patient before the arrival of doctors. It is better to sit the patient on a chair or lay on the bed, lifting his head. There must be enough fresh air in the patient’s room, so open the windows. The patient should be given nitroglycerin, which he should place under the tongue and dissolve slowly. Today, this drug is available both in tablets and in the form of a spray.If you have a can on hand, then you need to make one injection from the sublingual area. This procedure can be repeated after 5-7 minutes if there is no relief after the first time.

An equally life-threatening condition is blockage of the pulmonary artery. Patients complain of increasing pain during inspiration, which disappears after taking an analgesic. A characteristic sign of thromboembolism is the absence of irradiation to other departments.

Causes

Thoracolgia may appear due to disruption of the cardiovascular system, diseases of the upper respiratory tract and lungs, pathologies of the digestive tract, spine.In addition, chest pain is often psychosomatic or trauma-related.

In addition, frequent stresses or prolonged emotional stress can be the causes of the syndrome in question.

Physical inactivity can also cause thoracolgia. In the absence of physical activity, the pectoral muscles are compressed, resulting in pain.

A strong and prolonged cough irritates the tendons and muscles concentrated in the thoracic region.This provokes the onset of pain.

In addition, the causes of thoracolgia include an increase in the size of the thyroid gland, congenital pathologies of the musculoskeletal and muscular system, diaphragmatic hernia, and diseases of the abdominal organs.

Only a doctor who has to conduct a thorough examination of the patient and a number of diagnostic measures is able to determine the causes.

Diseases in cardiology associated with chest pain

In 40-50% of cases of patients visiting a doctor for thoracolgia, there are pathologies of the heart and blood vessels.That is why you need to know how this or that cardiological disease manifests itself, which causes discomfort and discomfort in the chest.

Myocardial infarction is a particularly dangerous condition that can lead to the death of a patient if adequate assistance is not provided in time. This pathology is characterized by complete blockage of the vessels that supply the heart muscle with blood. As a result, nutrition of myocardial tissues stops and cell death occurs.

With a heart attack, patients experience severe pain in the central part of the chest, which radiates to the left arm.The attack lasts longer than 30 minutes and is accompanied by fear of death, unexplained anxiety, shortness of breath, lack of oxygen. Nausea and even vomiting may be present.

Angina pectoris has a similar mechanism of development. However, the blockage of the vessels supplying the heart occurs partially, therefore the symptoms are less intense. Attacks occur against a background of severe emotional stress and prolonged psychological stress. Patients feel pressure in the central part of the chest, and pain radiates to the left arm, back, and sometimes to the lower jaw.

Myocarditis is characterized by symptoms similar to those of a heart attack. However, it differs in the mechanism of development of the disease, in which there is no blockage of blood vessels.

Pericarditis – this disease causes an inflammatory process that develops in the membranes of the heart. Patients complain of pain that spreads throughout the sternum and radiates to the neck. In this case, the intensity of the symptoms increases with food intake, deep breathing, when the patient is in the supine position.

Hypertrophic cardiopathy is a pathology in which the heart muscle becomes hardened, which causes burning pain.Concomitant symptoms are insomnia, increased fatigue, shortness of breath, dizziness.

For mitral heart disease, in which the valve does not close completely, aching pain in the middle of the chest and on the left becomes a characteristic symptom. Patients complain of dizziness, increased heart rate.

Atherosclerosis of the coronary vessels. This is a serious condition in which cholesterol plaque builds up on the walls of the artery and blocks the lumen.Blood ceases to circulate normally and to nourish the brain. If there is a complete blockage of the vessel, then its rupture is possible. In this state, the patient experiences unbearable pain in the sternum, which is capable of giving back, abdomen, and neck.

Diagnostics

As you can see, the symptoms for different diseases are quite similar. Therefore, in order to find out what caused thoracolgia, it is not enough to familiarize yourself with the complaints of patients. It is necessary to carry out a thorough examination, which includes several diagnostic procedures:

• Electrocardiography, if necessary, ECG is carried out with stress.

• Chest X-ray.

• Gastroscopy, allows you to explore the upper gastrointestinal tract.

• Angiography is performed to assess the condition of the coronary vessels.

