What Causes a Sudden, Sharp Pain in the Chest? – Cleveland Clinic

Without warning, there’s a sharp, stabbing pain in your heart.
Um. That can’t be good, right?

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Chest pain is scary, and it can be serious. But a whole lot of things can cause stabbing pain in your chest, and some have nothing to do with your heart, says cardiologist Sapna Legha, MD.

Here’s what might be causing that breath-stopping pain — and
when you should consider it an emergency.

What causes sharp pain in the heart?

Chest pain isn’t always as bad as you might think. A 2016 study in the Journal of the American Medical Association (JAMA) found that less than 6% of people who go to the emergency room for chest pain actually have a life-threatening problem.

That doesn’t mean you should ignore the pain, of course. It could signal something serious.

So what’s going on inside your ribcage? Dr. Legha points to some of the common causes of sharp chest pain.

Pulmonary embolism

Sharp chest pain could signal a pulmonary embolism, a clot that lodges in the lungs. Besides pain, symptoms can include shortness of breath, pale skin, racing heart and cough.

Gastrointestinal problems

Acid reflux, or gastroesophageal reflux disease (GERD), can cause a burning sensation in your throat or chest — classic heartburn. But sometimes, GERD can cause sharp chest pain and pressure, Dr. Legha says. So can esophagitis, an inflammation of the lining of the tube that connects the throat to the stomach.

With these conditions, pain is more likely after eating, exercising or lying down. You might also have a hard time swallowing.

Musculoskeletal problems

If you recently hauled a heavy box or worked out too hard at the weight gym, you might have developed a case of costochondritis — inflammation of the cartilage around the sternum. A bad case can cause significant pain. 

Aortic dissection

This dangerous condition strikes when the layers of the aorta, the heart’s major blood vessel, tear apart. It feels like a sharp, tearing pain in your chest and back. Other symptoms include shortness of breath, fainting or dizziness, weak pulse and stroke symptoms.

This isn’t a sharp pain that eases after a minute, but pain you can’t ignore. (And you shouldn’t. It’s a 911 situation.)

Coronary artery disease

Coronary artery disease can cause a painful sensation in the chest called angina. But usually, that pain is described as heaviness, achiness, tightness or pressure, rather than a sharp, sudden blast of pain. “This type of pain is usually brought on by exertion and goes away with rest,” Dr. Legha says.

Heart attack

Typical heart attack pain is similar to the pain of coronary artery disease: A heaviness, tightness or pressure. But some people experience atypical symptoms, especially women and people with diabetes, Dr. Legha says. It’s unusual for a heart attack to cause pain without other symptoms, though, such as shortness of breath, cold sweats, nausea, dizziness or lightheadedness.

When does chest pain = emergency?

Unfortunately, it can be tough to pinpoint the cause of chest pain on your own. So how do you know if it’s an emergency?

Chest pain but no other symptoms: Make a doctor’s appointment

If you’re young and otherwise healthy, and the pain eases up
after a few minutes, it’s probably not urgent, Dr. Legha says — especially if
you don’t have any other symptoms.

“If you’re stable and not clutching your chest in pain, you
can probably just schedule an appointment with your primary care doctor,” she
says. “Not every pain needs to be worked up in the emergency department.”

Chest pain with other symptoms: 911 or the ER

If you have other symptoms associated with serious heart and lung problems (like shortness of breath, a lot of sweating or nausea), call 911 or get yourself to the ER.

Chest pain with other heart disease risk factors: 911 or the ER

Similarly, play it safe if you have risk factors for heart disease — high blood pressure, high cholesterol, diabetes, a history of smoking or a family history of heart problems. Err on the side of caution and see a doctor right away, she adds. “It’s always better to be safe and have it evaluated.”

Sternum Pain With Exercise | Livestrong.com

Sternum pain can be caused by inflammation of cartilage in your chest.

Exercise is beneficial for heart, lung, bone and tissue health. However, exercise can sometimes lead to unknown pains that can alarm unsuspecting exercisers. Pain in your sternum — or breast bone — during exercise can occur as the result of a variety of conditions or injuries. While most problems are simple and not life-threatening, always consult your physician if you experience sternum pain while exercising.

