Sharp short-term pain in the sternum in the middle. Why there is a strong sharp or aching pain in the chest in the middle

Many people face the problem of chest pain. Some of them try not to pay attention to the presence of chest pains, but still it is worth listening to your body, because this problem can indicate the presence of various disorders, including serious disorders.

When you know the exact cause of the pain syndrome, this will give you the opportunity to act adequately and in a timely manner, along the way, you can always provide first aid to a loved one based on your experience. But of course, this is in emergency cases when it is impossible to call an ambulance or the situation requires making quick decisions at your own peril and risk.

Why does pain appear in the chest in the middle? The appearance of pain can be associated with pathologies of the heart, blood vessels, problems in the bronchi or lungs, diseases of the spine (thoracic region), intercostal neuralgia, gastrointestinal disorder, somatic dysfunction of the nervous system, or disorders of the thyroid gland (thyroid gland).

Causes of chest pain can be

IHD (ischemic heart disease) in the form of angina pectoris, myocardial infarction, which are just characterized by pressing pains that occur mainly in the chest on the left, but can also be felt in the middle. In this regard, AMI (acute myocardial infarction), which requires urgent medical measures, is especially dangerous for life.

Osteocondritis of the spine, in particular - thoracic osteochondrosis, which is a disease of the intervertebral discs (degenerative changes). They become thinner, their shock-absorbing function worsens, as a result of which the gap between the vertebrae decreases, their convergence occurs with possible pinching of the nerves. In this case, a person has point pains in the chest, according to the type intercostal neuralgia. If they are not treated, further progression of the disease occurs. As the height of the discs decreases, they flatten, can form an intervertebral hernia, which further compresses the nerve roots, causing pain in the chest in the middle or in the region of the heart.

Diseases of the lower respiratory organs. Diseases of the lower respiratory system, such as bronchitis, pneumonia, pleurisy, tuberculosis, tumor. The pain occurs during a coughing fit and is aggravated by taking a deep breath. In this case, there is an increase in temperature, headaches, body aches, shortness of breath. Here are some additions:

at pleurisy a lot of fluid accumulates in the pleural cavity, which presses on the intercostal muscles and the diaphragm, causing pain.
at tuberculosis and tumors, in addition to pain in the chest cavity, there is the appearance of streaks of blood in the coughed up sputum, general weakness and a slight increase in body temperature (up to 37.5 degrees).

Cardioneurosis. With neurosis of the heart, the chest often hurts in the middle. This is a functional disorder of the nervous system, resulting from its overstrain. With cardiac neurosis, pain is often paroxysmal in nature, less often they become permanent. The attack begins with a feeling of lack of air and tingling in the chest. Then the pulse accelerates. It seems to the person that he is about to suffocate. Most often, an attack provokes emotional stress.

Neuralgia intercostal. Yes, intercostal neuralgia is characterized by pain in the area where the intercostal nerves are located. It intensifies during inhalation and during movement, subjectively perceived by a person as pain inside the chest. And sometimes a person is afraid to take a breath, it hurts so much in the chest.

peptic ulcer gastrointestinal tract. With a stomach or duodenal ulcer, the chest in the middle often hurts. Such pains are often accepted by a person as pains in the heart. But there is one difference. The appearance of pain in gastric diseases depends on the intake of food. Ulcers are characterized by so-called "hungry" pains that occur 1-2 hours after eating. It is enough to eat at least a piece of bread, and they practically disappear.

Biliary dyskinesia. Spasms occur in the gallbladder, resulting in pain in the chest. Since the pain is very similar to an angina pectoris attack, it is necessary to conduct an additional examination to make a diagnosis.

Diseases of the thyroid gland. Pathology of the thyroid gland can cause pain in the chest in the middle. In this case, a tumor in the cervical region or chest, general weakness, changes in the patient's weight, pressure surges, and fever can also be observed.

VSD. Vegetative-vascular dystonia causes malfunctions in the autonomic nervous system. It is manifested by painful sensations in the head, stomach, heart, panic attacks. In this case, the chest in the middle may hurt.

The chest hurts in the middle: what is the first aid for an injury

The chest can hurt not only with various diseases, but also after an injury, in which fractures of the ribs or damage to vital organs often occur.

