It hurts in the sternum in the middle and gives. Organs located in the middle of the chest. Microtrauma caused by excessive loads

Sharp pains in the chest area occur spontaneously, are a symptom of disorders in the internal systems of the body. They have another name - thoracalgia. Against this background, breathing becomes difficult, movements are constrained. Acute pain syndrome may indicate a heart attack, so it is important to provide emergency care in a timely manner.

Possible reasons

Sharp pain sensations are an important sign of many pathologies that are localized not only in the sternum, but also in other organs. Pain can indicate both the initial stage of the development of the disease, and the exacerbation.

An important role is played by the place of localization - on the left, on the right, in the middle. It can occur between the shoulder blades and under them. In this area there are many nerve endings and blood vessels, through which the pain syndrome is transmitted from one organ to another. Therefore, there are so many reasons for taracalgia.

Pathologies of the cardiovascular system

Most often, with sharp and sudden pain in the sternum, people suspect that the problem lies in heart disease. In fact, it is. List of the main pathologies of the heart and circulatory system in acute pain syndromes:

1. . Sharp pain is compressive, burning or pressing in nature. The intensity can vary from 30 seconds to 15 minutes. Place of localization - to the left of the sternum or behind it. Irradiates to the area of ​​the left arm, neck, scapula, epigastrium. Only with angina pectoris does it spread through the teeth and lower jaw.

It occurs after any physical activity - wearing weight, playing sports, climbing stairs, walking fast. Feature - the more the disease progresses, the less physical activity is required for the onset of pain. Possibly nitroglycerin.

1. . Discomfort occurs in the retrosternal region, the minimum duration is 10-15 minutes, but it can last for many hours. The nature of the pain is burning, squeezing, squeezing or bursting. It is localized behind the sternum or slightly to the left. It appears after physical activity or at rest.

Seizures are repeated frequently. Place of distribution - both upper limbs, shoulder blades, neck, back. With myocardial infarction, there are specific symptoms: nausea, vomiting, shortness of breath, increased sweating, fear and anxiety. Does not help.

1. and myocardial dystrophy. Pain is accompanied by fever, palpitations, drowsiness and shortness of breath. The characteristic of sensations is cutting, stabbing, which are localized behind the sternum.

The pain syndrome spreads to the neck, shoulders, epigastric and dorsal region. You can lower the threshold like this: take a sitting position, lean forward a little. You can get rid of pain with analgesics with a non-narcotic effect.

1. Dissecting aortic aneurysm. Pain syndrome, as in a heart attack, but sometimes stronger. The place of localization is the retrosternal region, radiates to the spine, lower abdomen, limbs. Occurs after emotional manifestations, physical exertion, excess blood pressure.

A sharp pain bursting and tearing, it can manifest itself in waves. The duration of the attack is different - from a minute to several days. Accompanied by the asymmetry of the pulse, which is measured on the radial and carotid arteries.

Blood pressure can rise suddenly and then fall just as sharply. If you measure blood pressure on different hands, then the difference fluctuates, like the pulse. It is problematic to eliminate pain immediately, so you have to inject drugs more than 2 times.

1. Thromboembolism in the pulmonary arteries characterized by a sharp intense manifestation in the central part of the chest, but can occur on the left and right. The minimum duration is 15 minutes, the maximum is several hours.

The attack leads to shortness of breath, fainting (syncope). Occurs after surgery on deep veins against the background. Pain can be relieved with narcotic analgesics.

Diseases of the digestive system

The main pathologies of the esophagus, which are manifested by sharp pains in the chest, are cancerous neoplasms, gastroesophageal reflux, peptic ulcer, esophagitis. The site of origin is the passage of the esophagus. In the process of swallowing and passing food through the esophagus, the pain threshold increases and is transmitted to the chest.

Additional symptoms:

• nausea and vomiting;
• heartburn;
• belching with sourness;
• burning in the epigastric region.