Costochondritis

Costochondritis is an inflammation of the cartilage that surrounds your sternum. Exercise and the heavy breathing that often accompanies exercise can make the symptoms of costochondritis more prevalent. The symptoms of costochondritis can be alarming due to the fact that they mimic the symptoms of a heart attack, including pain and tenderness along the breast bone, pain when breathing or coughing, and difficulty breathing. Visit your doctor if you experience these pains because costochondritis can be the result of an infection. Treatment includes muscle relaxants and anti-inflammatory medications.

Sprains

Abnormal twisting and turning — especially turning core exercises — can lead to a pulled muscle or torn cartilage in your sternum area. Pain is normally felt along the sternum, and tends to decrease when you rest and increase when you participate in physical activity.

Fractures

A sternum fracture can occur as the result of a fall during exercise or a direct blow to the chest during participation in contact sports. Common symptoms of a chest fracture include pain, tenderness, visual deformity and bruising. Most sternum fractures are treated with rest and discontinuing exercise until you are healed. Only sternum fractures that cause damage to your internal organs require more complex treatment and possible surgery to repair the damage.

Angina

Angina can cause a tight, heavy feeling in your chest near your sternum. This is a result of reduced blood flow to the heart. Angina can be a sign of heart disease and should be treated by a physician as soon as possible. You may also experience pain in your arms, neck, shoulders, back and jaw, in addition to nausea, fatigue, shortness of breath, sweating, dizziness and anxiety. Angina triggered by physical exertion or exercise is termed “stable angina.” This type of angina is only triggered during physical exertion. Simple lifestyle changes can help to treat stable angina; these include taking breaks during exercise, controlling your weight, not eating large meals, managing diabetes and not smoking.

6 Facts About Chest Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

Pericarditis

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

Myocarditis

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

Mitral valve prolapse

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

Aortic dissection

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

Coronary microvascular disease (MVD)

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

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

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

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

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

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

4.

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

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

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

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

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

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

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

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

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

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

Commonly asked questions

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

Questions

you should ask

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

Is My Chest Pain Heartburn, or Is It Something More Serious?

Chest pain can be scary, but it doesn’t necessarily mean you’re having a heart attack.

Here’s what else it could indicate.

Chest pain or discomfort is one of the symptoms people experience when they are having a heart attack, but it can also be a sign of something else. These questions can help you figure out whether your symptoms mean you should get immediate medical help or make an appointment with a doctor.

Do your symptoms appear after eating?

If you have overindulged or eaten greasy or spicy foods, you may experience a scorching feeling in your chest. This could be heartburn, which is a symptom of acid reflux and is caused by GERD, or gastroesophageal reflux disease.

“30%-40% of patients presenting to ER with chest pain have chest pain due to acid reflux, or GERD,” says Caitlin Houghton, MD, a general surgeon at Keck Medicine of USC and assistant professor of clinical surgery at the Keck School of Medicine of USC. Although, “heartburn can be due to heart problems and should be checked by an ER or local doctor,” she adds.

Is your pain accompanied by a runny nose, coughing, sore throat and fever?

Acute bronchitis can make your chest ache, a pain that worsens if you have a hacking cough. The condition occurs when your bronchial tubes become inflamed. Mucus builds up, leading to shortness of breath and feeling like you have a cold.

Your doctor may prescribe anti-inflammatory drugs and ask you to rest and drink plenty of liquids to thin the mucus and keep your bronchial tubes lubricated. If symptoms continue longer than 10 days, consider getting a chest X-ray to determine whether your condition has turned into pneumonia or if there is another culprit causing your pain.

Do you have a rapid heart rate, fever, fatigue or trouble breathing?

Myocarditis is an inflammation of the heart muscle that produces symptoms resembling a heart attack. If you have these symptoms, seek medical help immediately.

Do you feel pressure in your chest and discomfort in your shoulders, arms, neck, jaw or back? Do you feel like you have indigestion?

Angina signals an underlying heart condition that can lead to a heart attack. Stable angina is triggered by emotional stress, smoking, heavy meals and extreme variances in temperature, all of which cause your heart to work harder.

