Causes and when to see a doctor

Many conditions can cause pain in the sternum, including injuries, pneumonia, bronchitis, and costochondritis. Gastrointestinal problems, such as acid reflux, can cause pain behind the sternum.

People may believe that their sternum pain is a heart attack symptom. However, it is possible to differentiate the two.

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

The sternum is a flat T-shaped bone that sits at the front of the chest and connects to the ribs with cartilage. It forms part of the rib cage, a series of bones that protects the heart and lungs from injuries.

People often refer to the sternum as the breastbone.

Sternum pain can result from problems with muscles and bones near the sternum, as well as the sternum itself.

Substernal pain is discomfort occurring behind or below the sternum. It often results from gastrointestinal conditions.

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

• costochondritis
• sternum fracture
• sternoclavicular joint injury
• collarbone injuries
• muscular strain or bruise
• hernia
• acid reflux
• pleurisy
• bronchitis
• pneumonia

Costochondritis is inflammation of the cartilage between the sternum and ribs. The medical term for this area is the costochondral joint.

The symptoms of costochondritis include:

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

Inflammation in the costochondral joint may occur due to injury, infection, or irritation. A person may experience costochondritis due to:

• impact trauma
• respiratory tract infections
• severe coughing
• physical strains

Learn more about costochondritis here.

Like fractures in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention in case of additional damage to the heart and lungs.

Symptoms of a sternum fracture include:

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

Learn more about fractures here.

The sternoclavicular joint connects the top of the sternum to the collarbone. 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
• popping or clicking around the joint

The collarbone connects to the top corners of the sternum by cartilage. Due to the direct connection between the two structures, injuries to the collarbone may cause pain in the sternum area.

Collarbone trauma

Impact and stress trauma can damage, or even fracture, a person’s collarbone. Collarbone trauma may affect its connection to the sternum and the surrounding musculature. This may mean a person feels pain either in or around their sternum.

Depending on the location of collarbone trauma, other symptoms may include:

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

A great many muscles connect to the sternum and ribs. Injuries or trauma can result in bruising these muscles, which may cause them to ache. Strenuous or repetitive movements can also cause strains in these muscles.

Learn more about muscle strains here.

Most hernias occur in the abdomen. However, a hiatal hernia can affect the chest area and cause substernal pain.

A hiatal hernia occurs when the stomach moves past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

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

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

Learn more about hernias here.

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest.

Pain in this region can also result from inflammation or a spasm of the windpipe. People with GERD should talk with their doctor about preventing further damage to this area.

Learn the difference between heartburn, acid reflux, and GERD here.

Pleura are sheets of tissue between the lungs and ribcage. Inflammation to these tissues is pleurisy.

Pleurisy can cause a sharp, stabbing pain at the site of irritation, which may worsen if a person breathes deeply, coughs, or wheezes.

If inflammation occurs toward the upper middle chest, pleurisy may cause substernal pain.

Learn more about pleurisy here.

Bronchitis is the inflammation of the primary airways of the lungs. The condition can cause:

• chest pain
• severe coughing spells
• shortness of breath
• wheezing

Inflammation of the primary airways may cause substernal pain.

Learn more about bronchitis here.

Pneumonia is a common lung infection that causes air sacs in the lungs to inflame and fill with fluid. The medical term for these air sacs is alveoli.

Pneumonia can cause sharp chest pains, which a person may feel behind their sternum.

Other symptoms of pneumonia include.

• severe coughing
• shortness of breath
• fever
• sweating
• nausea and vomiting
• loss of appetite
• confusion

Infectious bacteria, viruses and fungi can cause pneumonia.

Learn more about pneumonia here.

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 collarbone trauma, such as bruising or swelling
• difficulty breathing
• grinding or popping sensation in joints near the sternum
• frequent belching
• heartburn
• feeling too full
• throwing up blood

People experiencing chest pain may worry they are having a heart attack. However, 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 often occurs with the following symptoms:

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

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

While sternum pain is not usually 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 accompanied by heart attack symptoms
• is persistent and does not improve over time
• is accompanied by intense vomiting or vomiting blood

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

Physical trauma, costochondritis, and muscle strains are common causes of sternum pain.

Conditions such as pneumonia, pleurisy and GERD can also cause pain in nearby tissue that people may mistake for sternum pain.

Read the article in Spanish.

Top 7 Causes of Sternum Pain | How to Get Relief

6 most common causes

Osteoarthritis

Acute Costochondritis

Illustration of a doctor beside a bedridden patient.

