A man's chest hurts. Angina pectoris as a typical cause of pressing pain behind the sternum. Osteochondrosis or organ diseases: how to find out why it hurts in the chest

The first thing that comes to mind with chest pain is heart problems, which is not always true. Pain in the chest can occur for various reasons: from ordinary overwork to dangerous diseases.

The causes of pain can be determined by its nature and accompanying symptoms. The problem cannot be left unattended! Pain is a kind of SOS signal transmitted by the body. It is necessary to respond to it in order to avoid serious complications.

Causes of chest pain

Behind the ribs it hurts with pathologies of various organs. This is due to the structure of the nervous system. The nerve trunk divides into branches in the chest area.

Therefore, through a common trunk, pain in one organ responds in another. For example, stomach pains are perceived as heart pains and vice versa.

Pain in the chest with pathologies:

• of cardio-vascular system;
• musculoskeletal system;
• mediastinum;
• central nervous system;
• respiratory organs;
• gastrointestinal tract.

Note! The nature and intensity of pain vary and help establish the diagnosis. It is almost impossible to do this without the help of a specialist. Therefore, you need to see a doctor. Any pain sensations are unpleasant, but sometimes they are not life-threatening, and in other cases, you need to start fighting them immediately.

Musculoskeletal system

Painful sensations in the chest in diseases of the spine are very reminiscent of "heart."

The most common cause is osteochondrosis. Due to malnutrition or excessive load on the spine with incorrect posture or excessive training, the spine is modified.

Elastic intervertebral discs, cartilage and bone tissue are destroyed. As a result, the nerve endings are compressed, which causes spasms.

Pain in the chest responds to such pathologies of the ODA as:

• scoliosis;
• ankylosing spondylitis;
• rheumatoid arthritis;
• slouch;
• Tietze syndrome;
• herniated discs.

Good to know! Soreness in the chest region is felt with injuries of the spine, ribs and shoulder blades. Hardware studies in a medical institution will help establish the diagnosis.

The cardiovascular system

Vascular and heart diseases confidently occupy the first place in terms of mortality. Therefore, it is especially important to recognize alarming symptoms in time. This is the only way to prevent tragedy.

"Heart" pain is conditionally divided into two subgroups, depending on the origin:

• anginal causes ischemia;
• cardialgia is characteristic of defects, inflammation of the heart muscle and congenital pathologies, as well as vegetative-vascular dystonia.

Pain accompanies the course of the most dangerous diseases. Among them:

• myocardial infarction;
• angina;
• rheumatic lesions;
• inflammation of the heart;
• aortic aneurysm;
• pulmonary embolism;
• pericarditis;
• infarction of the posterior wall of the ventricle.

Note! All of these diseases are deadly. During their exacerbations, the score usually goes by minutes.

Gastrointestinal tract

Soreness behind the sternum is a hallmark of many pathologies of the digestive tract. Main:

• stomach ulcer;
• hiatal hernia;
• reflux;
• pancreatitis;
• damage to the esophagus;
• diaphragmatic abscess;
• idiopathic expansion of the esophagus;
• duodenal ulcer;
• Mallory-Weiss syndrome (rupture of the esophageal mucosa);
• cholecystitis.

Attention: if a gastrointestinal disease is diagnosed, it does not mean that chest pain is caused by it. Diseases of the abdominal organs are often asymptomatic and do not exclude coronary artery disease.

Stories from our readers!
"I cured my sore back on my own. It's been 2 months since I forgot about my back pain. Oh, how I used to suffer, my back and knees hurt, lately I couldn't really walk normally ... How many times I went to polyclinics, but there they only prescribed expensive pills and ointments, which were of no use at all.

And now the 7th week has gone, as the joints of the back do not bother a bit, in a day I go to the country to work, and from the bus it’s 3 km, so I walk easily! All thanks to this article. Anyone with back pain should read this!

Respiratory system

The lungs occupy a large area of ​​the chest, so the pathology of the respiratory organs causes pain.

Chest pain causes most lung diseases:

• lobar pneumonia;
• pneumothorax;
• tuberculosis;
• emphysema;
• lung cancer;
• abscess;
• pleurisy;
• hydrothorax (accumulation of fluid in the pleura);
• lung infarction.

Good to know! Traumatic injuries of the pulmonary and pleural regions also cause pain. Most respiratory diseases are very dangerous and require immediate medical attention.

Symptoms of diseases that cause chest pain

Pain syndromes in the chest vary in location and characteristics, depending on the reasons they are caused. Accompanying symptoms also help establish the diagnosis.

Pain with problems with the musculoskeletal system can be:

• Constant or attacks.
• Always becomes when moving.
• "Shoots" in the shoulder and shoulder blade.
• It becomes more intense during inhalation and coughing (similar to intercostal neuralgia).
• It can be distinguished from cardiac or gastric by the drugs that bring relief.
• Pain medications and warming ointments help, not heart medications.

Cardiovascular disease is defined by several signs of pain:

• The first is localization behind the sternum or in the chest on the left. "Shoots" into the left hand, the interscapular region, into the bone of the lower jaw.
• By nature, heart pain is: cutting, pressing, baking.
• It becomes more painful due to physical or emotional overstrain.

In diagnostics, the time factor is of great importance. With a heart attack, the pain does not last continuously for a long time. Usually the duration of the attack does not exceed 15 minutes, after rest or medication.

Pulmonary embolism is characterized by shortness of breath. Chest pain appears suddenly, it hurts to inhale. You may cough up blood.

Attention: pain in the heart for longer than 20 minutes is a symptom of myocardial infarction and aortic aneurysm. Additional signs are also characteristic of myocardial infarction: fear, anxiety, shortness of breath.