Easier breathing after injury

give the patient a sitting or semi-sitting position;
in the presence of tight outerwear, unbutton it;
give the victim a sniff of ammonia or wipe the skin around the temples with it;
provide the patient with maximum comfort.

To improve cardiac activity you can give the patient to drink 15-20 drops corvalola or another vasodilator drug (Valocardin).

To avoid shock

give the victim 2 tablets of an anesthetic (ketanov, analgin);
put something cold on the chest;
in the presence of visible fractures of the ribs, immobilize them;
warm the patient
monitor the condition until the arrival of the ambulance brigade.

In case of injury, in addition to the above measures, it is necessary to treat the skin around the wound with an antiseptic solution (hydrogen peroxide, iodine, brilliant green), apply a sterile bandage to the wound and apply cold.

The chest hurts in the middle: what is the treatment if there was no injury

Treatment for chest pain depends on the disease that caused it.

ischemic heart disease. For angina pectoris, it is enough to put 1 tablet under the tongue nitroglycerin(nitrosorbitol). If after 6 minutes the pain has not gone away, put another 1 tablet sublingually, this can be done 3-5 times, but if chest pain does not go away within 30 minutes under the influence of nitrate-containing agents, the development of acute myocardial infarction should be suspected and an ambulance should be called immediately giving the patient peace of mind.

Osteochondropathy. With thoracic osteochondrosis, it is necessary to restore the correct mobility of the intervertebral discs. To do this, a set of exercises is selected, general strengthening drugs, agents that regenerate cartilage tissue are prescribed.

Inflammation of the respiratory organs. If inflammatory diseases of the respiratory system are detected, it is necessary to get an appointment with a general practitioner who will prescribe the correct and dosed intake of anti-inflammatory drugs and substances that improve sputum expectoration, you may have to connect antibiotics to suppress pathogenic microbial flora. True, remember that antibiotics are completely ineffective in viral diseases - SARS, influenza, adenovirus infections. This will require powerful antiviral agents.

Neuralgic disorders. Treatment of intercostal neuralgia consists in the intramuscular injection of painkillers, B vitamins, non-steroidal anti-inflammatory drugs. Additionally, massage, manual therapy, physiotherapy, therapeutic physical culture (exercise therapy) are prescribed.

Heart neurosis. To cure cardioneurosis, you need to eliminate the cause of the disease and strengthen the body. It is recommended to avoid stressful situations, observe the daily routine and consume the maximum amount of fresh fruits, which contain vitamins and trace elements that help restore the nervous system. It is important to increase your own resistance to stress. And to increase stress resistance, you can take a course of relaxing massage. Acupuncture and vacuum therapy also have a beneficial effect on the nervous system, relieving excess tension. Doctors practice the use of herbal remedies that help get rid of excessive emotionality, as a result of which pain in the chest cavity and other symptoms of heart neurosis disappear.

Treatment stomach ulcers and duodenum aimed at eliminating the cause of its occurrence and healing the formed defect. Here you can not do without a diet. For the period of treatment, it is necessary to exclude fried and spicy dishes, freshly squeezed juices, sweets from the diet.

If the cause of the disease is helico–bacterium (Helicobacter pylori), you need to take a specific complex of antibiotics. Drugs are used that lower the acidity of gastric juice and restore the integrity of the mucous membrane of the stomach or duodenum. Severe pain will be relieved by antacids, for example Almagel-A with an analgesic element.

Vegetovascular dystonia I . To get rid of VVD, psychotropic drugs, substances that improve cerebral circulation and vitamin complexes are used. Physiotherapy also works well. The body needs to be strengthened, soothed and supported.

Chest hurts in the middle: when to see a doctor

As you can see from the above, chest pain in the middle is a rather unpleasant phenomenon that may indicate simple disorders or serious diseases.

When you need urgent medical attention

with severe pain in the chest, accompanied by fainting or a fit of coughing after physical exertion;
with burning pain or a feeling of strong bursting in the chest cavity, which radiates to the area of the left shoulder, neck or lower jaw;
with severe pain that does not go away within 15 minutes and does not get better after rest;
when there is a feeling of pressure inside the chest cavity, combined with an acceleration of the pulse, heavy breathing, sweating, dizziness, anxiety;
pain of high intensity with shortness of breath and the appearance of blood when coughing.

