Chest pain (thoracalgia) is pain in the chest of varying nature and intensity. Soreness often radiates to the arm, shoulder blade, collarbone. The symptom occurs during pathological processes in the lungs, mediastinal organs, with damage to the heart, neuromuscular apparatus. Sometimes the chest hurts in diseases of the abdominal organs. To establish the cause of thoracalgia, ultrasound and X-ray of the chest organs, EGDS are performed, the abdominal cavity is examined, and laboratory tests are prescribed. To relieve pain, analgesics, NSAIDs, physiotherapy methods are used.
general characteristics
Discomfort and pain in the chest are found in various pathologies of the musculoskeletal system, internal organs and skin, so pain is very variable. By nature, the pain is dull, pressing, stabbing, squeezing. Some patients describe their sensations as an intense burning sensation in the sternum. The duration of the pain syndrome ranges from several minutes to several weeks, while the pain remains constant or increases over time. Often there is irradiation in the arm, collarbone, shoulder blade.
Unpleasant symptoms are aggravated by sudden movements of the body, deep breaths, physical activity. In case of damage to the nerve trunks, the chest hurts more on palpation, accidental touches, the pain subsides when lying still. For inflammatory processes of the pleura, a decrease in discomfort in the position on the sore side is characteristic. Constant pain of moderate intensity and sudden severe pain attacks are an indication for seeking medical help.
Causes of chest pain
Causes of chest pain on the left
In the left half of the chest cavity there is a heart with great vessels, so the pain syndrome is often caused by cardiac pathology. Sensations range from moderate discomfort that develops with physical activity to severe chest pain, forcing the patient to remain still. Most often, chest pain on the left is caused by:
- Coronary syndrome: stable and unstable angina, myocardial infarction.
- Inflammatory heart disease : infective endocarditis, rheumatism, myocarditis.
- Violations of the conduction system of the heart : arrhythmias, extrasystole, paroxysmal tachycardia.
- Increase in blood pressure .
- Cardiac manifestations of collagenosis : systemic lupus erythematosus, dermatomyositis, vasculitis.
- Dissecting aortic aneurysm .
- Respiratory diseases : left-sided croupous or focal pneumonia, left-sided pleurisy, tuberculosis.
- Diaphragmatic hernia .
- Damage to the abdominal organs : splenomegaly, acute and chronic pancreatitis, spleen injury.
- Rare causes : tumors (lung, bronchi, pleura), peptic ulcer.
Causes of chest pain on the right
The symptom is most often associated with damage to the respiratory system. The pain syndrome is constant, intense, sometimes patients have to take a forced position on their side. The chest begins to hurt more with deep breaths, sharp turns of the body, coughing fits. Common causes of chest pain on the right:
- Infectious processes : right-sided bacterial or viral pneumonia, purulent bronchitis.
- Pleurisy : dry, exudative.
- Injuries : chest contusions, hemothorax and pneumothorax, lung contusion.
- Pathologies of the biliary system : cholecystitis, biliary dyskinesia, cholelithiasis.
- Liver damage : viral hepatitis, neoplasms, echinococcal cysts.
Causes of chest pain
When the chest hurts in the middle, and discomfort radiates up the esophagus, this often indicates a pathology of the upper digestive system, but may be a sign of other diseases. Patients note an increase in symptoms with torso tilts, sudden movements. The main causes of chest pain:
- Gastroesophageal reflux .
- Damage to the thoracic esophagus : esophagitis, dyskinesia of the esophageal sphincter, esophagus spasm.
- Pathology of the stomach : hyperacid gastritis, peptic ulcer.
- Respiratory system dysfunctions : tracheitis, bronchitis, bronchial asthma.
- Heart disease : endocarditis, myocarditis, pericarditis.
- Volumetric formations of the mediastinum : pathology of the thymus (hyperplasia, cyst, thymoma), lymphoproliferative syndromes (lymphogranulomatosis, non-Hodgkin's lymphomas), granulomatous processes (sarcoidosis, tuberculosis, silicosis).
- Complications of pharmacotherapy : long-term use of NSAIDs, corticosteroids, absorbable antacids.
- Rare causes : Zollinger-Ellison syndrome, osteochondrosis, intercostal neuralgia.
Causes of breast pain
There are two types of pain in the breast: cyclic, associated with the menstrual cycle, and non-cyclic, indicating the development of the disease. Pain syndrome during hormonal changes occurs symmetrically on both sides, and local pathological processes usually cause unilateral discomfort. There are such causes of pain in the mammary glands, such as:
- External factors : improperly selected bra, tight clothing in the chest.
- Physiological conditions : a few days before the onset of menstrual bleeding, during pregnancy and lactation.
- Inflammation of the mammary gland : lactational mastitis, purulent mastitis, breast abscess.
- Fibrocystic mastopathy : nodular and diffuse forms.
- Nipple involvement : inflammation, eczema, Paget's cancer.
- Benign tumors : fibrolipoma, intraductal papilloma, adenoma.
- Malignant neoplasms : intraductal carcinoma, tubular carcinoma, papillary carcinoma.
- Complications of pharmacotherapy : pain after taking oral contraceptives, antipsychotics and antidepressants.