Heart Attack

Illustration of a doctor beside a bedridden patient.

Pleurisy

Illustration of a doctor beside a bedridden patient.

Sternum fracture

Sternum pain quiz

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Sternum pain can be caused by a variety of conditions, some of which are serious. Some common causes of sternum pain include inflammation, arthritis, muscle strain, heartburn and acid reflux, heart attack, and sternum injury.

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If your sternum pain is severe, radiating to other parts of the body, or accompanied by symptoms such as shortness of breath, nausea, sweating, or dizziness, it could be a sign of a heart attack or other serious condition and requires immediate medical attention.

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If the pain is from a minor known injury and can be managed with rest, ice, and over-the-counter medications, seeing a doctor may not be necessary. If the cause of your sternum pain is unknown, or if it persists despite at-home care, it is a good idea to see a doctor for further evaluation and treatment. If the sternum pain is severe, worsening, or accompanied by other symptoms such as shortness of breath, nausea, or sweating, you should seek medical attention immediately.

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The treatment for sternum pain might include rest, gentle stretching, anti-inflammatory medications, steroid medications, lifestyle and diet changes, pain medication, or in some cases surgery. Treatment depends on the underlying cause, so it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan. If your sternum pain is severe, worsening, or accompanied by other symptoms such as shortness of breath, nausea, or sweating, you should seek medical attention immediately.

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The sternum, also known as the breastbone, is the long, flat bone in the middle of your chest. You can have pain in this area because of infection, inflammation, injury, or the breakdown of cartilage affecting the sternum itself.

Problems with nearby organs like the heart, lungs, and esophagus can also cause pain in this area. This includes a heart attack, pleurisy (a lung inflammation), and acid reflux.

Usually, if the pain is in the actual sternum, you’ll have sharp pain when you push in the middle of your chest. But because the symptoms of chest bone pain are so similar to other causes of chest pain, you might need to have tests to check for heart attack and other serious conditions.

If your problem is just with your actual sternum, you may feel better with rest, gentle stretching, and anti-inflammatory medications. But if there are other issues, you might need prescription medications, joint injections, or surgery.

Causes of sternum pain

1. Costochondritis

Symptoms

• Pain in the sternum, usually sharp
• Worsening pain with deep breathing or movement
• Pushing or pressure on the sternum is painful.

Costochondritis is inflammation of the cartilage that links your ribs to your sternum. It’s the most common cause of chest bone pain. Usually you feel pain when you push on the sides of your sternum. In many cases, the cause is unknown, but it is sometimes related to exercise or a recent illness.

Because costochondritis feels so much like more serious causes of sternum pain, you should see a doctor. They will probably do a chest X-ray and an electrocardiogram (EKG), which will be normal if it’s costochondritis.

Usually, costochondritis gets better with rest and gentle stretching. But if you are very uncomfortable, ice and anti-inflammatory medication can help. If the pain is severe, you may need a steroid injection.

Dr. Rx

If you have costochondritis or a muscle strain, ask your doctor how long your symptoms might last, and how you can manage your symptoms. It’s a relief to be diagnosed with a non-life-threatening condition, but it doesn’t mean that your pain goes away immediately! There are things you can do to control the pain. —Dr. Anne Jacobsen

2. Sternoclavicular arthritis

Symptoms

• Pain at the top of the sternum
• Worsening pain with activity
• Swelling and tenderness
• Pain radiating into the arms

Osteoarthritis is a breakdown of joint cartilage over time. The sternoclavicular joint is where the top of the sternum (breastbone) meets the clavicle (collarbone).

Osteoarthritis in this area can cause pain in the sternum, especially near the top part. It happens as you age, but it might occur earlier if you had a previous injury in that area. Because this is the area where your torso connects to your arms, this joint works hard. A study in the Journal of Clinical Rheumatology found that 90% of people over the age of 60 have osteoarthritis in this joint, but not all have symptoms.

Your doctor may order X-rays, a CT scan, or an MRI to diagnose sternoclavicular arthritis. Rest and anti-inflammatory medication may help you feel better. Some people may need joint injections with steroid medications. When sternum pain is severe, you may need surgery.

3. Muscle strain

Symptoms

• Sharp or achy pain in the sternum
• Worsening pain with movement
• Muscle spasm
• Bruising or tenderness of a chest wall muscle

A strained or pulled muscle in the chest wall can cause chest bone pain. This injury is caused by overuse or repetitive movement, an increase in activity level, or a sudden improper movement. Pulled muscles can also happen during an illness that causes coughing or vomiting.