With problems in the gastrointestinal tract, the following are added to the pain syndrome:

• heartburn,
• excess gas,
• vomit,
• burp,
• nausea.
• chest pain begins in a hungry state or immediately after eating. Helps to cope with pain taking antispasmodics.

P good to know! With pathological respiratory organs, the pain intensifies in the process of breathing and coughing. Accompanied by sputum, fever, shortness of breath. Sometimes there may be: hemoptysis, excessive sweating, cyanosis.

Pain and crunch in the back over time can lead to dire consequences - local or complete restriction of movement, up to disability.

People, taught by bitter experience, use a natural remedy recommended by orthopedists to cure their back and joints...

When to see a doctor?

If the pain in the chest does not go away for a long time or recurs periodically, it is worth going to the hospital in any case.

It is worth expediting a visit to the doctor if the painful syndrome is accompanied by the following symptoms:

• heartburn, which is not saved by over-the-counter medicines;
• pain in chest after eating.

Urgent medical attention is required when the chest hurts for more than 15 minutes, or is added to it:

• loss of consciousness;
• hemoptysis;
• coughing attacks after exercise;
• dizziness;
• pressing sensation from the chest extends to the back, back, neck, lower jaw;
• jumping pulse;
• sweating;
• intermittent breathing;
• vomit;
• anxiety.

First aid

If a sharp pain in the chest is accompanied by the above symptoms, it is necessary:

• call an ambulance;
• lay the patient so that the head is slightly lower than the legs;
• get rid of clothes that make it difficult to breathe;
• ventilate the room;
• give nitroglycerin;
• wait for the doctor.

You can't self-medicate!

Diagnosis and treatment of chest pain

Diagnosis of the causes of chest cramps should be carried out by a qualified specialist in a medical facility. It is not the fact of discomfort that needs to be treated, but the primary disease that causes them.

Diagnosis begins with a survey and examination to determine the diseases of which organ is associated with pain.

To clarify the diagnosis, hardware procedures are performed:

• study of the gastrointestinal tract;
• exercise testing;
• vascular angiography;
• radiography;
• CT scan of the chest.

Based on the results of the research, the doctor establishes a diagnosis and determines the necessary treatment.

Any pain causes discomfort, but if it is a sudden pain in the chest, intense anxiety is added to the discomfort. What could it be - a heart attack, a heart attack, or maybe intercostal neuralgia? What to do in this case - wait until the pain goes away, go to the doctor or call an ambulance?

The sternum is a flat bone located in the center of the chest that articulates with the ribs. The sternum consists of three parts: the body itself, the handle and the xiphoid process. With excessive physical exertion, all of the above parts can move. With injuries, bruises, pain in the injured area of ​​\u200b\u200bthe sternum, of course, increases. The same pain sensations are observed when pressing on the sternum, bending the torso.

In fact, the causes of pain in the chest can be very different, from heart failure to lung diseases or pathologies of the abdominal cavity. As a rule, angina pectoris, myocardial infarction, osteochondrosis, stomach ulcers or injuries are such an unpleasant symptom, and therefore it is important to pay attention to the nature and localization of pain in order to identify the problem in a timely manner and respond to it correctly. Let's see what chest pain in the middle can talk about?

Causes of chest pain

All causes of pain in the chest can be conditionally divided into:

• pathologies of the cardiovascular system;
• diseases of the bronchopulmonary system;
• diseases of the gastrointestinal tract;
• neurological diseases;
• injury.

1. Diseases of the cardiovascular system

Often, it is heart disease that provokes pain in the middle of the chest. As a rule, these are serious diseases such as a heart attack or angina pectoris. Regardless of what kind of disease struck a person, he feels a sharp pain in the middle of the chest, which radiates to the left side.

A distinctive feature of angina pectoris is a squeezing, pressing pain that simply fetters a person, preventing him from moving. No wonder such an attack is called "angina pectoris." With angina pectoris, pain can occur not only on the left side, but also in the sternum. In this case, the patient feels the presence of a foreign object in the upper chest. The pain may radiate to the left shoulder, hand or shoulder blade, and be accompanied by a burning sensation. To relieve the attack, you need to put a Nitroglycerin tablet under the tongue. Literally in a minute the attack will recede.

Pain, signaling the development of myocardial infarction, manifests itself somewhat differently. As a rule, this is a sharp pain behind the sternum, which increases with physical exertion and can radiate to the inner surface of the left arm or to the left shoulder blade. With the development of an attack, such pain may cover the lower jaw, shoulder and neck, and a tingling or numbness will be felt in the left arm. In a heart attack, the nature of the pain in the chest is sharp, burning and tearing. In addition, such pain is accompanied by cold, sticky sweat, suffocation, anxiety and fear for one's life. At the same time, the patient's pulse quickens, his face turns pale and his lips turn blue. Painkillers and Nitroglycerin do not help in this situation. Faced with a myocardial infarction, you must immediately call an ambulance, because this condition threatens a person's life.

If there is continuous chest pain, predominantly in the upper part of the chest, this may be an indication of an aortic aneurysm. The aorta itself is a large vessel that comes from the left ventricle of the heart. Vessel dilation, or aneurysm, can occur for many reasons. In this case, pain sensations are observed for quite a long time, and with physical exertion they are significantly enhanced. The slightest suspicion of an aortic aneurysm requires immediate hospitalization. Surgical intervention is necessary to overcome the existing ailment.

Also, pain in this part of the chest is sometimes the cause of a disease such as pulmonary embolism, characteristic of the right ventricle of the heart. The pain in this case is strong, resembling angina pectoris, but they do not radiate to other areas. The main symptom of pulmonary embolism is an increase in pain with each breath. Painkillers help relieve pain, but even after taking them, the pain syndrome does not subside for several hours. Immediate medical attention is indispensable.