Another disease is a hernia in the opening of the diaphragm in the esophagus. Feelings resemble angina pectoris, pain in the chest is localized in the lower third, substrate, chest cavity. A feature is an increase in the pain threshold in the supine and sitting state, but if a person is in an upright position, the pain disappears or decreases. Symptoms are the same as in other pathologies of the esophagus.

Oddly enough, but esophageal pain can be stopped with Nitroglycerin, and the nature of the pain syndrome resembles ischemia. For these reasons, recognition of the disease is not immediately possible.

Respiratory problems

Sharp pain in the chest most often occurs with pleurisy, trauma, pneumothorax, and tumor neoplasms.

Main symptoms:

1. Pain sensations are prolonged, their intensification occurs during breathing.
2. Appears shortness of breath, cold sweat, tachycardia, cyanosis.
3. Quite often, blood pressure decreases, which causes the skin to turn pale.
4. The person feels a general weakness.
5. With pneumonia, the pain syndrome is very sharp, accompanied by collapse, intoxication symptoms. The main concern is the formation of a lung abscess.
6. The location is different - in the middle, on the left or right side.
7. An increase in body temperature, chills and a state of fever.

Diseases of the spine

The most common diseases are displacement of discs in the thoracic vertebrae, injuries, thoracic sciatica and osteochondrosis. Characteristic features and signs:

1. The type of pain is prolonged and burning, squeezing or sharp, localized in the chest, transmitted to the lower back and cervical region.
2. It is aggravated by raising the arms up, the static position of the body, carrying weights, bending and moving. And also during deep breathing, tilting of the head and palpation.
3. Symptoms are in many ways similar to those of coronary heart disease (angina pectoris, myocardial infarction, etc.).
4. Analgesics and mustard plasters help to get rid of pain.
5. There is numbness of the extremities in the spine, pain in the head and dizziness.
6. A person gets tired quickly, in the daytime is in a sleepy state.

How dangerous is a sharp pain in the sternum?

It is impossible to say unequivocally whether a sharp pain in the chest area is dangerous, since it depends on the cause of the occurrence. For example, in case of cardiovascular pathologies, it is necessary to act immediately, since these diseases carry the risk of developing thrombosis, thromboembolism, and other disorders that lead to sudden cardiac arrest.

With pathologies of the digestive system and lungs, diseases become chronic, causing additional complications, up to oncological neoplasms and death. If the spine is affected, a person may remain disabled, as motor ability is lost, the muscular system atrophies.

Symptoms that require urgent medical attention:

• constriction of the heart, feeling of fading and lack of air;
• severe shortness of breath and heaviness in the sternum;
• pain spreading to the left arm, teeth, back;
• nausea and vomiting;
• powerful dizziness with rapid heartbeat and breathing;
• difficulty swallowing and fever;
• - excessive increase or decrease;
• sharpness of pain at rest;
• prolonged and constant intensity of pain.

If you do not call an ambulance in a timely manner and do not provide primary first aid, a fatal outcome is possible.

Diagnostics

The nature of the sharp pain in different diseases is largely the same, so it is important to conduct a thorough examination to establish an accurate diagnosis.

Diagnostic activities include the following:

1. Questioning the patient. The doctor asks about the nature of the pain syndrome, the duration of the attack and associated symptoms. Be sure to study the history of all past diseases and existing chronic ones.
2. The doctor listens and taps the heart, measures blood pressure, pulse.
3. Conduct an electrocardiogram. If pathologies of the cardiovascular system are detected, the patient is referred for echocardiography, angiography and coagulogram. Assess the functionality and condition of the heart, blood vessels. Daily Holter monitoring is recommended.
4. Chest X-ray.
5. Ultrasound examination of the digestive and other organs.
6. Collection of urine and blood samples for general and biochemical studies.

If necessary, methods such as computed tomography and magnetic resonance imaging can be prescribed, depending on the alleged cause of a sharp pain syndrome.

Medical treatment

The method of treatment is selected based on the cause of thoracalgia. These can be drugs for vasodilation, blood thinning, strengthening the walls of veins, pain relief; restoring heart rate, etc.