Rest, ice, and over-the-counter pain medications can relieve muscle strain. But in more severe cases, you may need physical therapy or surgery.

4. Heartburn and acid reflux

Symptoms

• Burning pain in the chest, abdomen, or throat after eating
• Pain in the sternum
• Bad breath or bad taste in your mouth

Heartburn is a brief burning pain in your throat, chest, or abdomen that is caused by stomach acid. When it happens frequently, it can be a sign of acid reflux.

Both heartburn and reflux are caused by a problem with the sphincter (ring of muscles) that separates the esophagus from the stomach. When the sphincter doesn’t close tightly or opens too frequently, stomach acid or food can travel out of the stomach back into the esophagus.

Heartburn can also be caused by a hiatal hernia, which happens when part of the stomach slips through a hole in the diaphragm (the muscle that separates the chest from the abdomen).

Certain foods and drinks, including spicy or fatty foods, alcohol, and coffee, can trigger heartburn. Overweight people and pregnant women have a higher risk for reflux.

Your doctor may prescribe changes to your lifestyle and diet, medications, and sometimes surgery.

5. Pleurisy

Symptoms

• Sharp sternum pain
• Worsening pain with breathing and coughing
• Pain may go away when you hold your breath
• Cough and fever

The lungs and the inside of the chest are covered with a thin protective tissue called the pleura.  Pleurisy is inflammation and swelling of this tissue. A viral or bacterial lung infection, autoimmune disease, or other conditions in the lungs or chest can cause pleurisy.

Rest, over-the-counter anti-inflammatory medications (ibuprofen), and sometimes antibiotics can help you get better.

6. Heart attack

Symptoms

• Pain or pressure under the sternum
• Pain radiating to the arm or jaw
• Shortness of breath
• Nausea
• Sweating

Some people having a heart attack experience chest pain in or under the sternum. A heart attack is a blockage in an artery of the heart, which prevents blood and oxygen from reaching that area. It is caused by a blood clot that travels from a fatty buildup (plaque), inside the artery.

Heart attack can be life-threatening and requires immediate treatment. When you go to the ER for sternum pain, you’ll likely have tests like an EKG, blood tests, and a chest X-ray.

Treatment should begin as soon as possible after symptoms start, so call 9-1-1, if your pain could be heart related. You may get medications or have a procedure like a heart catheterization with balloon or stent treatments to open up your arteries. Severe cases may need surgery to create a bypass around the blocked artery.

7. Sternum fracture

Symptoms

• Pain in the sternum
• Worsening pain when breathing, coughing, or moving
• Swelling and tenderness of the sternum

Sternum fracture is a break in the sternum bone. This usually only happens in a serious trauma, like a car accident or falls from a high height. Seatbelts save lives in car accidents, but they cross over the sternum, which can fracture it in a high-impact crash.

Because breaking the bone requires such force, doctors will order additional CT scans to check for injuries to the vital organs behind the sternum, including the heart, lungs, and major blood vessels.

Ice, over-the-counter pain medications, and, sometimes, prescription pain medications may relieve your sternum pain. You may need surgery to fix the break or to treat other injuries inside the chest.

Pro Tip

A number of the conditions mentioned here (for instance, costochondritis, muscle strain, and pleurisy) are what doctors refer to as a “diagnosis of exclusion.” This means that there’s not one specific test to make the diagnosis and that the symptoms can mimic the symptoms of other serious conditions. Once we rule out anything serious, we treat the non-serious problem that is most likely. —Dr. Jacobsen

Other possible causes

Other conditions that may cause pain near the sternum include:

• Pneumonia or bronchitis
• A blood clot in the lung (pulmonary embolism)
• Anxiety
• Tumors
• Patients who have had open heart surgery may have chronic pain in the sternum because doctors have to split this bone in half to perform the procedure.
• Some people have genetic conditions that cause the sternum to sink into the chest or to jut forward, and this may cause pain.

When to call the doctor

• Pain in the sternum from a minor injury
• Pain is not controlled with rest, ice, and over-the-counter medications.

Should I go to the ER for sternum pain?