2. Pathologies of the bronchopulmonary system

Dull pain in the chest can be an alarming bell, talking about serious diseases of the respiratory system. For example, this symptom often accompanies complicated bronchitis, pleurisy, pneumonia or tracheitis. A characteristic feature of pain in such diseases is an increase in discomfort when inhaling, and sometimes the inability to take a deep breath.

It is not difficult to explain the cause of such pain. The fact is that the inflammatory process in the lungs affects the diaphragm and intercostal muscles, which causes pain with every muscle contraction in the respiratory system. An additional symptom in the case of these inflammatory diseases is an increased body temperature, as well as a strong cough that does not go away for a long time.

3. Diseases of the gastrointestinal tract

Pathologies of the stomach often lead to this type of pain. Especially often this symptom appears with an exacerbation of a stomach ulcer, duodenal ulcer or diaphragm abscess. In these cases, aching dull pain in the center of the chest is complemented by pain in the back and intensifies when you press on the stomach area.

In addition, pain in the heart area can appear after eating (especially if a person has eaten a lot of fatty foods), or vice versa, with an increase in hunger. Such pain develops due to the general innervation of the stomach and may be a consequence of diseases such as pancreatitis or cholecystitis.

Feeling pain in the middle of the chest may be due to strong contractions of the gallbladder. Intense pain in the sternum, radiating to its left side, may be a symptom of damage to the bile ducts and bladder. Pain, somewhat reminiscent of the heart, occur in acute pancreatitis. Very often, chest pain becomes simply unbearable. A person often takes it for a heart attack, not taking into account the lack of spread to other organs. Only with the help of intensive treatment in a hospital can suffering be alleviated.

4. Neurological diseases

Stitching pains in the chest during movement, sharp turns of the body and deep breaths are far from always related to a sick heart. It may well turn out that they are caused by neurological diseases, which include intercostal neuralgia, thoracic sciatica and osteochondrosis. The nerve roots connecting the ribs to the spine are compressed and irritated during the movement of the chest, which causes a sharp dagger pain in the sternum.

Symptoms in the case of these ailments are extremely diverse: the pain can be aching, stabbing, dull or pressing. It does not subside in the case of rest and intensifies with movement. Moreover, over time, the nature of the pain may change. Moreover, antispasmodics and painkillers in this case do not bring relief.

5. Injuries

Previous injuries, bruises of the chest, fractures of the ribs or displacement of the vertebrae can also provoke pain of varying intensity in the middle of the chest. Even if the injury did not lead to a fracture, it is quite possible that there was compression of the vessels and a violation of blood flow to the muscle tissues. The result is swelling and aching pain in the chest. And from additional symptoms, a bruise and discomfort may appear when probing the painful area.

Other reasons

There are other reasons for the appearance of pain in the middle part of the chest. Pain in the sternum may be due to an increase in the thyroid gland, disorders in the structure of the spine are also reflected in pain in the middle part of the sternum.

How to distinguish neuralgia from angina pectoris

In the event of an attack of angina pectoris, the patient feels how the pain simply “spreads” throughout the chest, and in the case of neuralgia, it is localized in a certain place. Moreover, at rest, neuralgic pain immediately subsides, but the intensity of pain in the heart does not depend on physical exertion. At the same time, taking a Nitroglycerin tablet, the same pain in angina pectoris will subside. If it is a heart attack or neuralgic pain, the drug will not eliminate pain.

Symptoms requiring an immediate emergency call

With all the symptoms described above, it is very difficult for a person to understand the causes of discomfort and pain in the chest. However, there are a number of characteristic signs that require emergency medical attention. So, you need to call an ambulance if:

• a dagger pain appeared in the chest, from which one can lose consciousness;
• chest pain radiating to the lower jaw and shoulder;
• pain sensations last more than 15 minutes, and do not disappear even at rest;
• when inhaling, there is a feeling of squeezing in the chest, which is complemented by an unstable pulse, dizziness, nausea and vomiting;
• there were sharp dagger pains with intermittent breathing, high fever and bloody cough.

Feeling at least one of the above symptoms, do not try to figure out its causes. Just call an ambulance and take a horizontal position. Before the doctors arrive, try not to take painkillers (only Nitroglycerin is possible) so that they do not affect the diagnosis. And further. Do not try to refuse hospitalization if the attack has already passed by the arrival of specialists. Remember, the disease is better to prevent than to cure later.

A very common symptom that every person can encounter, it occurs, as a rule, with a disease of the organs located directly in the chest. It is also an echo of the disease of the abdominal organs. Such an ailment can become a symptom of diseases of the heart, lungs, esophagus or diaphragm. Let's consider each case in more detail.

With heart diseases such as coronary heart disease, angina pectoris or myocardial infarction, a person always feels pain in the chest on the left, which can radiate to the left arm, left shoulder or both hands, it is also possible to feel pain between the shoulder blades, in the neck and lower jaw. In this case, as a rule, the sensations of pain are strong, squeezing and pressing, there is a feeling of heaviness and lack of air, the pain is stabbing in nature, as if “thousands of needles are stuck inside”.

Intense physical activity can provoke this pain.(for example, climbing stairs to the 5th floor). This pain lasts no more than 10 minutes, this is a very dangerous symptom, because often attacks of pain in the heart are fatal. With a sharp pain in the chest in the middle, a person may experience a state of pain shock. Perhaps even dizziness, clouding of consciousness and fainting. The pulse becomes rapid or there is a feeling of interruptions in the work of the heart, the lips and face turn pale, cold clammy sweat comes out, the eyes express fear.