Drug groups:

1. For the cardiovascular system, antiarrhythmic drugs (Verapamil), beta-blockers (Metoprolol, Propranolol) and sodium channel blockers (Lidocaine, Quinidine), ACE inhibitors (Captopril, Fosinopril), statins (Lovastatin, Pravastatin), fibrins (Metalise, Actilyse) are prescribed. ), nitrates (Nitroglycerin, Nitrong), anticoagulants (Flagmin, Heparin).
2. For the spine - chondroprotectors (Artra, Dona, Moltrex, Chondrolon), non-steroidal anti-inflammatory drugs (Ibuprofen, Nimesil, Ketoprofen).
3. Narcotic analgesics (Sedalgin, Nurofen-Plus) and non-narcotic (Spazmalgon, Brustan) character.
4. For the digestive system, antispasmodics (No-shpa, Papaverine) and antacids (Almagel, Maalox).
5. For the lungs - antibiotics (Tavalik, Avelox), macrolides (Clarithromycin), carbapenems (Imipenem) and more.

Folk remedies

Traditional medicine offers many recipes, but it is strictly forbidden to use them on your own, since it is important to know the exact diagnosis.

Recipes for diseases of the spine:

1. To relieve pain, a rub is made from such a collection: dandelion root, birch buds, mint, coriander (components in equal proportions). From the total, separate 6 tbsp. l., add a glass of boiling water, put on fire and boil for 5-7 minutes. After that, put in a container 150 grams of butter and the same amount of vegetable oil. Cook for another 15-20 minutes. Store the mixture in the refrigerator, apply to pain points with rubbing movements. Put cling film on top and wrap with a woolen cloth.
2. You can make compresses from freshly squeezed horseradish juice or black radish.
3. Inside you can take chamomile decoctions.

Remedies for lung diseases:

1. You can get rid of pain and cough with the help of cottage cheese cakes. Lightly heat homemade cottage cheese, mix it with a small amount of honey, put it on a gauze bandage. Apply to the chest on both sides at night.
2. With pneumonia, this mixture helps: 1 crushed aloe leaf, 2 tbsp. l. water and 6 tbsp. l. honey. Mix thoroughly and put on fire. Let it languish for a couple of hours. Take chilled 3 times a day for 1 tbsp. l.

Digestive system:

1. To normalize the microflora, restore functionality in pathologies such as an ulcer, use chaga (a growth or fungus on a birch trunk). The growth must be dried and put in a thermos 4 units. Pour in water that cools slightly after boiling (900 ml). Insist 24 hours. A highly concentrated extract will be obtained, which is diluted with boiled water before use to a shade of weakly brewed tea. Drink before dinner 30 minutes 1 time per day, 100 ml.
2. Propolis will help relieve pain. For 40 ml of 70% alcohol you need 10 grams of propolis. Grind the bee product on a fine grater. Infuse for 7 days, take orally in a diluted form once a day. For a glass of water, you need from 20 to 40 drops of tincture.
3. You can remove heartburn with viburnum jam. For 200 ml of boiling water, you need to take 1-2 tbsp. l. jam. Drink as a tea drink before meals.

Strengthening the heart and blood vessels:

1. Combine in equal proportions grated horseradish root and natural honey. Take 3 times a day one hour before meals for a tablespoon.
2. Rinse 5 medium-sized lemons, grind with a meat grinder. Grind 2 large heads of garlic and half a liter of honey. Infuse for a week, eat 1-2 tbsp. l. on an empty stomach To improve the taste and saturation with useful substances, the addition of walnuts is allowed.

Prevention of severe chest pain

To prevent sharp pains in the chest, whatever the causes, it is possible with the help of preventive measures:

• lead a healthy life;
• stick to moderate sports;
• inhale fresh air - ventilate the apartment;
• pay special attention to the diet - give up harmful foods;
• avoid stressful situations;
• pay attention to any symptoms and promptly treat diseases of the lungs, heart, blood vessels, gastrointestinal tract and spine.