You need to visit a doctor:

for heartburn-like pains that do not go away after taking heartburn medications;
with recurring pain after eating, which relieve antacids.

Why does it hurt in the center of the chest?

Video channel "Catch the answer!". Why does the chest hurt?

Constant pain signals probable problems with the stomach, spine or pancreas. If the pain intensifies, this indicates the development of pathological processes in the organ and requires immediate medical attention.

Pain in the chest can be a consequence of strong psycho-emotional experiences. In this case, the pains are variable and differ in duration. In this case, sedatives usually help.

Pain in the chest area can be a symptom of a whole range of diseases. These may be signals of malfunctions of organs such as:

heart,
lungs,
spine,
liver,
stomach and duodenum.

If the symptoms are neglected, the disease can be fatal, so contacting a doctor here should be without delay. A full examination is necessary to identify the cause of the ailment, and hospitalization for an examination should not be neglected. A burning sensation and painful pressure means that an attack of angina pectoris or a myocardial infarction is possible.

Chest pain can cause:

Oncological diseases of the cardiovascular system, organs of the respiratory system, thoracic spine.
Cardiac ischemia.
Thromboembolism of the lungs - that is, blockage of blood vessels.
Perforation of gastric and duodenal ulcers is fraught with internal bleeding.
Pancreatitis.
Aortic dissection.
Heart attack.

Pain in the middle of the sternum often indicates that a person has problems with the internal organs of the respiratory system or abdominal cavity.
When diagnosing a problem, doctors work through all the options, so they prescribe a whole range of studies. During the diagnostic process, the functionality and structure are examined:

esophagus
hearts;
aorta;
trachea.

Aching pain can be accompanied by other unpleasant sensations. Other areas of the body are also examined, because underlying diseases can provoke the development of side problems. The location of pain is likely to indicate another ailment.

Self-diagnosis can be carried out by determining the type of pain. The conclusions made after this should not be taken as an official diagnosis, because only a qualified physician can make the right decisions. Dull pain in the sternum in the middle is most often a sign of:

diseases of the respiratory system and lungs;
diseases of the digestive tract or stomach;
chronic or acquired heart and vascular disease;
deviations in the structure or work of the spine in the thoracic region;
endocrinological diseases indicating problems in the functioning of the thyroid gland.

The pain that occurs in the center of the sternum may be systematic or episodic. In any case, it is necessary to seek the help of doctors. It often becomes impossible to get rid of unpleasant sensations without a detailed diagnosis and the appointment of the necessary treatment. Doctors will be able to determine the course of treatment only after conducting all the studies, tests and making an accurate diagnosis.

How to help a person with a sudden attack?

Systematic pain always indicates a serious illness, so in this case, the help of qualified specialists is the only way out. A strong sudden pain sensation can be deadly to a person, therefore, if it occurs, measures must be taken immediately. Urgently calling an ambulance will be the first step to getting rid of suffering.
There is a certain algorithm of actions that will help delay the peak of an attack and gain valuable time. Before the arrival of emergency assistance, you must do the following:

in the place of location of unpleasant sensations, apply a mustard plaster, a special plaster or pepper lotion;
make a compress based on camphor oil or ethyl alcohol;
apply an anesthetic (topical preparations are most often used);
take inside any of the modern analgesics;
take a specific dose of nitroglycerin (recommended only for people with chronic heart disease and heart failure).

The above actions will help to reduce pain as much as possible.

Practice shows that pain in the middle is most often a clear sign of diseases of the cardiovascular system.

Less common causes of pain in the center of the chest

Unpleasant sensations in the chest area may not be chronic or pathological in nature. A common cause of the problem is injury. The danger in this case is that the patient may not immediately feel a serious injury or even a fracture. The pain attack begins at any time, so help must be provided immediately.
The breast bone can be damaged in various situations:

accidents;
fights;
falls;
consequences of work.