If you experience such pain in the chest area, you should contact a cardiologist, or call an ambulance if the attack has already happened. The first emergency aid in such cases is the intake of nitroglycerin, which dilates the blood vessels and leads to the normalization of the patient's condition, the pain completely disappears within 5 minutes.

So, the cause of chest pain can be:

• heart disease;
• lung diseases;
• chest trauma;
• diseases of the esophagus.

Chest pain due to lung disease

Pain in the middle of the chest can be a consequence of lung disease - pleurisy of the lungs, bronchitis, tracheitis, pneumonia. In this case, pain occurs as a result of a long dry, strong cough with sputum. As a rule, they increase with bouts of coughing and sharp breaths. The temperature rises, headache, pain in muscles, joints, general weakness, shortness of breath. With the accumulation of a large amount of fluid in the pleural region, there is a possibility of blue skin. Lung diseases, especially those of a complicated nature, lead to damage to the intercostal muscles and diaphragm, which in turn causes pain.

Some diseases of the digestive tract also lead to sensations of pain in the chest in the middle. These diseases include: gastric or duodenal ulcer, diaphragmatic abscess, reflux esophagitis. With such diseases, the upset from the stomach gives to the chest. As a rule, this symptom is accompanied by the appearance of heartburn (burning sensation, terrible sensations behind the sternum), belching sour or bitter, nausea, possibly vomiting, irritability, poor sleep, pain in the left hypochondrium or stomach.

Pain in the chest area with injuries

Rib cage can hurt as a result of injury in a fight, fall or accident. Blows to the chest can rupture blood vessels or muscles, resulting in pain in the chest. Pain is usually aggravated by a sharp and deep breath, bending, turning and twisting of the body. After particularly severe injuries, you may feel unwell when you feel with your hands. In this case, most often there is a crack or fracture of the sternum. It is necessary to consult a doctor as soon as possible, who, in turn, will determine the exact cause of the onset of unpleasant painful sensations and provide you with appropriate assistance.

The pain described above can also be a sign of thyroid disease. Typical symptoms in this case can be a swelling in the neck or chest (symptom of goiter of the thyroid gland), a sharp change in behavior, weakness, slowness, fatigue, a rapid increase or decrease in the patient's weight. The pressure and body temperature, physical and mental activity may decrease.

Directly on chest pain is affected by the instability of the thoracic spine. The most basic disease is osteochondrosis. Osteochondrosis is an inflammatory process of the cartilaginous tissue of the joints. This ailment can be caused by incorrect posture, the location of the spine in an uncomfortable position for him, associated with fixed work or a sedentary lifestyle of a person.

In this case, pain in the chest is either permanent or paroxysmal. Almost always, the characteristic changes in pain depend on a change in the position of the patient's body - the pain intensifies when the back is bent and subsides when the person lies on a flat surface or sits with his back straight.

The disease usually does not show up immediately., begins, like any lesion of cartilaginous tissue, with pain at the beginning of movement, disappearing after movement for a certain period of time. Many do not attach importance to these symptoms, which is erroneous, the disease progresses, more unpleasant symptoms appear. Since the thoracic spine is inactive, the load on it is not large, so even the appearance of an intervertebral hernia in this area is likely to go unnoticed, unless, of course, one of the many nerve roots is clamped.

Chest pain can occur in people of all ages. It not only brings with it discomfort, but also a signal that it is necessary to undergo a thorough examination by a doctor in a medical institution.

As you know, in the chest there are organs that are very important for life, and a failure in the work of one of them can lead to death. Consider all the possible causes of chest pain and methods for its elimination.

Pain with what characteristics you need to pay attention to:

1. The nature of the manifestation of pain: pulls, pricks, whines, burns.
2. Pain type: dull or sharp.
3. Place of localization: right, left, center chest.
4. Where does it send: hand, spatula.
5. When it appears most often: day or night.
6. What can cause pain: coughing, physical activity, breathing or something else. Read about it here.
7. What helps relieve pain: change in body position, drugs.

Pressing pain on the left

When you feel a pressing pain in the left side of the chest you need to see a doctor without delay.

The main reasons for its development:

1. Aortic aneurysm. A very serious illness. There is an accumulation of blood in the vessel as a result of the fact that their membranes have exfoliated.
2. Myocardial infarction or angina attack. The condition requires immediate hospitalization. Pain in this condition indicates a problem with a large muscle.
3. Gastric ulcer. Pain occurs after eating. Often a common antispasmodic drug (no-shpa) can alleviate a person's condition.
4. Inflammatory process in the pancreas (pancreatitis). Pain in this organ is projected onto the left side of the chest and is pronounced. In most cases, discomfort provokes eating.
5. Hernia in the diaphragm. This pathology occurs due to the prolapse of intestinal loops through weakened places in the diaphragm into the chest cavity. As a result, it is very difficult for the patient to breathe.

Presses on the right

There are many reasons for feeling pain on the right, both easily eliminated and very serious:

1. Intercostal neuralgia or panic attack.
2. If, with pain on the right, the heart contracts very quickly, then this can be a signal for the development of cardiac pathologies.
3. Associated cough, sputum production, and fever may indicate lung problems.
4. and rapid breathing indicate tracheitis.
5. With pathological processes in the stomach and esophagus, the food eaten will cause discomfort.
6. If there is pain when swallowing and compression of the chest at the top right, then this may be a symptom of ordinary laryngitis. Visit an otolaryngologist to confirm the diagnosis.
7. Right-sided fracture of the ribs is also the cause of discomfort in the chest.

Stories from our readers!
"I cured my sore back on my own. It's been 2 months since I forgot about my back pain. Oh, how I used to suffer, my back and knees hurt, lately I couldn't really walk normally ... How many times I went to polyclinics, but there they only prescribed expensive pills and ointments, which were of no use at all.