In addition, patients undergo a blood test for markers of heart attack. In some cases, abdominal ultrasound, CT and MRI are performed.

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Possible causes and when to sound the alarm

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

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

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

Chest pain comes from:

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

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

What are the most common causes of chest pain?

Causes related to the heart

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

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

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

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

• Myocardial infarction (heart attack)

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

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

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

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

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

• Variant angina

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

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

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

• Hypertrophic cardiomyopathy

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

• Aortic dissection

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

Causes associated with the lungs

A number of problems that are associated with the lungs cause chest pain:

• Pulmonary embolism

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

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

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

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

• Pulmonary hypertension

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

Causes related to the digestive organs

• Heartburn (acid reflux)

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

• Problems with the gallbladder or pancreas

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

• Stomach or duodenal ulcer

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

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

Other causes of chest pain include:

• Panic attacks

panic attacks.

• Shingles

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

What to do if chest hurts?

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

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

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

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

When to see a doctor?

Pain in the area of ​​the heart is one of the most common reasons people seek emergency help. Heart pain is not always heart pain. It is often not associated with heart problems. However, if you are experiencing chest pain and do not know about the state of your cardiovascular system, the problem can be serious and it is worth taking the time to find out the cause of the pain.

Causes

Pain in the area of ​​the heart has many causes, they can be divided into 2 large categories – “cardiac” and “non-cardiac”.

“Heart” reasons

Myocardial infarction – a blood clot that blocks the movement of blood in the arteries of the heart can cause pressing, constricting chest pains that last more than a few minutes. The pain can radiate (radiate) to the back, neck, lower jaw, shoulders and arms (especially to the left). Other symptoms may include shortness of breath, cold sweats, and nausea.

Angina pectoris.

Over the years, fatty plaques can form in the arteries of your heart, restricting blood flow to your heart muscle, especially during exercise.It is the restriction of blood flow through the arteries of the heart that causes attacks of chest pain – angina pectoris. Angina is often described by people as a feeling of tightness or tightness in the chest. It usually occurs during exercise or stress. The pain usually lasts about a minute and stops at rest.

Other cardiac causes.

It can be pericarditis – inflammation of the heart shirt, while the pains are most often acute, stabbing in nature.Less commonly, the cause of pain is a dissection of the aorta, the main artery in your body. The inner layer of this artery can be separated by blood pressure and the result is sharp, sudden and severe chest pain. Aortic dissection can result from chest trauma or a complication of uncontrolled hypertension.

“Non-heart” reasons

Heartburn is the throwing of stomach contents into the esophagus, often combined with a sour taste and belching.Chest pain with heartburn is usually food-related and can last for hours. This symptom most often occurs when bending or lying down. Eases heartburn by taking antacids.

Panic attacks – manifested by attacks of gratuitous fear, combined with chest pain, heart palpitations, hyperventilation (rapid breathing) and profuse sweating, you may suffer from “panic attacks” – a kind of dysfunction of the autonomic nervous system.

Tietze’s syndrome. Sometimes the cartilaginous parts of the ribs, especially the cartilage that attach to the sternum, can become inflamed. The pain in this disease can occur suddenly and be quite intense, mimicking an attack of angina pectoris. However, the location of pain may vary. In Tietze syndrome, pain may worsen when pressing on the sternum or ribs near the sternum. Pain in angina pectoris and myocardial infarction does not depend on this.

Osteochondrosis of the cervical and thoracic spine leads to the so-called vertebral cardialgia, which resembles angina pectoris.In this condition, there is intense and prolonged pain behind the sternum, in the left half of the chest. Irradiation to the hands, interscapular region may be noted. The pain increases or decreases with changes in body position, head turns, arm movements.

Diseases of the lungs.

Pneumothorax (collapsed lung), high pressure in the vessels supplying the lungs (pulmonary hypertension), and severe bronchial asthma can also present with chest pain.Muscle diseases.

Pain caused by muscle diseases, as a rule, begins to bother when turning the body or raising the arms. Chronic pain syndrome such as fibromyalgia. May cause persistent chest pain.

Rib injury and nerve entrapment. Bruises and fractures of the ribs, as well as entrapment of the nerve roots, can cause pain, sometimes very severe. With intercostal neuralgia, pain is localized along the intercostal spaces and increases with palpation.