Because these conditions may have overlapping symptoms, many people with pain in the sternum will need to be tested for a heart attack. You should go to the ER immediately if you have any of the following:

• Sternum or chest bone pain that isn’t from a minor injury
• Pain radiating to your arms, jaw, or back
• Shortness of breath, nausea, sweating, or dizziness
• Pain related to a car accident or other traumatic injury

Pro Tip

Pain in the sternum is a complaint where we really need to consider every piece of evidence to feel confident making the right diagnosis. Bloodwork shows if there is injury to the heart muscle or an infection. An EKG shows if there are electrical changes from a heart attack. A chest x-ray or CT scan can show some infections. —Dr. Jacobsen

Treatments

At-home care

If you had a minor injury or if your doctor has ruled out serious causes of your pain, try the following:

• Rest
• Ice
• Over-the-counter anti-inflammatory or pain medications

Other treatment options

• Prescription medications like antibiotics or heart medications
• Joint injection
• Physical therapy
• Surgery

Anne Jacobsen, MD.

Community Emergency Medicine Physician, Kansas City

Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medic…

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Chest pain – causes, symptoms and diagnosis, indications for seeking medical attention

Almost everyone perceives chest pain as a potential heart problem. However, there can be many reasons for discomfort. In any case, it is impossible to determine on your own what caused the discomfort. Only a qualified doctor can determine the cause.

Wrong diagnosis, lack of treatment, uncontrolled attempts to anesthetize the place of discomfort often lead to the development of severe pathologies.

To make sure that the pain is not a sign of a serious illness or to choose a treatment for an identified pathology, it is better to visit a doctor. Causes of pain can be caused by diseases of the heart, lungs, gastrointestinal tract and neurological problems. If you do not know which doctor to make an appointment with first of all, come to the Kutuzov Medical and Diagnostic Center. We have all the experts who will help you make an accurate diagnosis. Start by making an appointment with a therapist and follow his instructions.

Such different chest pains

Thoracalgia is a term for chest pain (from the words “torax” – chest and “algia” – pain).

It can hurt, both on one side of the chest, and in the middle, in the upper or lower part. The nature of the pain is:

• Pungent and burning.
• Dull and aching.
• Stab.
• Compressive.

Among the main causes of a disturbing symptom in the chest are diseases, injuries and pathologies:

• Heart and vessels.
• Lungs.
• Musculoskeletal system – muscles, ribs and spine.
• Nervous system
• Gastrointestinal tract.

Let’s dwell on them in more detail.

Heart problems

Pain in the chest in the middle or in its left side occurs in various diseases of the heart:

• coronary artery disease, angina pectoris – impaired blood flow in the heart arteries. Often an attack of sharp pain lasts up to 15 minutes. Occurs during physical exertion, stress, excitement, disappears after rest.
• Myocardial infarction – cell death and scarring of the heart muscle. It is characterized by severe pain in the chest on the left and in the middle, which does not go away after 15-20 minutes. Additional symptoms include weakness, fear of death.
• Pericarditis or myocarditis is an inflammatory process in the muscle or lining of the heart. They are characterized by acute or aching pain in the chest when inhaling in the middle of the chest, which are aggravated by eating or lying down.
• Mitral valve prolapse – in addition to chest pain, it causes shortness of breath, dizziness, up to fainting.
• Pulmonary hypertension – increased pressure in the pulmonary arteries, the attack is similar to a heart attack.

A characteristic feature of heart pain is that it often occurs against the background of emotional or physical stress, accompanied by a feeling of panic, fear of death.

Lung diseases

This is a common cause of chest discomfort. Main causes and characteristic symptoms:

• Inflammation or abscess of the lung – the process proceeds with severe pain in the chest (right or both parts of the chest), fever, cough.
• Pleurisy (inflammation of the pleura) – there is pain with a deep breath, usually accompanied by fever, cough.
• Thromboembolism of the pulmonary artery with a blood clot – there is a sharp pain in the chest, tachycardia, difficulty breathing.
• Pneumothorax – accumulation of air in the pleural cavity when the lungs are damaged due to injuries of the ribs, spine. There is pain when inhaling, shortness of breath, dry cough, blood pressure may decrease.
• Bronchial asthma – acute spasms resolve with chest pain and wheezing, wet cough, bouts of shortness of breath

Diseases of the gastrointestinal tract

Major diseases that cause pain in the esophagus or may spread from the abdomen to the chest area:

• Gastroesophageal reflux disease (GERD) – irritation of the esophageal mucosa due to reflux of gastric contents.
• Dyskinesia or perforation of the esophagus – increased pressure in the esophagus due to the slow movement of food or rupture due to injury.
• Gastric ulcers.