The cause of the problem may lie not only in bone damage. Falls and accidents can damage the diaphragm, which is the muscular organ that separates the chest cavity from the peritoneum. Serious ruptures are fraught with internal hemorrhage, which are potentially life-threatening. Having established the symptoms of internal hemorrhage, it is urgent to call emergency care.
Pain in the middle of the sternum often worries athletes who are used to constantly increasing the level of physical activity. The discomfort that occurs after two hours of intense training is not a reason to call an ambulance. Despite this, it is necessary to consult with doctors in order to exclude the possibility of pathological or exacerbation of chronic ailments.

Pain when inhaling

Doctors distinguish six groups of diseases, a symptom of which may be pain in the sternum in the middle when exhaling, inhaling or pressing:

chronic infectious diseases of the respiratory tract (pneumonia, tracheitis, bronchitis, laryngitis);
disorders of the heart and blood vessels (aneurysms, heart attacks, pericarditis, coronary syndrome);
disorders in the functioning of the pulmonary system (benign and malignant tumors, metastases, injuries);
violation of the structure of the ribs and the vertebral trunk;
ailments caused by a malfunction of the nervous system.

How to determine the stage of the disease?

Burning pain in the middle of the sternum may indicate an actively developing disease. Unpleasant sensations in the chest area must be quickly diagnosed by establishing the degree of pain in order to protect a person from possible consequences. Signs of a serious illness may include:

unbearable pain in the center of the chest;
strong loud cough;
blood and mucous secretions;
Dyspnea;
uneven breathing.

All of the above symptoms indicate the presence of a dangerous progressive disease. In this situation, a person needs to be helped immediately.

Pain in osteochondrosis of the thoracic spine

Unpleasant sensations in the middle of the sternum can also be a symptom of a disease of the musculoskeletal system. Compression in the chest area may be accompanied in this case by the following:

pain in the center of the back (especially noticeable when tilting the body and raising the arms);
decreased sensitivity of the upper and lower extremities;
problems in the digestive tract;
deviations in the work of the male reproductive system (in exceptional cases);
pressure in the region of the heart muscle.

Diseases of the spine are fraught with serious consequences. Inactivity can lead to deterioration in the functioning of the kidneys, liver and pancreas. The main rule for the prevention of the disease is to maintain an active lifestyle.
People who lead an inactive lifestyle fall into the risk zone, as a result of which, the vertebral discs lose their functionality, cartilage tissue is destroyed. Proper nutrition also plays a big role in spinal health.

Prevention of chest pain

Quitting bad habits can be the first step in dealing with bad feelings. Smoking and alcohol abuse adversely affects the cardiovascular system:

violation of the heart rhythm;
loss of vascular elasticity;
narrowing of arterial lumens;
failure of the normal heart rhythm;
increase in blood pressure.

No one is immune from injuries, which often lead to deformation of the bones of the chest and diaphragm. When playing sports, follow a normal training regimen, alternate work with rest, provide your body with a high level of protection.

Timely treatment of infectious diseases of the upper respiratory tract will reduce the risk of pain to a minimum. Systematic physical education will increase the tone of not only external, but also internal muscles. Improving the work of the heart muscle will favorably reflect on the general state of health.
For people who are forced to work at a computer, the health of the spine should come first. From chronic discomfort in the area of the shoulder blades and the thoracic spine will help get rid of:

systematic physical education;
dousing;
comfortable and correct working conditions;
spa treatments, massages;
bath procedures;
healthy food.

The heart, lungs, esophagus and large vessels receive afferent innervation from the same thoracic nerve ganglion. Pain impulses from these organs are most often perceived as chest pain, but since there is a decussation of afferent nerve fibers in the dorsal ganglia, chest pain can be felt anywhere between the epigastric region and the jugular fossa, including the arms and shoulders (as referred pain).

Pain impulses from the organs of the chest cavity can cause discomfort, described as pressure, fullness, burning, aching and sometimes sharp pain. Since these sensations have a visceral basis, many patients describe them as pain, although it is more accurate to interpret them as discomfort.

With an aortic dissection, the pain is usually very severe, peaks immediately, and usually radiates to the back.

