Heaviness in the chest appears with psycho-emotional disorders (stress, panic, depression), diseases of the circulatory system (CHD, pericarditis and myocarditis, cardiomyopathy), respiration (pneumonia, bronchial asthma, tuberculosis). Diagnostic search includes standard instrumental methods: ECG and Holter monitoring, echocardiography, chest x-ray. To clarify what caused the heaviness in the chest area, they also carry out invasive diagnostics - coronary angiography, puncture, scintigraphy. Relief of symptoms is usually performed by medical methods, surgical interventions are less often used.
Causes of heaviness in the chest
Physiological factors
As a rule, a person encounters an unpleasant heaviness in the chest with severe fear or anxiety. There is a feeling that everything is shrinking inside, pulling or aching pains appear. Symptoms are accompanied by interruptions in work or a feeling of sinking heart. Discomfort in the chest is sometimes perceived as the beginning of a heart attack, but the condition returns to normal immediately after the person calms down, and the traumatic factor disappears.
Depression
Heaviness with nagging pain in the chest, which is most pronounced in the first hours after awakening, is pathognomonic for masked depression. Patients are concerned about discomfort in the precordial region, sometimes the condition is aggravated by pressing or squeezing pain. Characteristically, there are no mood changes typical of depression, so patients are confident that they have a cardiac disease.
Diseases of the cardiovascular system
Heaviness, discomfort in the projection of the chest are often associated with cardiac problems. In such cases, the symptoms are more typical for middle-aged and elderly people. Unpleasant sensations are often combined with tingling or pain in the heart, shortness of breath during exercise, swelling of the lower extremities. Heaviness in the chest is a manifestation of such heart lesions as:
- ischemic heart disease. Stable angina is characterized by recurrent episodes of chest tightness and constricting pain. Severity develops at the beginning of the paroxysm, provoked by physical activity or stress. Sometimes the symptom continues to disturb the patient even in the periods between angina attacks.
- Myocarditis. Pathology manifests itself suddenly, more often in young patients. A person complains of heaviness with moderate aching pain in the chest, accompanied by shortness of breath, fever. Sometimes there are interruptions in the heart rhythm.
- Pericarditis. With exudative inflammation of the pericardium, patients feel increasing heaviness, tightness in the chest, and progressive shortness of breath. Changing the position of the body does not affect the intensity of symptoms. Swelling of the jugular veins and puffiness of the face are usually noticeable.
- Cardiomyopathy. For non-inflammatory heart disease, a constant or periodic heaviness in the chest is typical, which worries a person for several months or even years. Manifestations are moderate, do not interfere with normal life, so patients go to the doctor only in case of an exacerbation of the problem and the development of heart failure.
- Cardiac tamponade. Patients experience sudden heaviness in the chest, the inability to breathe deeply, severe weakness and cold sweat. The condition is life-threatening, without medical help it ends with collapse or acute heart failure.
- postinfarction syndrome. The disease is characterized by the appearance of pressing pains and heaviness in the chest 2-4 weeks after myocardial infarction. Patients notice a deterioration in well-being, an increase in shortness of breath and weakness, discomfort in the chest cavity. Often the clinical picture is supplemented by fever.
Heaviness in the chest
Respiratory diseases
Damage to the bronchopulmonary system is another common cause of heaviness, pressing and squeezing sensations in different parts of the chest. The symptom most often occurs within the framework of typical inflammatory processes: acute and chronic bronchitis, pneumonia. Discomfort increases during coughing attacks or attempts to take a deep breath. Heaviness in the chest is accompanied by fever, weakness, secretion of mucous or purulent sputum.
In chronic processes - tuberculosis, pneumoconiosis - patients complain of periodic tightness in the chest area, incomprehensible discomfort or aching sensations. Manifestations occur without a visible provoking factor, persist for many months. With an exacerbation of the pathology, heaviness in the chest is replaced by dull pain.
Attacks of heaviness and a feeling of chest compression are observed during an exacerbation of bronchial asthma. Unpleasant symptoms develop as harbingers of a paroxysm of suffocation, accompanied by nasal congestion, skin itching, and coughing. In the interictal period, chest heaviness is experienced by patients with moderate and severe asthma.
Heaviness and periodic soreness in the chest are found in chronic mediastinitis. Symptoms are slightly expressed, periodically they intensify and are supplemented by fever. Patients complain of pressing or dull pains without a clear localization, discomfort at the time of deep inspiration and coughing. Similar manifestations occur with neoplasms of the mediastinum: thymoma, lymphoma, cysts.
