Pain in the heart occurs due to cardiac and non-cardiac causes. The most common pathologies accompanied by pain syndrome: angina pectoris, arterial hypertension, arrhythmias. The symptom is characteristic of myocarditis and pericarditis, rheumatism, cardiomyopathy. Extracardiac factors - cardioneurosis, osteochondrosis, GERD, etc. For diagnosis, instrumental techniques are performed (ECG, echocardiography, coronary angiography), laboratory tests (lipid profile, assessment of acute phase parameters, study of markers of myocardial necrosis). To stop pain in the heart, treatment of the underlying disease is necessary.
Cardiac neurosis is the most common cause of heart pain. Symptoms are more common in emotionally labile people of young and middle age, adolescents, pregnant women. For cardioneurosis, pain sensations that are variable in strength and nature are typical. Patients complain of pressing, burning, stabbing pains. Discomfort is mainly manifested with stress, excitement.
A specific sign of cardioneurosis is a constant fear of a severe cardiac disease, myocardial infarction. The patient begins to listen to his feelings and interprets even minor pains in the heart as a sign of a deadly disease. In addition to the pain syndrome, there is increased sweating, a feeling of heat or chills, and tremor of the fingers. After the normalization of the psycho-emotional state, the symptoms disappear without a trace.
The appearance of pain in the heart is characteristic of stage 2 hypertension, when hypertrophy of the muscular layer of the heart develops. There are aching or pulling sensations provoked by excitement, physical exertion. The pain is long, but not intense, so most patients do not attach much importance to discomfort. Against the background of pain, there are bouts of dizziness, "flickering flies" before the eyes.
Cardiac arrhythmias are manifested by various pains in the precordial region - stabbing, aching, pulling. Usually, the symptom is accompanied by a feeling of interruptions or fading of the heart. Discomfort occurs for no apparent reason, at any time of the day. The pain syndrome has a low intensity, periodically worries for several months.
Patients complain that the heartbeat sharply quickens or slows down, the heart "misses a beat." With arrhythmia, the appearance of pain is aggravated by a general deterioration in well-being. The patient feels a lack of air, severe weakness, dizziness. In severe violation of the rhythm, pre-fainting states, fainting are possible. With prolonged existence of arrhythmia, there is a decrease in working capacity, deterioration of memory and attention.
During an anginal attack, a person feels severe pressing or squeezing pains in the heart. In response to a request to indicate the localization of pain, the patient presses his fist to the precordial region. Pain radiates to the left shoulder, arm, shoulder blade. Symptoms are provoked by physical activity or psycho-emotional stress. Soreness lasts no more than 10-15 minutes, disappears on its own or after taking nitroglycerin.
The clinical picture resembles a typical angina attack. In contrast to the stable form of coronary artery disease, pain in the heart continues for 20-3 minutes or more. Sometimes the pain syndrome is so strong that the patient loses consciousness. Specific irradiation to the neck, left arm. The pains are accompanied by pallor and cold sweat, frequent and weak pulse. The person feels an obsessive fear of death.
Acute stabbing pains in the heart disturb in inflammatory diseases - myocarditis, pericarditis. A feature of the clinical picture is constant pain of moderate intensity, which is combined with an increase in body temperature. In addition to pain, there is an increase in heart rate, shortness of breath, weakness. A severe course is characterized by the appearance of edema on the extremities, perioral cyanosis.
In acute rheumatic fever, characteristic of children and adolescents, there is a tingling sensation in the region of the heart, sharp pains. Basically, the symptom manifests itself 2-3 weeks after the transferred tonsillitis. Along with heart complaints, pain in large joints is felt, subcutaneous nodules are formed. For chronic rheumatic heart disease, dull, aching pains due to an acquired defect are typical.
Osteochondrosis is a common cause of chest pain, which patients mistakenly take for a manifestation of cardiac pathology. Discomfort becomes more noticeable with a deep breath, torso tilts to the side, palpation of the ribs and intercostal spaces. Pain in vertebrogenic cardialgia is sharp, intense. To facilitate them, a person takes a stationary position, breathes shallowly to minimize chest movements.
With GERD, severe burning pains in the retrosternal region, which resemble angina pectoris, are disturbing. Symptoms are associated with eating, often they appear in the morning after waking up. The intensity of the burning behind the sternum increases with bending forward, in the supine position. GERD is characterized by a combination of pain with heartburn, sour belching, discomfort in the epigastric region.
The initial appointment with a cardiologist begins with an anamnesis, an external examination, and a physical examination of the cardiovascular system. During auscultation of the heart, deafness of tones, functional or organic noises are heard. Measure blood pressure in the arms and legs, if necessary, prescribe ABPM. To establish the etiology of pain in the heart, a number of laboratory and instrumental techniques are carried out:
Given the high prevalence of non-cardiac causes of heart pain, consultation with other specialists is usually necessary. With possible GERD, EFGDS, pH-metry are prescribed. To assess the condition of the ribs, the thoracic spine, x-rays are performed in two projections, CT, MRI. If cardioneurosis is suspected, tests are performed to assess the functional state of the autonomic nervous system.
Most cases of pain in the heart occur with emotional and physical overstrain, so a person needs to sit or lie down, try to calm down. It is necessary to unbutton the collar, remove tight clothing, provide access to fresh air. In case of interruptions in the work of the heart, it is advisable to take a deep breath and strain, press your fingers on the closed eyeballs. To stop anginal pain, nitrovasodilators are used.
After verification of the main diagnosis, complex etiopathogenetic treatment is carried out. If problems are identified from the digestive organs, the patient is referred to a gastroenterologist. Therapy of osteochondrosis is carried out by a neurologist, vertebrologist. For pain in the heart associated with cardiovascular pathology, the following are prescribed:
Treatment of cardioneurosis begins with the selection of non-drug methods. Patients are advised to normalize the daily regimen, increase the time of sleep and rest, and avoid stressful situations if possible. With serious psycho-emotional problems, individual and group psychotherapy is effective. To normalize the work of the central nervous system, herbal sedatives are taken.
The intervention of cardiac surgeons is required if conservative therapy for myocardial infarction is ineffective or impossible. To restore coronary blood flow, transluminal balloon angioplasty (TLBAP), percutaneous angioplasty with the installation of a stent at the site of arterial stenosis, is used. Less common is coronary artery bypass grafting (CABG).
Operative treatment is necessary for severe arrhythmias. In most situations, they resort to the implantation of a pacemaker that maintains the correct heart rhythm. In case of malignant tachyarrhythmias, the installation of a defibrillator is indicated. To eliminate atrial fibrillation, extrasystoles use the technique of radiofrequency ablation.