This type of angina is episodic but controllable. Your doctor can help you understand and manage the condition.

Unstable angina is characterized by sudden chest pain or worsening or persistent chest discomfort that occurs during sleep or reduced physical activity. It is caused by a reduction in blood flow to the heart. This is a serious health issue that requires immediate medical attention.

Are you experiencing shortness of breath, nausea, arm pain, fatigue, profuse sweating or pale and clammy skin?

If you experience these symptoms for longer than five minutes and have no explanation for them, call 911. You could be having a heart attack.

by Heidi Tyline King

Do you have questions about heart disease? Our team of cardiologists can help. If you are in the Los Angeles area, request an appointment or call (800) USC-CARE (800-872-2273).

Diagnosis and Management of Esophageal Chest Pain

Chest pain in children and young people

Chest pain in children and young people

What causes chest pain in children and teenagers?

A variety of factors can cause a child or teenager to feel chest pain. In most cases, chest pain in children and teenagers is not caused by a heart problem.

The most common cause of chest pain in children and teenagers is chest wall pain. “Chest wall” is a term for the structures that enclose and protect the lungs, including the ribs and sternum.

We do not always know what causes chest wall pain, but it is typically associated with brief sharp pain that is worse with breathing in. Injury to the ribs, sternum or other bones in the chest and back also can cause chest wall pain. There are also a variety of muscles and joints in the chest area that may be sore, inflamed or strained. Causes can include an infection or injury, such as from sports or a fall.

Typical chest wall pain is not treated with medications, although chest wall injuries and inflammation can respond to non-steroidal anti-inflammatory medications, such as ibuprofen. Otherwise, treatment for the chest pain will be dependent upon the underlying cause of the pain.

Sometimes, a cold (upper respiratory infection) or persistent cough can cause soreness and pain in the chest area. Some children will describe acid reflux (“heartburn”) as chest pain. Stress or anxiety may also bring on a feeling of chest pain.

Heart conditions that can cause chest pain in a child are very rare. They include pericarditis (an inflammation of the sac that surrounds the heart), myocarditis (a viral infection of the heart), arrhythmias (abnormal fast heart rhythms), or, very rarely, blockage or other problems with the coronary arteries (the tiny vessels that carry oxygenated blood to the heart tissue). Another cardiac cause of chest pain can be due to dissection, or tearing, of the aorta, the main artery that directs blood from the heart out to the body.

What should I do if my child has chest pain?

Understandably, when a child complains of chest pain, parents worry there is a problem with the heart. In children, it’s unlikely that chest pain is caused by a heart problem.

However, do not ignore chest pain in a child. Make an appointment with your GP and explain what your child is experiencing. The doctor will decide whether further tests are needed.

If the child complains of chest pain, and also has a fever, is sweating or having trouble breathing, or has a very rapid heart rate, is pale, or has severe pain like a ripping sensation, do not wait — get help immediately. Also, if there is a family history of “aortic dissection,” or tearing of the aorta, or of Marfan syndrome, an emergency evaluation is immediately needed.

What should I expect if my child visits JPUH  for chest pain?

The paediatrician will listen to your child’s heart and ask questions about the circumstances that led to the chest pain, your child’s medical history, and the family medical history. The doctor will read an electrocardiogram (ECG ), a record of the electrical activity of your child’s heart, to determine whether a heart problem may be causing your child’s symptoms.

The doctor might do other tests, such as an exercise stress test, ECG, or chest X-ray, or might send your child home with a  Holter monitor to continuously record your child’s heart rhythm as they go about their normal activities. However, the vast majority of children will not need further testing and will likely be found to have a normal heart.

What causes pain in the sternum?

Table of contents

1. What is the sternum?
2. Causes of sternum and substernal pain
3. Symptoms of sternum pain
4. When to see a doctor

breastbone pain is pain or discomfort in the area of the chest that contains the sternum and the gristle copulative it to the ribs. The sternum is placed near the heart, so galore people experiencing sternum pain may confuse it with more general chest pain.

Some people experiencing sternum pain worry they may be having a heart attack. nevertheless, in most cases, sternum pain is unrelated to the heart and caused primarily due to problems with the sternum itself or the near gristle.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

What is the sternum?