Shingles. This infection, caused by the herpes virus and affecting the nerve endings, can cause severe chest pain. Pain can be localized in the left side of the chest or be shingles in nature. This disease can leave behind a complication – postherpetic neuralgia – the cause of prolonged pain and increased skin sensitivity.

Diseases of the gallbladder and pancreas. Gallstones or inflammation of the gallbladder (cholecystitis) and pancreas (pancreatitis) can cause pain in the upper abdomen, radiating to the heart and more.

Since chest pain can be due to many different causes, do not self-diagnose or self-medicate or ignore severe or prolonged pain. The cause of your pain may not be as serious – but it should be checked by a specialist to determine it.

When should you see a doctor?

If you experience acute, unexplained, and prolonged chest pain, possibly in combination with other symptoms (such as shortness of breath) or pain that radiates to one or both arms.Under the scapula – an urgent need to see a doctor. Perhaps it will save your life or calm you down if no serious health problems are found.

What to do with pain in the heart?

1. Take it easy. At rest, the heart consumes less oxygen, so if there is damage to the heart muscle, there will be less chance of serious complications.

2. Stop the provocative load – stop, if you are walking, sit down.If you are in a noisy stuffy room, go outside if the exit is not far away and you do not need to go up / down stairs.

3. Take any sedative at hand: phenazepam, corvalol, motherwort, valerian, etc.

4. Think about the nature of the pain. If the stitching pains, aggravated by a deep breath or twisting of the trunk, as well as by pressing with a finger, then most likely the pains are not of cardiac origin. If the pain is dull, constricting, localized behind the sternum, and not in the armpit, then there is the likelihood of developing an attack of angina pectoris.

5. If there are signs of an attack of angina pectoris – dull, squeezing, pressing pain behind the breastbone, then it is better to call an ambulance. Waiting for an attack of angina pectoris is an unacceptable negligence to your health, which can lead to the development of myocardial infarction, especially if you have never experienced chest pains before.

6. If there is a suspicion of the development of an attack of angina pectoris, it is necessary:

• Stop work immediately, try to sit down or lie down;
• Unbutton the collar, unfasten the belt;
• put a nitroglycerin tablet or a validol tablet under the tongue, take 30 drops of valocordin or corvalol;
• If after that the pain persists for 5 minutes, put a second nitroglycerin tablet under the tongue, ask your family or colleagues to immediately call an ambulance.
• When calling an ambulance, tell the operator the most detailed description of the pain: the nature, location (place) where it is given, the duration of the attack, whether the patient has heart disease, what medications he is taking.

7. If there is no suspicion of angina pectoris – pain in the chest is not intense, stitching, intensified with a deep breath, turning, bending of the body, given to the back, then take an anesthetic and call a doctor at home.

Cardialgia – (Clinics Di Center)

Heart pain: causes of

Pain in the area of ​​the heart is one of the most common reasons people seek emergency help.Heart pains can be divided into two main groups according to their origin.

Perhaps most people at least once in their lives have experienced pain or other discomfort behind the sternum or to the left of it in the chest, exactly where the heart is located. These pains draw attention to themselves and cause anxiety more than many others – this is how we instinctively react to “problems” in the location of such an important organ. It is not without reason that pain in the region of the heart is the most frequent reason for seeking medical help.

The pains in this area are varied. They prick, crush, squeeze, bake, burn, whine, pull, pierce. They can be felt in a small area or spread over the entire chest, given to the shoulder, arm, neck, lower jaw, abdomen, under the shoulder blade. They can appear for several minutes or last for hours, or even days on end, can change when breathing, moving arms and shoulders, or changing posture … Sometimes they occur during physical or emotional stress, sometimes at rest or in connection with a meal.

There are many causes of pain in the heart area. They can be heart diseases such as angina pectoris, myocardial infarction, inflammation of the heart and its membranes, rheumatic lesions. But often the source of pain is located outside the heart, as, for example, with neurosis, diseases of the ribs and thoracic spine, problems with the gastrointestinal tract and many other diseases.

Why does the heart hurt

Pain in the area of ​​the heart is one of the most common reasons people seek emergency help.Heart pains by their origin can be divided into two main groups:

• anginal pain arising at various stages of ischemic disease;

• cardialgia caused by inflammatory heart disease, congenital diseases and heart defects or vegetative-vascular dystonia.