Gastrointestinal diseases are characterized by pain that occurs before, after or during meals, and may be accompanied by heartburn and other symptoms.

Injuries and diseases of the musculoskeletal system

Thoracalgia appears due to injuries, diseases of the spine, aggravated after physical exertion. Main causes and symptoms:

• Osteochondrosis, herniation and protrusion of the intervertebral discs in the thoracic spine, scoliosis cause chest pain, which is aggravated by movement or prolonged immobility.
• Rib fractures.
• Muscle spasms, sprains, intercostal neuralgia – cause pain in the chest on the right or left, depending on the place where the pathology has arisen.
• Tietze’s syndrome or inflammation of the costocartilaginous joints.
• Pain of a neurological nature – from “goosebumps” in the chest to severe pain occurs due to mental disorders, with panic attacks.

Pain in the right or left side of the chest may have other causes: neoplasms in the lungs or breast, shingles and other diseases.

The doctor’s task is to make a diagnosis in time and correctly. This will help: heart examinations, ultrasound, radiography and other diagnostic procedures.

Medical emergency needed if:

• Acute chest pain does not improve after 15 minutes and after rest.
• There is dizziness, shortness of breath, increased sweating, palpitations.

In other cases, it is also advisable not to postpone the consultation with the doctor for a long time. Who to contact – a cardiologist, a neurologist, a gastroenterologist – depends on the symptoms. But this is not always possible to determine independently. In this case, start with a consultation with a therapist who will help you understand the issue and, if necessary, refer you to a specialist.

In other cases, it is also advisable not to postpone the consultation with a doctor for a long time. Who to contact – a cardiologist, a neurologist, a gastroenterologist – depends on the symptoms. But this is not always possible to determine independently. In this case, start with a consultation with a therapist who will help you understand the issue and, if necessary, refer you to a specialist. Be healthy!

Diagnosis of any disease requires modern equipment and vast medical experience. Especially when it comes to chest pain.

Our clinic offers its patients a full range of medical examinations on high-precision equipment. Our doctors select the most informative and safe diagnostic methods.

Turning to us, you can be sure that the cause of the pain will be established as quickly and accurately as possible. High-tech diagnostic devices allow you to monitor the work of all organs and systems without causing you unnecessary discomfort.

We value the time of our patients, so all consultations and procedures are by appointment. By booking an appointment, you can be sure that the doctor will be waiting for you. Come to the clinic to find out the cause of pain and discuss treatment options.

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Chest pain

Chest pain – any pain or discomfort in the chest area. It can be caused by various diseases, including pathology of the heart, blood vessels, pericardium, lungs, pleura, trachea, esophagus, muscles, ribs, nerves. In some cases, chest pain is a sign of damage to organs outside the chest, such as the stomach, gallbladder, pancreas.

Chest pains are very diverse: sharp, dull, aching, cutting, stitching, drawing, bursting, burning or pressure. Painful sensations differ in different diseases, but pain is not a specific symptom of a particular disease. Characteristics of pain may vary depending on the age, sex of the patient, concomitant diseases, psychological characteristics. Identifying the immediate cause of chest pain is often difficult and requires a series of diagnostic procedures.

It is one of the most alarming symptoms, as it can be a manifestation of severe, life-threatening conditions that require emergency medical attention, in particular myocardial infarction.

Russian synonyms

Thoracalgia, chest pain, chest pain

English synonyms

Chest pain, pain in the chest, thoracalgia.

Symptoms

Chest pain can be of different nature. Sometimes it is given in the arm, shoulder, shoulder blade, back, neck. The patient may complain not only of pain, but also of tightness, burning, discomfort in the chest area.

Unpleasant sensations may be aggravated by coughing, deep breathing, swallowing, pressure on the chest, changes in body position (permanent or intermittent). Pain and discomfort in the chest may be accompanied by a number of additional symptoms, depending on the underlying disease: belching or bitterness in the mouth, nausea, vomiting, difficulty swallowing.

General information about the disease

Chest pain is a manifestation of various diseases, each of which requires a specific medical approach.