The sternum is sometimes best-known as the sternum. This flat bone sits at the front of the chest and connects to the ribs with gristle.

The sternum is part of the rib cage, a series of castanets that protects the heart and lungs from injuries.

Causes of sternum and substernal pain

The sternum is placed at the front of the chest and is connected to the ribs.

breastbone pain is normally caused by problems with the muscles and castanets near the sternum and not the sternum itself.

Pain felt just behind or below the sternum is called substernal pain and is sometimes caused by GI problems.

Some of the most common causes of sternum and substernal pain are:

• inflammation
• clavicle injuries
• sternoclavicular joint injury
• herniation
• sternum fracture
• acid reflux
• muscular strain or bruise

Costochondritis

Costochondritis is the most common cause of sternum pain and occurs when the gristle between the sternum and ribs becomes inflamed and irritated.

Costochondritis can sometimes occur as the result of degenerative inflammatory illness but may besides happen for no apparent reason.

The symptoms of inflammation include:

• sharp pain on the side of the sternum area
• pain that worsens with a deep breath or a cough
• discomfort in the ribs

Costochondritis is normally not a cause for concern. nevertheless, people experiencing symptoms of inflammation may want to consult a doctor if their symptoms worsen or do not go away.

Costochondritis: Causes, symptoms, and treatment

Costochondritis is a condition where the gristle in the sternum becomes inflamed, causation pain. Learn about symptoms, treatments and outlook.

Read now

Sternoclavicular joint injury

The sternoclavicular joint connects the top of the sternum to the clavicle. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

• mild pain or swelling in the upper chest area
• difficulty or pain when moving the shoulder
• pop or clicking around the joint

Collarbone injuries

Collarbone injuries may lead to durable pain or limited movement in the shoulder and upper chest.

While the clavicle itself is not part of the sternum, it is connected to the sternum by gristle. Injuries to the clavicle may cause pain in the sternum area.

Collarbone injuries are often the result of trauma, so much as a car accident or sports injury, although infections or inflammatory illness can besides cause them.

Symptoms of a clavicle injury include:

• severe pain when raising the arm
• bruising or swelling in the upper chest area
• abnormal positioning or drooping of the shoulder
• clicking and grinding in the shoulder joint

Hernia

Hernias may not be an apparent cause of pain near the chest. nevertheless, a hiatal herniation may cause substernal pain.

A hiatal herniation happens when the stomach moves out of its normal position up past the diaphragm and into the chest. Symptoms of a hiatal herniation include:

• frequent burping
• heartburn
• vomit blood
• a feeling of fullness
• trouble swallowing

People with substernal pain and symptoms of a hiatal herniation should see a doctor for prompt treatment.

breastbone fracture

Like a fracture in other environment of the body, sternum fractures can cause a lot of pain. breastbone fractures normally occur as a direct result of trauma, so much as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention, as the heart and lungs may besides be injured.

Symptoms of a sternum fracture include:

• pain during inhaling or coughing
• swelling over the sternum
• difficulty breathing

Acid reflux or GERD

Acid reflux happens when stomach acid wears away the lining of the trachea (esophagus). This happens primarily in people with internal organ reflux illness (GERD).

Acid reflux may cause substernal pain and discomfort in the chest and is generally attended by a burning feeling.

Pain in this region can besides be caused by inflammation or a spasm of the trachea. People with GERD should talk to their doctor about how to prevent further damage to this area.

Muscular strain or bruise

The sternum and ribs have galore muscles attached to them. These muscles can be pulled or strained by severe coughing or strenuous activity involving the arms or torso.

Injuries or trauma can result in bruising to these muscles, which may cause them to ache.

