Burning In The Chest : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 28/07/2022

Burning in the chest develops with gastroenterological (GERD, achalasia of the cardia), cardiological (angina pectoris, myocardial infarction), pulmonary diseases (bronchitis, pleurisy, pulmonary bleeding). The symptom occurs with intercostal neuralgia, and also as a component of a panic attack. To determine the cause of burning in the chest, tests are prescribed (hemogram, blood biochemistry, myocardial markers), instrumental methods - ECG and EchoCG, X-ray and CT of the chest, endoscopic visualization of the esophagus. Relief of burning pains includes antacids, antisecretory drugs, nitrovasodilators, antianginal drugs.

Causes of burning in the chest

Nutritional errors

The symptom is often observed with heartburn, which is caused by eating fried, spicy or smoked foods, drinking a large amount of carbonated drinks, strong coffee or tea. Burning in the chest occurs 15-2 minutes after the end of the meal. Unpleasant sensations are usually localized behind the sternum, they spread from the xiphoid process to the throat. Heartburn is accompanied by an unpleasant taste in the mouth, sour belching. Symptoms disappear on their own after 30-6 minutes.

Diseases of the esophagus

Esophageal pathology is the most common factor in the development of burning in the chest. The symptom manifests itself when acidic gastric contents are thrown into the esophagus, which is accompanied by damage to the mucous layer. Patients report that the painful symptom appears after eating, is aggravated in the supine position, when the torso is leaned forward. Burning most intensely felt behind the sternum.

A similar clinical picture is characteristic of GERD. In addition to these signs, patients complain of belching with air or sour, nausea, bad breath. Burning in the chest is also observed with achalasia of the cardia. In such cases, in addition to the typical symptoms, a “wet pillow” symptom is noted - regurgitation of the contents of the stomach occurs during sleep.

Occasionally, burning is a sign of esophageal varicose veins. At the beginning of the disease, the symptoms correspond to esophagitis: burning sensations behind the sternum that occur after eating, nausea and vomiting, deterioration of health when bending over and lying down. After physical exertion or overeating, burning pains in the chest intensify, against their background, bleeding from pathologically altered veins often opens. Vomiting of blood, weakness and pallor, impaired consciousness are noted.

Diaphragmatic hernia

A hernia of the esophageal opening of the diaphragm is characterized by a burning sensation in the retrosternal region, which spreads along the esophagus and radiates to the interscapular region. Discomfort starts suddenly. Usually it is preceded by an attack of coughing, straining, physical activity. The intensity of the symptom decreases after belching. vomiting. When the hernial sac is infringed, a constant burning pain in the chest appears, which is combined with shortness of breath, a decrease in blood pressure, and tachycardia.

Burning in the chest

 

Cardiac ischemia

In middle-aged and elderly people, burning in the chest is usually caused by cardiac pathology. Burning pains on the left side and behind the sternum occur during an attack of angina pectoris. The symptom is provoked by emotional shock, fast walking. At the onset of paroxysm, a person stops, sits down, takes the most immobile position. To stop the burning sensation, nitroglycerin is used, which eliminates discomfort in the chest in 5-1 minutes.

Severe burning pain that lasts 2 minutes or more indicates the development of acute coronary syndrome - myocardial infarction or unstable angina. In this case, the burning spreads over the retrosternal region, radiates to the scapula, left arm and collarbone, is combined with a rapid heartbeat, a drop in blood pressure, and cold sweat. Patients feel dizzy and faint, often experience a panic fear of death.

Respiratory diseases

Diseases of the bronchopulmonary system are also manifested by burning pain in the chest. They are more characterized by unilateral uncomfortable sensations that correspond to the localization of the pathological process. Burning occurs against the background of intoxication syndrome: fever, body aches, headache. The main respiratory causes of an unpleasant feeling in the chest:

  • Bronchitis. With inflammation of the bronchi, burning is more often located in the middle of the chest, accompanied by soreness behind the sternum. Discomfort is palpably aggravated by coughing. Burning pains persist for about 10-14 days, weaken as the frequency of coughing attacks decreases.
  • Pleurisy. Intense burning in one half of the chest is typical of fibrinous inflammation of the pleura. Painful symptoms are aggravated by tilting the body in the opposite direction, with deep breaths, laughing or coughing. To relieve pain, a person lies on his side and tries not to move.
  • Hemoptysis. Pathology is manifested by a painful paroxysm of coughing with the development of a strong burning sensation in the chest. In the sputum, blood impurities are noticeable - from a few streaks to numerous clots, indicating pulmonary bleeding.

Intercostal neuralgia

With damage to the nerves, the patient feels bouts of burning, which are localized on one side of the chest. Discomfort sensations begin at once or spread in waves along the intercostal spaces from the spine to the sternum. Burning pains are very strong, they force a person to freeze and hold their breath so as not to aggravate the discomfort. Paroxysm ends after 3-5 minutes.

panic disorder

During an attack, patients often experience a painful burning sensation throughout the chest, which is accompanied by a feeling of lack of air, the inability to swallow. An unpleasant symptom is complemented by tachycardia, interruptions in the work of the heart, chills or a feeling of heat. Among the mental manifestations, uncontrollable fear and anxiety predominate. A panic attack lasts up to 1 minute on average.