Rare Causes
- Poisoning : citrate intoxication, hydrogen sulfide poisoning.
- Diseases of the digestive system : GERD, achalasia of the cardia, dilatation of the esophagus.
- Emergency conditions : anaphylactic shock, heat stroke, toxic pulmonary edema.
Diagnostics
A comprehensive examination is started by a therapist or family doctor. The specialist conducts a physical examination and identifies the leading pathological syndrome, if necessary, sends the patient for a consultation with narrow specialists (pulmonologist, cardiologist). To establish a diagnosis, the results of instrumental and laboratory studies are required, of which the following are most often prescribed:
- X-ray of the OGK. Radiation diagnostics helps to differentiate cardiac and pulmonary pathology. The defeat of the respiratory system is manifested by focal infiltrates, rounded shadows, increased vascular pattern. Signs of cardiac problems are changes in the size and configuration of the shadow of the heart, congestion in the lungs.
- Electrocardiography. During the ECG, the electrical activity of the myocardium is assessed. On the cardiogram, a decrease in the voltage of the teeth or their inversion, deviation of the axis of the heart, signs of disturbances in the conduction system of the myocardium are detected. Of great diagnostic value is daily ECG monitoring, bicycle ergometric test.
- Echocardiography. Ultrasound diagnostics shows structural and functional abnormalities in the activity of the heart. The method is necessary for the diagnosis of pericarditis (effusion in the heart bag), cardiomyopathy (expansion of cavities or thickening of the walls of the organ). Echocardiography measures the contractile function of the left ventricular myocardium.
- invasive methods. In case of pathological processes in the pericardium, a diagnostic puncture is performed for bacteriological and cytological examination of exudate. In coronary artery disease, coronary angiography is performed to assess the degree of vascular damage. The functional state of the myocardium is determined by perfusion scintigraphy.
- Laboratory diagnostics. Analyzes are of secondary importance. In cardiac pathology, an extended biochemical study is indicated with the determination of the lipid spectrum and acute phase parameters, the measurement of myocardial markers. Diagnosis of pulmonary diseases requires microscopy and sputum culture.
echocardiography
Treatment
Help before diagnosis
Heaviness in the chest occurs when various organs and systems are damaged, therefore self-medication at home is unacceptable and is fraught with the progression of the underlying disease, the development of complications. Patients experiencing chest discomfort are advised not to delay contacting a therapist. If compressive pains are felt in the chest, the person has suffocation, febrile fever, and emergency medical care is required.
Conservative therapy
Therapeutic measures are selected after identifying the causes of the condition. Heaviness in the chest does not require special symptomatic therapy and disappears after the elimination of the underlying pathology. All patients are prescribed a sparing motor regimen, the maximum limitation of stress and psycho-traumatic factors. Drug exposure includes drugs of the following pharmacological groups:
- Antianginal agents . Used in combination for long-term therapy of coronary heart disease. They are supplemented with antiplatelet agents for the prevention of myocardial infarction and thrombosis. Nitrates are recommended for the relief of angina attacks.
- Anti-inflammatory drugs . Non-steroidal anti-inflammatory drugs are indicated for myocarditis and pericarditis, acute respiratory diseases. They act pathogenetically, and also relieve unpleasant and painful sensations. If non-steroidal drugs are ineffective, corticosteroids are taken.
- Antibiotics . Antimicrobial drugs are prescribed for pneumonia, pleurisy, purulent bronchitis as an etiotropic treatment. Antibiotics of the penicillin series are effective in inflammatory lesions of the heart against the background of rheumatism. For the treatment of tuberculosis, 3-4 specific drugs are combined.
- Antiallergic drugs . Leukotriene receptor antagonists and mast cell membrane stabilizers are used for the basic therapy of bronchial asthma. Classical antihistamines are used as pathogenetic therapy for many inflammatory processes with an allergic component.
- metabolic drugs . To improve the delivery and utilization of oxygen in the myocardium under conditions of ischemia, it is necessary to take cytoprotectors. The therapy is enhanced with ascorbic acid and B vitamins, which accelerate metabolic processes in the body.
Surgery
Minimally invasive therapies such as pleural and pericardial puncture are widely used. The intervention is carried out to eliminate exudate, which impedes the normal functioning of the organ, to eliminate heaviness, pain in the chest. Surgical treatment of CAD includes percutaneous balloon angioplasty, stenting, or coronary artery bypass grafting.