Symptoms of sternum pain

breastbone pain is normally caused by muscles or castanets encompassing the sternum.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

• pain or discomfort in the ribs
• pain that worsens during deep breathing or coughing
• mild, aching pain in the upper chest
• swelling in the upper chest
• stiffness in the shoulder joints
• severe pain when raising the arms
• signs of clavicle trauma, so much as bruising or swelling
• difficulty breathing
• grinding or pop sensation in joints near the sternum
• frequent belching
• heartburn
• feeling too full
• throwing up blood

breastbone pain vs.

heart attack

People experiencing any kind of chest pain may worry they are having a heart attack. nevertheless, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack besides occurs with the following symptoms:

• pressure, squeeze, or fullness in the center of the chest
• sweating
• nausea
• shortness of breath
• lightheadedness

nevertheless, anyone who thinks they are having a heart attack should seek immediate medical attention.

When to see a doctor

While sternum pain is not normally serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

• started as a result of direct trauma
• is attended by heart attack symptoms
• is persistent and does not improve over time
• is attended by intense vomit or vomit blood

A person should besides speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Pain in the region of the heart

Not all heart pain is a symptom of heart disease. If you are less than 30 years old and you are worried about aching pains in the apex of the heart, lasting for hours, from which you can get distracted by talking or everyday activities, then this is most likely a manifestation of vegetative-vascular dystonia. This pain, as well as piercing in the apex of the heart, is not dangerous. Another fairly common variant of chest pain is pain that increases with torso twists, deep breathing, and palpation (pressure).These are the so-called vertebrogenic (emanating from the spine) chest pains, which are most often caused by osteochondrosis of the thoracic spine or scoliosis. These pains are also not dangerous, but often very unpleasant and require examination and treatment by a neurologist.

But if you are a man over the age of 40 or a woman over the age of 55, and even smoke, suffer from arterial hypertension or diabetes mellitus, and your parents had heart attacks or strokes, then it is very likely that chest pains are symptoms angina pectoris. The disease is manifested by pain in the chest (in the middle of the chest) when walking (especially in cold or windy weather), climbing stairs, as well as other physical and emotional stress, against the background of increased blood pressure. The pains are of a squeezing nature (therefore angina pectoris was previously called “angina pectoris”), pressing or burning (not to be confused with heartburn!), Are given to the left arm or both hands, or to the lower jaw. Pains are often accompanied by shortness of breath, sweating, weakness. When you stop or stop the load, the pain behind the breastbone quickly (3-5 minutes) disappears.Typically, repetition of chest pains with the same physical activity, the pains are of the same nature and quickly disappear when the load is stopped or nitroglycerin is taken under the tongue. Often, patients know that an attack occurs precisely when going out into the street in cold weather, accelerating a step, climbing a hill, and can even say exactly at what distance (for example, after 100-200 meters) pain appears. Angina is a serious disease, so you need to be examined as soon as possible, temporarily postponing daily activities.Remember that if you leave this problem “for later”, hoping for “maybe”, then myocardial infarction may occur, from which people often die.

There are other less common causes of chest pain (eg, pneumonia, pleurisy, pericarditis, shingles). If pain occurs for the first time, then it is reasonable to find out their cause by contacting a doctor.

when you need to urgently call an ambulance

19 September 2019
14:40

Pain is the body’s way of notifying us that things are going wrong.If it causes significant discomfort, the usual painkillers have no effect, or they help badly, the pain grows, or suddenly pierces like a blow with a dagger, there are feelings of anxiety, panic, you must definitely listen to your body and take action. If painful sensations appear and disappear for a long time, but in the same place, it is imperative to inform the attending physician about it.

What can cause chest discomfort and when should an ambulance be called immediately?