If there is a sharp pain in the chest, consult a therapist who will conduct a preliminary examination, after which he will refer you to a highly specialized specialist. Do not deal with pain relief on your own, as the treatment of various diseases requires an individual approach.

Very often, the reason for visiting a doctor is a dull pain in the sternum in the middle. A similar phenomenon, the first obvious symptom of many diseases associated not only with the heart.

It is very important to understand that such painful sensations, and all accompanying symptoms, must be clearly described during a visit to the doctor in order to make a correct diagnosis and prescribe a rehabilitation course.

In order to understand the nature of the pains that arise, it is necessary to know for sure which problems with which organs or systems can cause discomfort.

As a rule, this is:

• respiratory system;
• problems with cardiac activity;
• circulatory system;
• past trauma to the chest;
• congenital pathology.

Other reasons are little known, or appear only in individual cases.

Causes

The causes of acute chest pain are very different. Starting from standard physical overwork, or excessive loads, and ending with acute pathological diseases. As a rule, congenital pathologies are extremely rare, and are associated with acute heart failure, heart disease and hypertension.

An accurate diagnosis can be established after visiting a doctor and completing a full course of examination. He will be able to answer the question why the chest hurts in the middle and what reasons serve as a provocative factor.

Consider the main types of possible foci of dull pain in the sternum and a number of accompanying symptoms.

Physical overvoltage

In adolescence, the formation of the chest occurs. This is age 12-18. Bones at this stage are not entirely strong, and can be damaged from any excessive physical activity. If acute pain occurs in the sternum in the middle, it is necessary to exclude the kind of physical activity that has become a provocative element and conduct a medical examination.

Injuries

Almost every injury associated with the chest leads to discomfort, and subsequent pain. If the bone itself was damaged directly, after a while, the first painful sensations covering the middle of the sternum will make themselves felt. It may seem to the patient that a heavy, voluminous object lies on the chest.

Problems with the organs of the respiratory system

Many doctors note that the respiratory system very often becomes a hotbed of sudden pain.

There is a strong cough, in some cases it comes to vomiting. As a rule, this is pain behind the sternum in the middle.

In rare cases, tuberculosis is the source of the problem. As a rule, the main symptom is a bloody cough. Further, secondary signs: burning in the chest, difficulty in breathing, discomfort during respiratory activity.

Heart disease, circulatory disorders

Of course, due to problems with cardiac activity, there is pain in the chest area. Basically, the local area of ​​pain is the left half of the body, but occasionally, it manifests itself in the center of the chest.

If these are short attacks, then pain occurs in the following areas:

1. in the middle of the chest;
2. on the left side of the body, slightly above the waist;
3. felt in the shoulder blade.

All of the above symptoms are especially noticeable during movement, sports or increased physical activity. The pain begins to subside after a short rest, preferably in the fresh air.

Dull sudden pain is the first sign myocardial infarction. With a similar condition, you must immediately contact a medical institution, and not wait for the development of consequences.

As a rule, there is another sure sign (of a psychological nature) - a strong fear on unreasonable grounds. Predisposition to a heart attack occurs in men of middle and advanced age. In the female half, this is a very rare occurrence.

Pain in the center of the chest occurs when the circulatory system is disturbed. As a rule, this is pulmonary thrombosis.

It is very important not to confuse the source of the pain. In heart disease, the pain is dull, sharp, severe. If the matter is in the circulatory system, the pain will be periodic, with prerequisites and will deliver prejudicial discomfort in the chest area.

Disorders in the alimentary tract

Often, stomach problems cause pain in the sternum in the middle.

The list of diseases that can become a source of pain:

• ulcer;
• acute pancreatitis;
• abscess;
• cholecystitis.

If there is a suspicion of one of the above diseases, it is necessary to pay attention to secondary symptoms: belching, frequent vomiting, heartburn in the gastric tract. Often, the local area of ​​pain is under the breastbone.

Little known causes

In addition to the main list of diseases that can cause severe pain in the sternum, there are little-known or individual causes of pain that may not manifest themselves for a long time, or act as a side effect of another disease.