Diagnostics

The primary examination of the patient is carried out by a therapist who makes a presumptive diagnosis and refers to a specialized doctor: pulmonologist, gastroenterologist, cardiologist. During a physical examination, the specialist listens to the heart and lungs to detect typical auscultatory changes, palpates the abdomen to identify gastroenterological pathology. To determine the causes of burning in the chest, the following are used:

  • ECG. Burning pain behind the sternum is an indication for immediate recording of a cardiogram. ECG captures signs of ischemia or myocardial necrosis, cardiac arrhythmias and conduction disturbances. In the presence of pathological abnormalities, echocardiography is performed to examine the anatomical structure and contractility of the myocardium, to assess cardiac output.
  • Radiography . The X-ray of the chest is used as a screening method and allows you to detect signs of cardiological or pulmonary diseases, manifested by a burning sensation in the chest. In the picture, you can see infiltration or decay of the lung tissue, symptoms of pleurisy, changes in the configuration or size of the shadow of the heart. To clarify the diagnosis, a chest CT scan is performed.
  • EFGDS. Burning in the chest, combined with digestive disorders, requires endoscopic diagnosis. When examining the esophagus, the doctor pays attention to the color of the mucous membrane, its integrity, the presence of erosions or ulcers. With EFGDS, the state of the stomach and duodenum is studied in order to exclude hyperacid conditions.
  • Neurological examination . During the examination, the symmetry and severity of the main reflexes are assessed, muscle tone is checked, and the patient's vegetative status is studied. Of the instrumental methods, electroneuromyography is recommended. If the attack resembles a panic attack, a consultation with a specialist in the field of psychiatry is required.
  • Blood tests . The hemogram reveals leukocytosis in inflammatory processes, a decrease in erythrocytes and hemoglobin in hemoptysis. To quickly diagnose a heart attack, determine the level of myocardial markers. In a biochemical blood test, they look at the ratio of plasma proteins, the number of acute phase indicators.

Electrocardiography is indicated for burning pain in the chest

 

Treatment

Help before diagnosis

Burning and heartburn, which are caused by errors in the diet, are easy to prevent: adhere to a balanced diet, do not lie down immediately after eating, avoid tight belts and clothes that squeeze the stomach. Patients with previously diagnosed GERD can take antisecretory and antacid drugs prescribed by a doctor to relieve the symptom. Nitrovasodilators are used for quick help with coronarogenic burning behind the sternum.

Conservative therapy

Treatment of burning in the chest is selected differently, taking into account the underlying disease that provokes a debilitating symptom. Most pathologies require outpatient treatment, but if an acute coronary syndrome is suspected or pulmonary hemorrhage requires hospitalization of the patient. Treatment regimens include drugs of different pharmacological groups:

  • Antisecretory agents . Medicines from the category of H2-histamine blockers, proton pump inhibitors effectively cope with the burning sensation caused by GERD. Medicines reduce acidity in the stomach, promote healing of inflammation and erosion of the esophagus, and prevent exacerbation of the disease.
  • Antianginal drugs . To reduce myocardial ischemia and reduce the risk of MI, beta-blockers, calcium antagonists, myotropic antispasmodics are used. They increase the delivery of oxygen to the heart muscle, dilate the coronary vessels, and increase the organ's resistance to hypoxia.
  • Antibiotics . The drugs are used for infectious lesions of the respiratory organs. They are selected empirically and adjusted after receiving the results of the antibiogram. With pleurisy, targeted intrapleural administration of antibacterial agents is indicated.
  • Anticonvulsants . Representatives of this group are prescribed for the treatment of persistent forms of neuralgia, which are not relieved by conventional analgesics and anti-inflammatory drugs. If necessary, therapy for burning in the chest of neurological origin is supplemented with antidepressants, tranquilizers.

Panic attacks require qualified psychiatric help. Patients are told about special techniques for controlling paroxysms. Methods of cognitive-behavioral therapy are recommended for the formation of constructive and positive patterns of thinking. Sometimes treatment is supplemented with psychoanalysis, group or family psychotherapy.

Surgery

The intervention of abdominal surgeons is necessary in case of a complicated course of diaphragmatic hernia. An operation for suturing and plastic surgery of the hernial orifice, methods of gastropexy and fundoplication are used. To achieve stable remission, patients with cardia achalasia undergo esophagocardiomyotomy followed by plasty. With hyperacidity, refractory to drug therapy, selective proximal vagotomy is prescribed.

Acute coronary syndrome may require myocardial revascularization with minimally invasive endovascular angioplasty or coronary bypass surgery. In case of bleeding from varicose veins of the esophagus, emergency endoscopic clipping or electrocoagulation of the affected vessel is performed. In case of massive pulmonary hemorrhage, the affected segment or lobe of the lung is removed.