What diseases can cause chest pain?
• – angina pectoris
• – heart attack
• – heartburn
• – chest contusion
• – fracture of ribs
• – increased anxiety or panic disorder
• – asthma, bronchitis, pneumonia
• – mitral valve prolapse
• – pericarditis
• – peptic ulcer
• – spasm of the coronary arteries
• – aortic dissection
When is chest pain a reason to urgently call an ambulance?
There is practically no connection between the strength and duration of chest pain and the danger of diseases that it may accompany.Even a slight discomfort behind the breastbone can be a symptom of heart vascular disease: for example, according to statistics, up to 30 percent of heart attacks that have occurred were not accompanied by any symptoms noticeable to a person.
Therefore, the most correct decision is to urgently consult a doctor for any alarming sensations in the chest. And the symptoms listed below will help you make the right decision when helping another person. So, you need to dial the emergency number if:
• – A person over 40 years of age and has one or more risk factors for heart disease: a family history of heart attacks and strokes, smoking, obesity, a sedentary lifestyle, high cholesterol, diabetes.
• – A person of any age has already been diagnosed with cardiovascular disease.
• – The pain is in the nature of strong compression, heaviness in the chest, making it difficult to breathe, or very sharp.
• – The pain is accompanied by nausea, weakness, shortness of breath, sweating, pallor, dizziness, or fainting.
• – Chest pain radiates (radiates) to the shoulder, arm or jaw.
• – Painful sensations are much more acute than those that have ever been experienced in this part of the body.
• – Pain causes increased anxiety, fear, a sense of doom.
• – The pain does not subside after 15–20 minutes.
• – The pain is constantly increasing.

If you find at least one of the above signs in yourself or another person, you must immediately call an ambulance.
If the ambulance team suspects you have heart disease, do not refuse hospitalization and do not ask for treatment at home.

Remember that the speed of diagnosing a heart attack and the immediate start of its treatment can save lives and protect a person from disability.A timely diagnosis of angina pectoris allows rapid and aggressive treatment to begin and to avoid further damage to the heart muscle.

Angina (chest pain) / Diseases / Clinic EXPERT

The most common symptom of coronary heart disease is angina pectoris (Latin angina pectoris, syn. Angina pectoris), also known as simply chest pain. Symptoms of angina pectoris may include discomfort, heaviness, pressure, pain, burning, fullness, constriction, or soreness associated with coronary artery disease.Very often, these symptoms are mistaken for indigestion.

Angina is a disease characterized by an attack of pain, mainly behind the breastbone, less often in the region of the heart, shoulders, arms, neck, throat, jaw or back.

When you feel these symptoms, pay serious attention to them. If you’ve never been diagnosed with heart disease, seek immediate medical attention. If you already have angina and are taking medication as directed by your cardiologist, try to determine if it is regular angina or if your symptoms have worsened.

Causes of angina pectoris

Angina pectoris appears when the blood flow to the heart area decreases. This impairs the delivery of oxygen and nutrients to vital muscle cells. When this happens, the heart muscle must use alternative, less efficient “fuels” in order to continue to perform its function as a blood supply to the body. A side effect of using this less efficient fuel is the production of lactic acid, which builds up in the muscles and causes pain.This is why some medicines used to treat angina pectoris work by blocking them.

Types of angina pectoris

• Stable angina pectoris – predictable pains that appear only during emotional and physical stress and disappear at rest.
• Progressive angina (unstable) is a type of angina that may indicate an impending heart attack. Pain with progressive angina pectoris differs from the usual one in that it makes itself felt, both with emotional and physical stress, and at rest.Progressive angina pectoris occurs more frequently, often at rest or with minimal physical activity, and this heart disease is the longest and most difficult to tolerate. Although this type of angina can be relieved with medication, it is unfortunately intermittent and can lead to a heart attack. This type of angina often requires special procedures and more intensive medical treatment.
• Prinzmetal angina (variant angina) – characterized by the appearance of pain at rest in the early morning or night hours or under the influence of low temperatures.Variant angina pectoris is a rare type of angina pectoris caused by spasm of the vessels supplying the heart. For this condition to appear, the initial stage of atherosclerosis is sufficient. In most patients, atherosclerotic plaques are found, giving persistent stenosis.

Frequently asked questions about angina

Can angina occur without coronary artery disease?

Angina pectoris may occur in the absence of any coronary artery disease. More than 30% of people suffer from aortic heart disease – a disease that manifests itself when the aortic valve is incompletely closed, or its narrowing (stenosis), or a combination of both, causing a decrease in blood flow to the coronary arteries.People with severe anemia and thickened heart muscles are more prone to angina pectoris because their blood does not carry enough oxygen.

How can angina be assessed?