• Acute myocardial infarction (heart attack). Acute chest pain in people over 40 years of age is most often associated with this disease. Myocardial infarction occurs when a portion of the myocardium is damaged and died as a result of impaired blood circulation in the coronary vessels. Most often, it is manifested by acute pain behind the sternum or to the left of the sternum, which is given to the back, neck, shoulder, arm and does not decrease when taking nitroglycerin or at rest. Symptoms vary from patient to patient. Elderly women are characterized by atypical symptoms: severe weakness, nausea and vomiting, rapid breathing, abdominal pain.

• Angina. A condition in which, as a result of atherosclerosis and narrowing of the coronary vessels, the blood supply to the heart muscle is disrupted. Pain in angina pectoris resembles that in myocardial infarction, but occurs during exercise, decreases at rest and is relieved by nitroglycerin.
• Dissecting aortic aneurysm. The aorta is a large vessel that carries blood from the left ventricle of the heart to organs and tissues. With a dissecting aneurysm, the intima (inner lining) of the aorta ruptures with blood penetrating into other layers of the aortic wall and subsequent dissection of the wall, which most often leads to complete rupture of the aorta and massive internal bleeding. The disease in most cases ends in death within a few hours or days, even with timely diagnosis and timely treatment.

Dissecting aortic aneurysm is most often the result of long-term arterial hypertension, and can also occur with Marfan syndrome, as a result of chest trauma, during pregnancy, or as a late complication of heart surgery.

The pain of a dissecting aortic aneurysm is similar to that of myocardial infarction and angina pectoris, may last for hours or days, and is not relieved by rest or nitroglycerin.

• Pulmonary embolism. Blockage by a thrombus of the pulmonary artery or its branches, through which venous blood flows from the right ventricle to the lungs for oxygenation. As a result, gas exchange is disturbed, hypoxia occurs, and pressure in the pulmonary arteries increases. Chest pain occurs suddenly, increases with deep inspiration, is accompanied by rapid breathing and, in some cases, hemoptysis. The risk of thromboembolism increases after surgery, prolonged forced immobility, during pregnancy, oral contraceptives, especially in combination with smoking, in oncological diseases.

• Pneumothorax. The accumulation of air or other gas in the pleural cavity – a slit-like space between the membranes lining the surface of the lungs and the inner surface of the chest. Accompanied by acute chest pain, rapid breathing, anxiety, loss of consciousness.
• Pericarditis. Inflammation of the heart sac (pericardium), that is, the serous membrane of the heart. Pain occurs due to friction of the inflamed sheets of the pericardium. Pericarditis may be due to a viral infection, rheumatoid arthritis, systemic lupus erythematosus, renal failure. Often there is idiopathic pericarditis, that is, pericarditis of unknown etiology. The pain is acute, occurs only in the initial stages of the disease, may be accompanied by rapid breathing, fever, and malaise.
• Mitral valve prolapse. Pathology of the valve, which is located between the left atrium and the left ventricle of the heart. In some people, when the left ventricle contracts, the mitral valve flexes into the atrium and some of the blood from the left ventricle flows back into the left atrium. In most patients, this does not cause discomfort, however, in some, the heart rate increases and chest pains appear, which do not depend on physical exertion and do not radiate, unlike angina pectoris.
• Pneumonia. Inflammation of the lung tissue. Chest pain in pneumonia is usually unilateral, aggravated by coughing, accompanied by fever, malaise, cough.
• Esophagitis. Inflammation of the esophagus. Accompanied by chest pain, swallowing disorder. Symptoms do not improve with antacids.
• Gastroesophageal reflux disease. A chronic disease in which the acidic contents of the stomach reflux into the esophagus, resulting in damage to the lower esophagus. In this case, there may be an acute, cutting pain in the chest along the esophagus, heaviness, discomfort in the chest, belching, bitterness in the mouth, impaired swallowing, dry cough.
• Pleurisy. Inflammation of the pleura. The friction of the inflamed pleura causes pain. Pleurisy can be the result of a viral or bacterial infection, cancer, chemotherapy or radiation therapy, rheumatoid arthritis.
• Rib fracture. In this case, the pain increases with deep breathing and movement.
• Other causes: pancreatitis, cholelithiasis, depression.

Who is at risk?

• People over 40 years of age.
• Obese.
• Patients with arterial hypertension.
• People with elevated blood cholesterol levels.
• Recent surgery.
• Suffering from alcoholism.
• Smokers.
• Pregnant.
• Suffering from cardiac arrhythmia.
• People with cancer.
• Taking certain drugs.
• People with chronic lung disease.