And now the 7th week has gone, as the joints of the back do not bother a bit, in a day I go to the country to work, and from the bus it’s 3 km, so I walk easily! All thanks to this article. Anyone with back pain should read this!

Presses in the middle

The sensation of pain in the central part of the chest signals all of the above diseases.

In addition to them will be:

In the presence of these factors, muscle spasm and unpleasant pain may develop.

Also, the infringement of the nerves and the sensation of pain in the middle of the chest are affected by:

1. Scoliosis.
2. Osteochondrosis.
3. Hernias of small vertebrae.

Disease symptoms

When pain occurs behind the sternum, the symptoms are quite different. This is due to a wide range of diseases that provoke unpleasant pain.

Dangerous symptoms, the appearance of which, you must immediately consult a doctor:

1. A sharp jump in body temperature.
2. Nausea and urge to vomit.
3. Increase in sweating.
4. The appearance of shortness of breath and impaired breathing.
5. Loss of consciousness. It can become one of the main symptoms of myocardial infarction.
6. An increase or decrease in heart rate.
7. During a change in body position, coughing or active movement, pain may increase.
8. Muscle weakness.
9. Body aches.

Symptoms are rarely alone, often they are combined and interfere with the correct provision of first aid.

If the following symptoms appear, you should immediately call an ambulance:

1. When the nature of the pain changes.
2. Pain in the left side of the chest, then in the right.
3. Increased pain when lying down.
4. First aid drugs do not show effectiveness.

After carrying out all possible types of diagnostics, the patient is sent to a specialist for treatment.

Treatment

Treatment begins only after the attending physician makes a diagnosis.

Depending on the causes of pressure behind the sternum, the following drugs are used:

1. Angina. It is possible to remove the attack with the help of nitroglycerin.
2. Cerebral atherosclerosis. First aid to reduce high blood pressure - "Farmadipin" drops, and for normal blood circulation in the brain, "Glycine" is prescribed.
3. Myocardial infarction. It is forbidden to take drugs at home. The patient must be urgently admitted to the hospital. Often these patients end up in the intensive care unit.
4. Osteochondrosis. In this disease, non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen), () are used. Actovegin is prescribed to improve blood circulation. Also, a positive effect in the treatment of this disease produces massage and acupuncture.
5. Intercostal neuralgia. Often this disease is confused with a heart attack. To stop the pain syndrome, muscle relaxants (tizanidine), corticosteroids (dexamethasone) are used, a warming patch is glued to the ribs or rubbed with an anesthetic ointment.
6. Gastritis in the acute stage. The first aid will be antispasmodics (no-shpa, bellastezin), sorbents (smecta, enterosgel, phosphalugel).
7. Angina. In the treatment of angina, it is important to provide the patient with complex treatment: antibiotics (Flemoxin, Summamed), gargling (Givalex), use sprays (Bioparox, Septolete).
8. Pulmonary embolism. First aid is provided only by the ambulance. In case of untimely treatment, it will not be possible to save the patient.
9. Depression, stress, hysteria. It is necessary to calm the person with special medicines (persen, dormiplant), provide psychological assistance.

Let's summarize all of the above and find out what needs to be done to provide first aid:

1. Call an ambulance.
2. While the team is driving, give the patient a semi-sitting position. Never place it on your back or stomach.
3. Help you breathe evenly and calmly.
4. For cardiac pathologies, put a tablet of validol or nitroglycerin under the tongue.
5. If the patient has fainted, wet a cotton ball with ammonia and hold it up to the nose.
6. Do not leave the person alone, wait together for the arrival of the doctors.
7. Never self-reset fractures and dislocations.
8. If the cause of chest pain is unknown, then warm compresses should not be used.

Pain behind the sternum can indicate both deadly conditions when the patient needs emergency medical care (myocardial infarction, pulmonary embolism), and predominantly functional disorders that do not require immediate hospitalization (neurocirculatory dystonia).

Therefore, it is desirable to know the basics of differential diagnosis for chest pain not only for doctors, but also for people without medical education, in order to understand how urgently and which doctor should seek help.

First of all, it is necessary to detail the signs of pain syndrome.
It is necessary to take into account the type of pain (acute or dull), its nature (pressing pain behind the sternum, burning, stabbing, etc.), additional localization (behind the sternum on the right, behind the sternum on the left), irradiation (gives between the shoulder blades, under the left shoulder blade, in the left hand, in the left little finger, etc.).

It is necessary to pay attention to the time of occurrence of pain (morning, afternoon, evening, night), the relationship with food intake or physical activity. It is desirable to know the factors that relieve pain (rest, forced position of the body, a sip of water, taking nitroglycerin), as well as factors that increase it (breathing, swallowing, coughing, certain movements).

In some cases, passport data (gender, age), family history data (what diseases the patient's relatives suffered from), information about occupational hazards and addictions can help in making a diagnosis.

It is necessary to collect an anamnesis of the medical history, that is, pay attention to previous events (infectious disease, trauma, dietary errors, overwork), and also find out if there were similar attacks before, and what they could be caused by.

Detailing the pain syndrome and other complaints of the patient, taking into account passport data and a careful collection of anamnesis in many cases make it possible to accurately make a preliminary diagnosis, which will then be clarified during a medical examination and various kinds of studies.

Angina pectoris as a typical cause of pressing pain behind the sternum

Typical angina attack

Angina pectoris (angina pectoris) and myocardial infarction are manifestations of coronary heart disease (CHD). IHD is an acute or chronic insufficiency of blood supply to the heart muscle, caused by the deposition of atherosclerotic plaques on the walls of the coronary vessels that feed the myocardium.

The main symptom of angina pectoris is a pressing pain behind the sternum on the left, extending under the left shoulder blade, to the left arm, left shoulder, left little finger. The pain is quite intense, and causes the patient to freeze in place with his hand pressed to his chest.