To evaluate your angina, your doctor will ask you a series of questions to determine your symptoms and their origin. After a thorough examination, he or she will order you one or more series of tests to determine the underlying cause of angina and the degree of coronary artery disease, if any. These tests include:

• Cardiac Stress Test
• An electrocardiogram (ECG) is a graphical representation of the potential difference resulting from the work of the heart carried out on the surface of the body.The ECG reflects the averaging of all vectors of action potentials that arise at a certain moment of the heart.
• Echocardiogram (ECHO-KG) or ultrasound of the heart
• Cardiac probing.

How is angina pectoris treated?

Treatment of angina pectoris depends on the severity of the underlying problem, namely the damage to the heart. For most people with mild angina, symptoms can be controlled with a combination of drugs and lifestyle changes, such as eating a healthy diet, lowering cholesterol levels, exercising regularly, quitting smoking, and controlling cholesterol and blood pressure.

Some medicines used to treat angina pectoris work by increasing the amount of oxygen delivered to the heart muscle or by reducing the heart’s oxygen demand. These medicines include:

• beta blockers
• nitrates
• calcium channel blockers
• ranolazine.

Other drugs for angina pectoris work by preventing blood clots, which can block blood flow to the heart muscle.

For patients with more severe or worsening angina, the doctor may recommend treatment based on opening the blocked arteries. These treatments include:

• angioplasty
• stenting
• coronary artery bypass grafting (CABG)
• external counterpulsation.

What if I have angina?

For any type of angina, it is recommended to stop and rest.

If you have been prescribed nitroglycerin to treat your angina, place 1 tablet under your tongue and let it dissolve.If you are using spray nitroglycerin, spray it under your tongue. Wait 5 minutes. If angina does not stop after 5 minutes, take another dose of nitroglycerin. Wait another five minutes, and if angina is still present, take the third dose.

If angina pectoris does not stop either after rest or after taking 2 doses of nitroglycerin, call an ambulance or ask someone to take you to the nearest hospital.

If you suspect you are having a heart attack, do not delay.Call an ambulance immediately. Don’t drive to get to the hospital. Take aspirin.

Prompt treatment of a heart attack is very important to minimize the amount of heart damage.

Why can’t I drive myself or ask someone to give me a lift to the hospital?

Upon the arrival of the ambulance, emergency personnel will immediately assist you with life-saving medications and oxygen to improve the flow of oxygen-rich blood to your heart.If you have any problems, they will provide you with emergency assistance.

What to remember about angina pectoris?

If you have angina, make sure you always have nitroglycerin on hand – you never know when you might need it. Nitroglycerin should be stored in a dark container away from heat and moisture. Always check the expiration date on the packaging and remember to change the opened container of nitroglycerin tablets every 3 months. The spray has a longer shelf life and must be replaced every 2 years.

Conversations about pain. Topic №1 – chest pain

Maslov Sergey Vyacheslavovich

Therapist, Cardiologist

April 26, 2021

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

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

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

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

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

Our First Discussion – BREAST PAIN

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

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

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

NOT SIMPLE OSTEOCHONDROSIS

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

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

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

HEART PAIN

Angina pectoris

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

Heart attack

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

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

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

Myocarditis

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

AORTIC DISEASE

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

LUNGS DO NOT PAIN

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

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

EFFECTS OF NEIGHBORS

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

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

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

ADD NOT PLUS

While listing the different causes of chest pain, there is one more important point to note. Diseases add up, which further complicates the doctor’s diagnostic task. It does not happen that if a person has osteochondrosis, then heart disease is excluded. More often, unfortunately, on the contrary, since the body is a single system, one problem begins to pull another.Therefore, if a patient has one specific complaint of chest pain, it is not always associated with one disease. Sometimes you have to deal with a group of diseases with similar symptoms, but a different clinical picture and a different approach to treatment. In this article, we have listed not all, but only the main causes of chest pain. But even this is enough to get an idea of ​​how diverse they are, and how senseless and dangerous it is to try to find a “medicine for pain” on your own.

Heart pain

Heart pain is pain or other discomfort behind the sternum or in the left side of the chest, where the heart is located. Pain in the region of the heart is very varied. They can be stabbing, pressing, aching, squeezing, pulling, cutting. They can occur in a limited area or throughout the chest, can be given to the shoulder, arm, or under the scapula. They can be milked from one minute to several hours, they can change with breathing or movement.Sometimes they occur during physical or emotional stress, sometimes at rest or in connection with food intake.