Anginal (ischemic, angina pectoris) pain occurs when there is a need to increase blood flow, which occurs during physical exertion or emotional stress.Therefore, these pains are characterized by the occurrence of attacks when walking, emotional disorders, and termination at rest, their rapid removal with nitroglycerin. By nature, ischemic pains are usually burning, pressing, squeezing; are felt, as a rule, behind the sternum and can be given to the left shoulder, arm, under the scapula, in the lower jaw. They are often accompanied by shortness of breath. Very strong, pressing, squeezing, tearing, burning pain behind the sternum or to the left of it is one of the symptoms of acute myocardial infarction, and this pain is no longer relieved by nitroglycerin.

Cardialgias arising from rheumatic heart diseases, myocarditis and inflammatory diseases of the outer shell of the heart – the pericardium, usually long-lasting, aching or stabbing in nature, spilled, occur to the left of the sternum, aggravated by breathing, coughing. They are not removed by nitroglycerin, but may subside after prescribing pain relievers.

Often, pain in the region of the heart is not associated with diseases of the heart itself.

If pain in the heart area changes with tilting and turning of the trunk, deep inhalation or exhalation, movement of the arms, and taking nitroglycerin or validol practically does not affect the intensity, then it is probably due to chest sciatica or diseases of the costal cartilage.

Severe pain along the intercostal spaces is sometimes the first sign of shingles, and short-term or intermittent pain in the region of the heart, more often concentrated in a small area, aching, stabbing or indefinite, is a frequent complaint of patients with neurosis.

Stress and depression can manifest as pain in the neck and shoulder region. Those who run to the doctor in fear, believing that he has “bad heart”, return home reassured: the pain is associated only with the muscles. Often, shortness of breath, squeezing or stabbing pains in the heart are caused by bloating in the intestines, which puts pressure on the heart and thereby disrupts its function. If you can associate pain in the region of the heart with eating a particular food or fasting, then the cause may be a disease of the stomach or pancreas.Also, the cause of pain can be infringement of the root of the heart nerve, a weakened thoracic spine, its curvature, osteochondrosis, etc.

How to find the cause of pain and what to do about it?

To clarify the cause of pain in the region of the heart, a thorough examination is required, prescribed by a cardiologist and cardiac surgeon.

When examining the activity of the heart, an obligatory method is an electrocardiogram (ECG), stress ECG (treadmill test, bicycle ergometry) – recording an electrocardiogram during exercise and Holter ECG monitoring is an ECG recording carried out during the day.

For the study of heart murmurs, the method of phonocardiography is used, and the method of echocardiography allows using ultrasound to examine the state of the heart muscles and valves, to assess the speed of blood movement in the cavities of the heart. Coronary angiography is used to examine the condition of the coronary arteries. To determine the lack of blood supply to the heart muscle, the method of myocardial scintigraphy is also used.

To exclude “non-cardiac causes” of pain in the heart, it may be necessary to conduct radiography, computed and magnetic resonance imaging of the spine, you may need to consult a neurologist or orthopedist.You may need to visit a gastroenterologist or medical psychologist.

By the way, according to the observations of cardiologists, if a person describes in detail and vividly his pains in the region of the heart, very often takes observations about his painful sensations “on a pencil” and reads them out to the doctor, most likely, these are not heart pains. If, in addition, a person believes that each time the pain is different, lasts for a long time (with no signs of heart failure), is accompanied by frequent heartbeats, sometimes disturbing more than the pain itself, cardiologists, as a rule, look for the cause of the disease outside the heart.

If the description of pain is sparse, without unnecessary words, if the patient remembers well the nature of the painful sensations, this often indicates a serious heart disease. However, any complaints of pain in the region of the heart should be consulted by a doctor.

The cardiologist will prescribe treatment for you based on your diagnosis. It is possible that a course of manual therapy will be enough to relieve you of heart pain caused by “non-cardiac” diseases.And it is possible that the only salvation for you will be a surgical operation aimed at plastic vessels or creating a bypass path for blood flow.

Remember – our heart was created for love, but we must learn to love and cherish it.