Diagnosis

Chest pain is not a specific symptom and may clearly indicate a particular disease. However, when this sign appears, the doctor must first of all exclude a number of life-threatening conditions that require immediate help. Sometimes only additional laboratory and instrumental studies can accurately determine the cause of chest pain.

Laboratory tests

• Complete blood count. Leukocytosis (with pleurisy, pneumonia), anemia (with dissecting aortic aneurysm), thrombocytosis and erythremia (with pulmonary embolism) can be detected.
• Erythrocyte sedimentation rate (ESR). Nonspecific indicator of inflammation. ESR can be increased with pleurisy, pericarditis, pneumonia and other diseases.
• C-reactive protein. Increased in inflammatory diseases, as well as in myocardial infarction. With angina pectoris, the level of C-reactive protein does not change.
• NT-proBNP (sodium uretic brain propeptide). Protein, the main part of which is found in myocardial cells. It is the precursor of the natriuretic peptide responsible for the excretion of sodium in the urine. This indicator is used to assess the risk of heart failure, identify the initial stages of heart failure, and evaluate ongoing therapy. Is highly specific. May be elevated in myocardial infarction.
• Troponin I. Troponin is a protein involved in muscle contraction. The cardiac form of troponin is found in the heart muscle and is released when the myocardium is damaged. It can be increased in myocardial infarction and other diseases accompanied by the destruction of cardiomyocytes.
• Myoglobin. A protein similar in structure to hemoglobin and responsible for the deposition of oxygen in muscle tissue, including the heart muscle. Increases with damage to muscle tissue, in the first hours after myocardial infarction.
• Alanine aminotransferase (ALT). An enzyme that is found mainly in the liver, as well as in skeletal muscles, kidneys and myocardium. An increase in ALT indicates liver damage, but may also indicate myocardial infarction and serves as an indicator of the extent of damage to the heart muscle.
• Aspartate aminotransferase (AST). This enzyme is found mainly in the myocardium, skeletal muscles, and liver. An increase in AST levels is a sign of myocardial infarction. The value of AST corresponds to the degree of damage to the heart muscle.
• Creatine kinase total. An enzyme involved in energy metabolism reactions. Its various isoforms are found in different tissues of the human body. An increase in the level of total creatine kinase is observed in myocardial infarction and myopathies.
• Creatine kinase MB. An isoform of creatine kinase found primarily in the myocardium and tissues of the nervous system. Its level corresponds to the extent of myocardial damage.
• Lactate dehydrogenase (LDH) total. An enzyme that is involved in energy metabolism and is found in almost all tissues of the body. Different types of LDH are present in different organs. Total lactate dehydrogenase may be elevated in myocardial infarction and liver disease.
• Lactate dehydrogenase 1, 2 (LDH 1, 2 fractions). These are types of lactate dehydrogenase, the increase of which is a more specific indicator of myocardial and renal damage.
• Lipase. Enzyme of the pancreas. Elevated lipase levels are specific to pancreatic diseases.
• Cholesterol, total. This is the main indicator of fat metabolism in the body. It is used to diagnose atherosclerosis and liver diseases.
• D-dimer. fibrin cleavage product. It is an indicator of fibrinolytic activity of the blood. The level of D-dimer can change with pulmonary embolism, dissecting aortic aneurysm.
• The main blood electrolytes are potassium, sodium, chlorine, calcium. A change in the level of blood electrolytes may indicate pathology of the kidneys, adrenal glands, endocrine diseases, and malignant neoplasms.
• Urea, serum creatinine. These are the end products of nitrogen metabolism, which are excreted from the body by the kidneys. Their increase may indicate kidney pathology.

Instrumental research methods

• Electrocardiography (ECG). ECG changes are detected in myocardial infarction, angina pectoris, pericarditis. Helps to determine the localization and degree of myocardial damage.
• Radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound examination (ultrasound) of the chest. These are imaging methods that allow you to assess the condition of the chest organs, identify injuries, neoplasms, signs of internal bleeding and other pathological changes.
• Transesophageal echocardiography. An ultrasound scan in which a transducer is inserted into the esophagus. With its help, the state of the heart, its valves, and large vessels are assessed. It is of great diagnostic value in pulmonary embolism, aortic aneurysm.
• Angiography. X-ray examination of blood vessels using a non-toxic contrast agent, clearly visible on the pictures. Allows you to assess the condition and patency of blood vessels, including coronary ones.

Treatment

Treatment depends on the underlying disease, the symptom of which is chest pain.