Additional symptoms of an angina attack: a feeling of fear of death, pallor, cold extremities, increased heart rate, possible arrhythmias and increased blood pressure.

An attack of angina occurs, as a rule, after exercise, during which the heart's need for oxygen increases. Sometimes an attack of typical chest pain can be provoked by cold or eating (especially in debilitated patients). A typical angina attack lasts two to four minutes, up to a maximum of 10 minutes. The pain subsides at rest, the attack is well removed by nitroglycerin.

It should be borne in mind that due to the characteristics of the blood supply to the female heart and the anti-atherosclerotic effect of female sex hormones, angina pectoris is rare in women of childbearing age (up to 35 years old is practically not diagnosed).

If you suspect angina pectoris, you should contact a general practitioner or cardiologist, who will prescribe a standard examination (general and biochemical blood tests, urinalysis, ECG).

Basic treatment for confirmation of the diagnosis of angina pectoris: diet, healthy lifestyle, taking nitroglycerin during attacks.

In the presence of concomitant diseases such as hypertension, diabetes mellitus, obesity, the treatment of these diseases will be both the treatment of angina pectoris and the prevention of further development of coronary artery disease.

Chest pain in Prinzmetal's angina

Unlike typical angina, Prinzmetal's angina occurs at night or in the early hours of the morning. The cause of attacks of insufficiency of the coronary circulation is an acute vasospasm.

Patients with atypical angina, as a rule, tolerate physical and psycho-emotional stress well. If overexertion causes seizures in them, then this happens in the morning hours.

Pain behind the sternum with Prinzmetal's angina is similar in nature, localization and irradiation to typical angina pectoris, and is well removed with nitroglycerin.

A characteristic feature is the cyclicity of attacks. Often they come at the same time. In addition, anginal attacks in atypical angina often follow one after another, uniting in a series of 2-5 attacks with a total duration of about 15-45 minutes.

With spontaneous angina pectoris, cardiac arrhythmias are more often observed.

Mostly women under 50 are affected. The prognosis for Prinzmetal's angina largely depends on the presence of concomitant diseases such as hypertension and diabetes mellitus. Sometimes special angina is combined with typical angina attacks - this also worsens the prognosis.

If you suspect spontaneous angina pectoris, you should immediately consult a doctor, since this kind of anginal attacks can be observed with small-focal myocardial infarctions.

Attending physician: therapist, cardiologist. Examination and treatment: if there are no special indications - the same as with typical angina pectoris. Atypical angina belongs to the class of unstable angina and requires constant monitoring.

Chest pain requiring emergency medical attention

Symptoms of myocardial infarction

In mild cases, pressing pain behind the sternum with myocardial infarction is similar in nature, localization and irradiation to angina pectoris, but significantly exceeds it in intensity and duration (30 minutes or longer), is not relieved by nitroglycerin and does not decrease at rest (patients often rush around the room, trying to find a comfortable position).

With extensive heart attacks, chest pain is diffuse; the maximum pain is almost always concentrated behind the sternum on the left, hence the pain spreads to the entire left, and sometimes the right side of the chest; gives to the upper limbs, lower jaw, interscapular space.

Most often, the pain rises and falls in waves with short breaks, so the pain syndrome can last about a day. Sometimes the pain reaches such intensity that it cannot be relieved even with the help of morphine, fentaline and droperidol. In such cases, the heart attack is complicated by shock.

Myocardial infarction can occur at any time of the day, but more often in the early morning hours of the night. As provoking factors, one can single out increased nervous or physical stress, alcohol intake, change of weather.

The pain is accompanied by such signs as a variety of heart rhythm disturbances (increase or decrease in heart rate, palpitations, interruptions), shortness of breath, cyanosis (cyanosis), cold perspiration.

If a myocardial infarction is suspected, emergency medical attention should be sought. The prognosis depends both on the extent of damage to the heart muscle and on the timeliness of adequate treatment.

Dissecting aortic aneurysm

The aorta consists of three membranes - internal, middle and external. A dissecting aortic aneurysm develops when blood enters between pathologically altered vessel membranes and dissects them in the longitudinal direction. This is a rare disease, so it is often misdiagnosed as a myocardial infarction.

The pain behind the sternum in a dissecting aortic aneurysm occurs suddenly, and is described by patients as unbearable. Unlike myocardial infarction, which is characterized by a gradual increase in pain, pain behind the sternum with a dissecting aortic aneurysm is most intense at the very beginning, when the primary dissection of the vessel occurs. Also, a very significant difference is irradiation along the aorta (first pain radiates between the shoulder blades, then along the spinal column to the lower back, sacrum, inner thighs).

A dissecting aortic aneurysm is characterized by symptoms of acute blood loss (pallor, drop in blood pressure). With the defeat of the ascending aorta with the overlap of the main vessels extending from it, asymmetry of the pulse on the hands, puffiness of the face, and visual impairment are observed.

There are acute (from several hours to 1-2 days), subacute (up to 4 weeks) and chronic course of the process.

If a dissecting aortic aneurysm is suspected, emergency hospitalization is necessary. To stabilize the process, patients are prescribed drugs that reduce cardiac output and blood pressure; operation is shown below.

The prognosis depends on the severity and localization of the process, as well as on the general condition of the patient (the absence of severe concomitant diseases). Mortality in surgical treatment of acute aneurysms is 25%, chronic - 17%.

After surgery for a dissecting aortic aneurysm, most patients remain functional. Much depends on the correct diagnosis and the availability of adequate treatment.