For example, severe damage to the chest during a blow or fall. Very often, damage to the diaphragm occurs, and as a result, internal bleeding may open, which carries a direct danger to human life.

Another little-known cause is excessive exercise. This is especially evident in people who prefer a sports lifestyle, or simply very active people.

The fact is that shortness of breath, problems with respiratory activity, discomfort in the middle of the chest can begin. Of course, this is not a reason to call an ambulance, but it is highly recommended to see a doctor. Perhaps this type of physical or sports activity is not suitable for you.

Diagnostics

Diagnosis and definition of the disease takes place in several stages. A qualified doctor will be able to determine in one day why the sternum hurts and prescribe a suitable course of treatment.

The first step is a direct interview of the patient himself. The doctor listens to complaints, asks the patient to describe the nature of the pain, how long ago it started to hurt, etc. This is necessary to collect general information, and to schedule the necessary examination as soon as possible.

It consists of:

1. x-ray (if necessary);
2. fluorography;
3. examination for external manifestations;
4. swallowing the probe (if the disease is associated with the gastrointestinal tract), etc.

As soon as the doctor establishes the possible source of the problem, he will prescribe the necessary series of diagnostics.

Is it possible to self-medicate, and how to help a person with a sudden attack of pain?

It is very important to reasonably assess your own condition, and not self-medicate at home.

Some conditions are incompatible with life and urgent medical attention is required. You don't have to deal with pain alone. In frequent cases, it comes to hospitalization and undergoing a full rehabilitation course in a medical institution.

What to do if a person's condition has deteriorated sharply, you need to call an ambulance. Before her arrival, it is necessary to maintain the patient's condition in every possible way.

For this, there is a special algorithm of actions:

• give an anesthetic;
• if the pain is related to the heart, give the patient a certain dose of nitroglycerin;
• lay on a flat surface, and slightly raise your head;
• make a heart massage, try to eliminate primary spasms;
• it is advisable not to go far from the person, as the condition can worsen in a matter of minutes.

Upon the arrival of the ambulance, it is necessary to state as clearly as possible the nature of the pain, the alleged focus, provide the patient's medical record with a medical history (if one was previously noted). All these actions will help doctors to take appropriate measures, and in a short time to improve the patient's condition.

Pain in the middle of the sternum can occur for a variety of reasons. And this does not always indicate problems with organs that are directly in the localization zone. Often such sensations can be an echo of diseases even of those organs that are located in the abdominal cavity. In order to start the correct effective treatment, it is necessary to accurately establish the cause and in the future build on it, and not ignore the phenomenon. Our body always signals us in time about any problems that have arisen. Therefore, it is important to learn to hear and correctly understand these signals.

Possible causes of pain in the middle of the chest in women and men

One of the most common causes is, of course, all sorts of heart problems. For example, angina pectoris, ischemic disease, and even myocardial infarction. In any of these cases, a person feels pain on the left side, but it can radiate to different places and be felt, including in the middle of the chest. Painful sensations are very strong and have a stabbing character. It seems to a person that thousands of needles are stuck into him. Such symptoms are extremely dangerous, since heart disease can even lead to death.

If the pain occurs suddenly and unexpectedly, then you can even lose consciousness. At this moment, the person's pulse quickens noticeably, and the face and lips become pale. You should call an ambulance or, if the attack was short, immediately make an appointment with a cardiologist. Nitroglycerin, which instantly dilates blood vessels, will help normalize a person’s condition.

Sometimes lung disease is the cause. For example, pleurisy, pneumonia, bronchitis and tracheitis. In this case, the pain will increase with a strong sharp sigh and cough. It is quite simple to explain the pain in this case - these diseases cause damage to the diaphragm and intercostal muscles.

Sometimes various problems with the gastrointestinal tract lead to pain in the middle of the sternum. For example, diaphragmatic abscess, duodenal ulcer or stomach ulcer. Because of them, stomach pain can radiate to the chest area.