Causes of pain in the ribs
In such cases, chest pain occurs on one or both sides, pain is often sharp, shooting. Soreness is aggravated by the slightest movement, careless touch, wearing tight clothing. Some patients find it difficult to breathe. The most common causes of rib pain are:
- Intercostal neuralgia .
- Herpes zoster .
- Injuries : severe chest bruises, rib fractures.
- Costal chondritis (Tietze's syndrome).
- Diseases of the vertebrae : osteochondrosis, intervertebral hernia, kyphoscoliosis.
- Muscle damage: fibromyalgia, muscle strain, physical overexertion.
- Osteosarcoma of the ribs .
Diagnostics
Finding out the cause of chest pain is done by a general practitioner or family doctor. To verify the diagnosis, the musculoskeletal system and internal organs are examined. The main methods are instrumental methods of visualization of anatomical structures; to clarify the cause of thoracalgia, laboratory diagnostics are performed. The most informative methods:
- Electrocardiography. To exclude or confirm the cardiac etiology of pain in the left side of the chest, an ECG is recorded in standard leads. Expansion and deformation of the complexes, elevation of the ST interval indicate myocardial ischemia. For the diagnosis of arrhythmias, Holter monitoring is performed.
- Ultrasound Research . Echocardiography (EchoCG) is necessary if the chest hurts on the left side. Evaluate the contractile function of the heart muscle, ejection fraction, signs of destructive lesions of the valvular apparatus. Abdominal ultrasound is used to detect diseases of the spleen, pancreas, or gallbladder that cause thoracalgia.
- Radiography . On chest radiographs, one can detect focal processes in the lung tissue, volumetric formations of the lungs and mediastinum, which are usually the etiological factor of chest pain. Women are scheduled for mammograms. Plain radiography of the gastrointestinal tract is recommended for the detection of diaphragmatic hernia, ulcerative defects.
- Endoscopic methods . EGD is performed to diagnose damage to the esophagus that provokes chest pain. During the study, the state of the mucous membrane, the contractility of the cardiac sphincter are studied. In case of severe damage to the respiratory system, bronchoscopy is indicated to examine the mucosa and take material for bakposev.
In general and biochemical blood tests, signs of inflammatory processes, pathologies of the liver and biliary system are detected. Bacteriological culture of sputum and bronchial washings is necessary to determine the type of pathogen. In women, the concentration of sex hormones is determined. If unbearable pain in the chest is felt and cancer is suspected, a biopsy of a suspicious formation is performed for cytological analysis.
Treatment
Help before diagnosis
In case of minor discomfort, it is enough to remain calm for several days, avoid physical exertion and overwork. For pain in the mammary glands before menstruation, patients are advised to wear soft, comfortable bras and take NSAIDs. With an intense pain syndrome or the addition of other pathological symptoms, it is necessary to consult a doctor who will find out why the chest hurts. If the pain is accompanied by loss of consciousness, cyanosis of the skin and cold sweat, the person needs emergency medical care.
Auscultation for chest pain
Conservative therapy
Medical tactics depend on the cause of the development of thoracalgia, in the case of diseases of the internal organs, etiotropic treatment is carried out, with unbearable pain, it is supplemented with analgesics. The chest hurts less after the use of warm compresses, electrophoresis with anti-inflammatory and analgesic drugs. To eliminate the cause that caused the pain syndrome, medicines of the following groups are used:
- Non-steroidal anti-inflammatory drugs . NSAIDs are the drugs of choice for rheumatic processes, they can stop the symptoms and maintain a stable remission. In bronchitis and pneumonia, they reduce the production of inflammatory mediators and relieve pain.
- Antianginal drugs . If it hurts in the pericardial region of the chest, the drugs improve the blood supply to the myocardium, increase the delivery of oxygen to the cell. Means also normalize heart rhythm, reduce the risk of heart attack. Apply calcium channel blockers, beta-blockers.
- Antibiotics . Etiotropic drugs are indicated for pneumonia, purulent bronchitis and pleurisy. They are selected empirically, in the future, the appointments are adjusted after the results of bakposev. Antibiotics reduce the activity of the inflammatory process, due to which the pain in the chest subsides.
- Antacids . Means lower the acidity of gastric juice, therefore, are effective in gastroduodenal reflux and hyperacid conditions. When taking antacids, the irritating effect of hydrochloric acid on the mucosa of the esophagus decreases, and pain is eliminated.
- Hormonal preparations . Estrogen drugs are used to treat severe pain in both breasts during the premenstrual period. Hormones of the adrenal cortex are recommended in case of severe rheumatic diseases, in which the chest and heart hurt.
- Cytostatics . The drugs are used for various oncological pathologies. Their action is aimed at destroying cancer cells and slowing down the growth of tumor tissue. Combinations of 2-3 drugs are most effective, the duration of administration depends on the stage and degree of response to chemotherapy.
Surgery
Pain in the chest area associated with complicated fractures of the ribs or spine requires surgical intervention - open reposition of fragments with fixation by bone osteosynthesis. With purulent mastitis, opening and drainage, washing the wound with antiseptics are shown. Oncological causes of pain syndrome serve as the basis for radical operations. To prevent recurrences, the affected organ, adjacent tissue and regional lymph nodes are removed.