Pulmonary embolism

Most often (about 90% of cases), pulmonary embolism complicates the course of thrombotic processes in the veins of the lower extremities and pelvis (thrombophlebitis of the veins of the lower leg, inflammation in the pelvis, complicated by thrombophlebitis).

Often the cause of PE is severe heart damage that occurs with congestion and atrial fibrillation (rheumatic heart disease, infective endocarditis, heart failure with coronary heart disease and hypertension, cardiomyopathy, severe forms of myocarditis).

PE is a formidable complication of traumatic processes and postoperative conditions; about 10-20% of victims with a hip fracture die from it. More rare causes: amniotic fluid embolism, cancer, some blood diseases.

Pain behind the sternum occurs suddenly, most often has an acute dagger character, and is often the first symptom of pulmonary embolism. Approximately a quarter of patients develop acute coronary insufficiency syndrome due to circulatory disorders, so some clinical manifestations are similar to those of myocardial infarction.

When making a diagnosis, anamnesis is taken into account (severe diseases that can be complicated by pulmonary embolism, operations or injuries) and symptoms characteristic of pulmonary embolism: severe inspiratory dyspnea (the patient cannot breathe in air), cyanosis, swelling of the cervical veins, painful enlargement of the liver. In severe lesions, there are signs of a lung infarction: a sharp pain in the chest, aggravated by breathing and coughing, hemoptysis.

If pulmonary embolism is suspected, emergency hospitalization is indicated. Treatment includes surgical removal or lysis (dissolution) of the thrombus, anti-shock therapy, and prevention of complications.

Spontaneous pneumothorax

Most often occurs in men 20-40 years old. As a rule, spontaneous pneumothorax develops among full health. Pain behind the sternum occurs suddenly, localized most often in the anterior and middle parts of the chest on the side of the lesion. Can give to the neck, shoulder girdle, hands.

Such patients are often mistakenly diagnosed with myocardial infarction. Help in the diagnosis may be a symptom of increased pain in the chest when breathing, as well as the fact that the position on the sore side brings significant relief to the patient. In addition, attention should be paid to the asymmetry of the chest, the expansion of the intercostal spaces on the side of the lesion.

The prognosis for timely diagnosis is favorable. Shown emergency hospitalization and aspiration (pumping) of air from the pleural cavity.

Spontaneous rupture of the esophagus

The clinical picture is very bright, and resembles the symptoms of myocardial infarction: sudden sharp pain behind the sternum and in the left lower side of the chest, pallor, tachycardia, pressure drop, perspiration.

For differential diagnosis, the symptom of increased pain during swallowing, breathing and coughing is important. In 15% of cases, subcutaneous emphysema (bloating) occurs in the cervical region.

It should be borne in mind that this pathology occurs mainly in men aged 40-60, often with a history of alcoholism.

Treatment: emergency surgery, antishock and antibiotic therapy.

The prognosis for timely diagnosis is favorable, however, according to some reports, about a third of patients die as a result of late and inadequate treatment.

Chest pain requiring a house call

Myocarditis

The causes of myocardial inflammation are most often viral diseases, less often other infectious agents. There are also allergic and transplant myocarditis. In some cases, a causal relationship cannot be traced, so there is such a nosological unit as idiopathic myocarditis.

Often, chest pain is the first symptom of myocarditis. The pain is usually localized behind the sternum and on the left side of the chest. Often the intensity is high enough.

The main difference between the pain syndrome in myocarditis and angina attacks is duration. With myocarditis, the pain lasts for hours or even days, without weakening.
The age of the patient matters. Angina pectoris affects middle-aged and elderly people, myocarditis is more common in young people.

In typical cases, with myocarditis, it is possible to trace the connection with an acute viral disease, after which there was a light gap, and then a pain syndrome appeared. Often, pain behind the sternum with myocarditis is accompanied by fever, with angina pectoris, the temperature remains normal.

In severe and moderate myocarditis, symptoms such as shortness of breath and cough with little physical exertion, swelling in the legs, heaviness in the right hypochondrium, indicating an enlarged liver, rapidly increase.

If myocarditis is suspected, bed rest, a thorough examination and treatment, taking into account the form of the disease, are indicated.

In the absence of adequate treatment, myocarditis often turns into cardiomyopathy.

rheumatic heart disease

Pain behind the sternum and in the chest on the left with rheumatic heart disease, as a rule, is not intense, accompanied by a feeling of interruptions.

With focal damage to the heart muscle, pain in the region of the heart of low intensity and unexpressed nature may be the only symptom of rheumatic heart disease.

With diffuse rheumatic heart disease, shortness of breath, cough during exercise, and swelling in the legs are pronounced. The general condition is severe, the pulse is frequent and arrhythmic.

With rheumatic lesions of the coronary vessels, the symptoms of rheumatic heart disease are supplemented by typical anginal attacks characteristic of angina pectoris.

For differential diagnosis, the relationship of the disease with a recent sore throat, scarlet fever or exacerbation of chronic ENT pathology (tonsillitis, pharyngitis) is important.

Often, patients have polyarthritis characteristic of rheumatism.

In controversial cases, attention is paid to age (the peak incidence of esophageal cancer occurs at the age of 70-80 years, while angina pectoris usually develops earlier) and gender (mainly men are ill).

Attention should be paid to predisposing factors, such as alcoholism, smoking, occupational hazards (for example, dry cleaners have an increased risk of this disease).

There is evidence that people who have poisoned themselves with alkali in childhood are more likely to get esophageal cancer, and the time interval between chemical injury and tumor development reaches 40 years.

As a predisposing factor, some diseases of the esophagus are considered, in particular, achalasia of the cardia (chronic dysmotility of the esophagus with a tendency to spasm of the sphincter that passes food from the esophagus to the stomach) and gastroesophageal reflux (chronic reflux of acidic contents from the stomach into the esophagus).