Symptoms

Only an experienced specialist can accurately determine the cause of the appearance. Often during the appointment, the doctor asks the patient additional questions that allow you to identify other symptoms of a particular disease.

• For example, if a person begins to experience pain due to problems with the gastrointestinal tract, then additional symptoms will be pain in the stomach or in the left hypochondrium, frequent heartburn, nausea, and even vomiting for no apparent reason. Here, the patient will be assigned additional tests and examinations related to the state of the stomach, which will help to make an accurate conclusion about the cause of the pain.
• In lung diseases, additional symptoms are cough, sore throat and sore throat, often fever. If the diagnosis is confirmed, then the treatment will eventually be directed precisely at eliminating problems with the lungs.
• If the cause of the pain lies in an unhealthy heart, then the person will periodically feel tingling and discomfort in this area, will often get tired, he may experience shortness of breath even with minimal physical exertion, it will be difficult to breathe.

Diseases that can cause pain in this area

Diseases may include:

• , reflux esophagitis, gastric and duodenal ulcer, diaphragmatic abscess;
• pleurisy, pneumonia, tracheitis and bronchitis;
• thyroid disease;
• angina pectoris, heart failure and ischemic disease;
• osteochondrosis and other diseases that lead to unstable work of the thoracic spine.

Even despite the abundance of medicines and drugs on the shelves of modern pharmacies, it is almost impossible to instantly eliminate and even alleviate chest pain caused by all the diseases described above.

First, you will need to go to an appointment with a specialist who can diagnose the main cause of pain, and then the patient will be prescribed a long-term complex treatment.

Even if the pain appears rarely and is poorly felt, this may indicate the development and complication of a disease. Therefore, the sooner treatment is started, the less the disease will bring consequences for the human body.

Pain in the sternum with injuries

It can also appear due to injuries resulting from traffic accidents, falls or other damage. If a person received a blow in this zone, then this can lead to a rupture of the muscles, which cause severe pain. As a rule, in these cases, the pain will clearly increase with deep sharp exhalations and inhalations, turns, bends and some other physical exercises.

If the injury was especially strong and serious, then the pain can be felt even by pressing on the middle of the chest or simply by placing a hand in this area. Most likely, this indicates a fracture or crack in the bones.

In this case, it is necessary to urgently contact the surgeon, as well as take a picture that will allow you to establish the exact cause. Until the visit to the doctor, the patient should avoid physical activity and be at rest, so as not to worsen his condition by careless movement.

Discomfort after exercise

If the pain appeared after sports training, then there may be several reasons for this. More often it occurs in beginners in sports who perform exercises on the pectoral muscles, forgetting about safety precautions or exceeding their capabilities (excessive loads).

This also applies to athletes who prefer exercises such as push-ups on the uneven bars, especially with weights.

If the whole thing is a banal overload, then after 2-3 days the pain should go away. Otherwise, you need to consult a doctor.

Video with a professional doctor about the work of the thoracic spine

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 navigate 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 alleviate 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 could have caused them.

Detailing the pain syndrome and other complaints of the patient, taking into account passport data and 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 peculiarities 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 pulmonary embolism is severe heart damage that occurs with congestion and atrial fibrillation (rheumatic carditis, 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 been poisoned in childhood with alkali are more likely to get esophageal cancer, and the time interval between chemical injury and tumor development reaches 40 years.

Some diseases of the esophagus are considered as a predisposing factor, in particular, achalasia 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, a 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).

There can be many reasons for women to feel the chest pain in the middle. This area contains the respiratory organs, esophagus and heart. The spine and ribs can also cause pain in the sternum. And, of course, do not forget about the specifics of the mammary glands, which most often cause an unpleasant symptom.

If a woman has a chest pain in the middle, then the causes can be characterized as physiological or pathological. The first category includes those symptoms that are the result of natural processes in the body. They may be unpleasant, but they do not pose a danger to life and health.

Pathological pain is a signal of the body about the presence of a disease. In this case, only a doctor can determine the degree of health hazard. Therefore, it is important to learn to distinguish between types of pain in order to independently determine their cause and, if possible, eliminate it without leaving home.