There are many reasons for pain in the heart. The causes of pain can be divided into 2 large groups – “cardiac” and “non-cardiac”.

“Cardiac” causes

• Myocardial infarction – pressing, compressive chest pains radiating to the left arm and under the scapula lasting more than 15-20 minutes.Other symptoms may include shortness of breath, cold sweats, and nausea.
• Angina pectoris – attacks of pressing, squeezing pains radiating to the left shoulder and under the scapula It usually occurs during physical exertion or stress and goes away at rest. The duration of the pain is no more than 15 minutes.
• Other cardiac causes. Other causes that may present with chest pain are due to inflammation of the heart muscle or the lining of the heart. The pain is most often acute or stabbing.There may also be an increase in body temperature and malaise. Less commonly, the cause of pain can be a dissection of the aorta, the main artery in the body. The inner layer of this artery can flake off under the pressure of the blood and as a result, there are sudden cutting pains in the region of the heart. Aortic dissection can be due to chest trauma or a complication of severe hypertension.

Non-cardiac causes

• Heartburn is a burning pain in the chest area.Often combined with sour taste and belching. The pain is usually associated with eating and lasts for hours. The cause is acidic gastric juice that travels from the stomach into the esophagus. The pain most often occurs when bending over or lying down. Eases heartburn by taking antacids.
• Panic attacks are disorders of the autonomic nervous system. The pain is accompanied by a rapid heartbeat, rapid breathing, bouts of unreasonable fear, and profuse sweating.
• Pleurisy – acute in the chest, which is aggravated by inhalation or coughing.The pain occurs due to inflammation of the membrane that lines the chest cavity inside and covers the lungs. Pleurisy can occur with various diseases, but most often with pneumonia.
• Osteochondrosis of the cervical and thoracic spine can cause vertebral cardialgia, which resembles angina pectoris. The pain in osteochondrosis is intense and prolonged, it can be given to the hands and the interscapular region. The pain increases or decreases with changes in body position, head turns, arm movements.
• Pulmonary embolism. This is a life-threatening condition and occurs when a blood clot, most often from the veins of the lower extremities, enters the pulmonary artery and blocks the flow of blood to the heart. Symptoms: Sudden, sharp chest pain that worsens with deep breathing or coughing. Other symptoms are shortness of breath, palpitations, anxiety, loss of consciousness.
• Other lung diseases. Pneumothorax (collapsed lung), high pressure in the vessels that feed the lungs (pulmonary hypertension), and severe bronchial asthma can also present with chest pain.
• Muscle diseases. Pain occurs when the trunk is moved or when the arms are raised.
• Rib injury and nerve entrapment. Bruises, rib fractures and entrapment of nerve roots can cause very severe pain. With intercostal neuralgia, pain is localized along the intercostal spaces and increases with palpation.
• Diseases of the esophagus. Spasm of the esophagus may cause sternum pain. In patients with this disorder, the muscles that normally propel food through the esophagus do not work in a coordinated manner.Another swallowing disorder known as achalasia can also cause chest pain. In this disease, a valve in the lower third of the esophagus does not open and does not allow food to enter the stomach. It stays in the esophagus and causes pain and heartburn.
• Shingles. This infection is caused by the herpes virus and affects the nerve endings. Pain can occur in the left side of the chest or be of a shingles in nature. This disease can leave behind a complication – postherpetic neuralgia – 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 that radiates to the heart.

Diagnosis of pain in the heart.

Pain in the region of the heart is not always indicative of heart disease. Methods that can help determine the cause of pain include:

• Electrocardiography (ECG).This method helps diagnose heart disease. It records the electrical activity of the heart through electrodes placed on the skin. Cardiac impulses are recorded as “teeth”. Since the damaged heart muscle cannot conduct electrical impulses normally, the ECG may indicate that the patient has heart disease.
• Blood tests to determine elevated levels of certain enzymes. This will help determine the dysfunction of various organs: heart, pancreas, gallbladder, etc.
• Ultrasound of the heart – echocardiography (ECHO KG).