The emaciation of the patient often attracts attention. Rapid unexplained weight loss should always be a concern for oncological pathology.

The prognosis for esophageal cancer diagnosed at this stage is usually poor. However, a correct diagnosis can correct palliative care aimed at alleviating the suffering of the patient.

Pain behind the sternum caused by the backflow of acidic stomach contents into the esophagus
Gastroesophageal reflux disease (reflux esophagitis) is the second most common disease of the esophagus, which is a tendency to retrograde reflux of stomach contents into the esophagus.

Pain behind the sternum with reflux esophagitis is strong, burning, aggravated by bending forward and in a horizontal position. Removed with milk and antacids.

In addition to pain, reflux esophagitis is characterized by symptoms such as belching, heartburn, pain when food passes through the esophagus.

The causes of reflux esophagitis are varied: from dietary errors (abuse of foods rich in caffeine, spices, mint, etc.) and bad habits (smoking, alcohol) to various diseases (cholelithiasis, stomach ulcers, systemic connective tissue diseases, etc.). .d.). Often reflux esophagitis accompanies pregnancy.

Since reflux esophagitis is often the result of many serious diseases, when its symptoms are detected, a thorough examination is necessary.

Pain behind the sternum of a spasmodic nature, caused by a violation of the motility of the esophagus
Pain behind the sternum of a spastic nature often occurs when there is an obstacle to the movement of food through the esophagus. Such an obstruction may be functional (for example, spasm of the sphincter through which food from the esophagus enters the stomach), or there may be an organic obstruction of the esophagus (tumor, cicatricial deformity). In such cases, the attack of pain is associated with food intake.

However, esophageal spasm can be caused by gastroesophageal reflux (as a reflex response to irritation of the esophageal mucosa by gastric acid). In addition, there are many functional disorders of esophageal motility that occur with spasm (esophagospasm, esophageal dyskinesia, achalasia of the cardia). With such pathologies, a clear connection between a painful attack and food intake is not traced.

Meanwhile, the pain caused by spasm of the esophagus is very reminiscent of an anginal attack in angina pectoris. The pain is localized behind the sternum or to the left of it, has a pressing character, radiates to the back, as well as to the jaw and left arm. Often the pain syndrome is well removed by nitroglycerin.

Attacks vary in length from several minutes to several hours and even days, which may be of diagnostic value. In addition, the fact that seizures are often relieved with a sip of water or analgesics may help in making a diagnosis.

Sometimes a painful attack with spasms of the esophagus is accompanied by pronounced vegetative manifestations, such as a feeling of heat, sweating, trembling throughout the body.

With attacks of pain behind the sternum caused by spasms in the esophagus, a combined examination of the cardiovascular system and the gastrointestinal tract is indicated.
Attending physician: therapist, gastroenterologist, cardiologist. Treatment is prescribed according to the results of the examination.

hiatal hernia

The causes of hiatal hernia may be congenital structural features of the diaphragm and / or diseases of the abdominal cavity, contributing to the development of pathology.

Pain behind the sternum with a diaphragmatic hernia is most often moderate, without pronounced irradiation. The pain is provoked by food intake and physical activity, disappears after belching or vomiting. Leaning forward makes the pain worse, and standing up makes it easier.
In addition, diaphragmatic hernia is characterized by symptoms such as: belching with air and food eaten, rapid satiety, repeated regurgitation at night (wet pillow symptom). Later, vomiting joins, often with an admixture of blood.

Hernia of the esophageal opening of the diaphragm, as a rule, is complicated by reflux esophagitis, esophageal motility disorders with a pronounced spasmodic component are often observed, so the clinical picture often requires differential diagnosis with angina attacks.

Thus, if a diaphragmatic hernia is suspected, a joint examination of the cardiovascular system and the gastrointestinal tract is also indicated.
Attending physician: therapist, gastroenterologist, cardiologist.

If a hernia of the esophageal opening of the diaphragm is suspected, it is recommended to sleep in a semi-sitting position, placing 2-3 pillows under the head end. Gastroenterologists advise in this case to avoid overexertion of the abdominal press and a forced position of the body with the body tilted forward. Fractional nutrition is shown.

Diseases of the cardiovascular system associated with impaired neuroendocrine regulation

Pain in the region of the heart (with an epicenter in the region of the apex of the heart or behind the sternum) is one of the leading symptoms of the disease. The intensity of the pain syndrome, along with the severity of other symptoms of neurocirculatory dystonia, plays a role in the classification of this pathology by severity.

With severe neurocirculatory dystonia, the pain syndrome strongly resembles acute myocardial infarction. Characterized by pain in the region of the heart of a pressing or compressive nature, undulating increasing and decreasing, which can last for hours and days. The pain syndrome is accompanied by a pronounced palpitation, fear of death, a feeling of lack of air; resistant to nitroglycerin.

Often, patients with neurocirculatory dystonia testify that pain in the region of the heart is relieved by various sedative drugs (validol, valerian root, etc.).

The presence of other symptoms of neurocirculatory dystonia also helps to conduct a differential diagnosis with coronary heart disease.

A characteristic feature of this disease is the multiplicity of subjective symptoms with the scarcity of objective data (most of the indicators are within the normal range). Very often, patients complain about the violation of the functions of many organs and systems: respiratory disorders with attacks resembling bronchial asthma; lability of blood pressure with a tendency to hypertension, less often to hypotension; spontaneous fluctuations in body temperature (from 35 to 38); disorders of the gastrointestinal tract (nausea, vomiting, constipation, followed by diarrhea, etc.); rich psychoneurological symptoms (dizziness, headache attacks, insomnia, weakness, lethargy, cardiophobia (fear of dying from heart disease), depression).