But if you have any doubts, it is better not to postpone the visit to the doctor. Pain syndrome is a common symptom of cardiovascular and oncological diseases. Early diagnosis of these pathologies helps to cure the patient with minimal damage to health and wallet.

The most common reason that a woman has a chest pain in the middle is an error in choosing underwear. Bras of the wrong size, putting pressure on the mammary glands, disrupt the normal blood supply to the tissues. This is how pain occurs. Unfortunately, for women who have been gifted by nature with large breasts, such symptoms can also occur when wearing underwear of an adequate size.

Another common cause of chest pain is mastalgia. This is a common symptom of premenstrual syndrome. In this case, the woman's body, "hoping" for pregnancy, begins preliminary preparation.

For the mammary glands, this results in:

• swelling;
• the appearance of nodules;
• pain is accompanied by burning.

Similar symptoms develop during the week before each menstruation and completely disappear after the end of menstruation. Another important difference from pathological processes is that both mammary glands are necessarily affected.

A similar manifestation of symptoms is possible with a rarer event - pregnancy. But in this case, the process becomes longer and is accompanied by a delay in menstruation. This is one of the signs of the birth of a new life in a woman's body. In this case, it is better to play it safe and purchase a test at any pharmacy in order to register at the antenatal clinic on time and prevent many of the dangers of bearing a fetus.

Lungs

Another common reason that a woman has a chest pain in the middle is the pathology of the respiratory system.

They are quite varied:

It can also be caused by stress caused by many days of severe coughing or hemoptysis. Therefore, determining the need to visit a doctor is quite simple.

gastrointestinal tract

Despite significant differences, women often confuse the stomach with the heart when trying to self-diagnose the cause of chest pain. As a result, the terrified patient already in the hospital learns that he has serious digestive problems, which also require appropriate treatment.

It is possible to distinguish diseases of the gastrointestinal tract as the cause of pain behind the sternum by the following accompanying signs:

• heartburn and burning in the throat;
• heaviness when swallowing;
• nausea or vomiting;
• pain in the upper abdomen.

A more accurate self-diagnosis can be carried out if you trace the time of onset of pain. With an ulcer, the stomach does not tolerate hunger. With gastritis, symptoms develop immediately after eating. The duodenum, as the most "patient", responds with pain an hour after a hearty meal.

A similar set of signs can occur without pathologies. This is how the body of a pregnant woman reacts to food intake. Symptoms in this case appear due to the pressure of the fetus on the internal organs.

Heart and blood vessels

One of the most dangerous categories of reasons that a woman has pain in the middle of her chest is the pathology of the cardiovascular system. Most often, pain syndrome is a companion of hypertension or heart failure.

But before you get scared, it's important to remember that pain isn't the only symptom. Unpleasant sensations should also be manifested through:

1. Deterioration of the body. Problems with the heart and blood vessels provoke a deterioration in performance, weakness and pallor of the skin. At the same time, physical activity and stress often provoke an exacerbation.
2. Pulse increase. Trying to cope with the load, the heart works too fast, which is easy to feel. Because of this, there is a burning sensation and pain in the lungs, which cease to cope with increased gas exchange.
3. neurological reactions. Exacerbation of problems with the cardiovascular system is manifested through anxiety and confusion. The person sweats profusely and feels a severe headache.

If even some of these symptoms appear, it is better to consult a doctor.

ODS

The spine can also "give" a woman chest pain. In this case, it occurs as a result of curvature or osteochondrosis. The ribs often react to scoliosis, because of which it begins to stab in the side.

Osteochondrosis is dangerous because it can lead to a pinched nerve. In this case, a woman can easily confuse severe chest pain with a heart attack. The difference will manifest itself through a burning sensation in the back. There will also be specific pain when trying to press on the shoulders.

Spinal problems are rarely life-threatening, but they can significantly limit a person for many years. Therefore, you should not neglect the health of your skeleton, so as not to be bedridden later.