Pain in the chest with massive pulmonary embolism is often very similar to pain in a heart attack, but at the same time, severe shortness of breath is almost always noted (an increase in respiratory rate - tachypnea). In the event of a pulmonary infarction, after 3-4 days, pains appear on one side of the chest of a pleural nature (aggravated by deep breathing and coughing). Diagnosis is facilitated by taking into account risk factors for pulmonary embolism and the absence of signs of infarction on the ECG. Clarification of the diagnosis is carried out after hospitalization.

Pericarditis is characterized by increased pain with deep breathing, coughing, swallowing, in the supine position. Often the pain radiates to the trapezius muscles. The pain is relieved by bending forward or lying on the stomach.

The main extracardiac diseases in which chest pains are noted include diseases of the lungs, gastrointestinal tract, spine and chest wall.

In diseases of the lungs and pleura, pain is usually on the one hand, in the lateral sections of the chest, aggravated by breathing, coughing, moving the body. Diseases of the esophagus and stomach most often cause sensations such as heartburn, burning, which are associated with food intake and are often aggravated in the supine position. In emergency conditions, the pain can be acute ("dagger"). Diagnosis is facilitated by the absence of a history of angina pectoris, identification of a connection with food intake, pain relief in a sitting position, after taking antacids. Pain caused by damage to the spine and chest wall is characterized by the appearance or intensification during movements of the trunk, pain on palpation.

Thus, chest pain caused by extracardiac diseases is almost always markedly different from pain in the typical course of diseases of the cardiovascular system.

Many people have pain in the region of the heart of a "neurotic" nature ("neurocirculatory dystonia"). Neurotic pains are most often felt on the left in the region of the apex of the heart (in the region of the nipple). In most cases, you can indicate the place of pain with your finger. Most often, neurotic pains of two types are observed: acute, short-term pains of a “piercing” nature that do not allow inhalation, or prolonged aching pains in the region of the heart for several hours or almost constant. Neurotic pains are often accompanied by severe dyspnea and restlessness, up to the so-called panic disorders, and in these cases, the differential diagnosis from acute coronary syndrome and other emergency conditions can be quite difficult.

Thus, with typical manifestations of the pain syndrome, it is quite easy to establish the diagnosis of all the listed urgent cardiac conditions. Pain in the chest caused by extra-cardiac pathology, with a typical clinical picture, also always differs markedly from pain in lesions of the cardiovascular system. Difficulties arise with atypical or completely atypical manifestations of both cardiovascular and extracardiac diseases.

After hospitalization and examination of patients with chest pain, 15-70% are diagnosed with acute coronary syndrome, about 1-2% - pulmonary embolism or other cardiovascular diseases, in the rest of patients the cause of chest pain is extracardiac diseases.

Symptoms of chest pain

The symptoms that appear in severe diseases of the chest cavity are often very similar, but sometimes they can be differentiated.

Unbearable pain radiating to the neck or arm indicates acute ischemia or myocardial infarction. Patients often compare myocardial ischemic pain with dyspepsia.
Pain associated with exertion, disappearing at rest, is characteristic of exertional angina.
Excruciating pain radiating to the back indicates dissection of the thoracic aorta.
Burning pain radiating from the epigastric region to the throat, aggravated by lying down and relieved by taking antacids, is a sign of GERD.
High body temperature, chills, and coughing are indicative of pneumonia.
Severe dyspnea occurs with pulmonary embolism and pneumonia.
Pain can be triggered by breathing, movement, or both in both severe and mild illnesses; these triggers are not specific.
Short (less than 5 seconds), sharp, intermittent pain is rarely a sign of a serious pathology.

Objective examination

Symptoms such as tachycardia, bradycardia, tachypnea, hypotension, or signs of circulatory problems (eg, confusion, cyanosis, sweating) are nonspecific, but their presence increases the likelihood that the patient has a serious illness.

Lack of conduction of breath sounds on the one hand is a sign of pneumothorax; resonant percussion sound and swelling of the jugular veins testify in favor of a tension pneumothorax. Fever and wheezing are symptoms of pneumonia. Fever is possible with pulmonary embolism, pericarditis, acute myocardial infarction, or rupture of the esophagus. Pericardial friction rub is in favor of pericarditis. The appearance of an IV heart sound (S 4), a late systolic murmur of papillary muscle dysfunction, or both of these signs appear with myocardial infarction. Local CNS lesions, aortic regurgitation murmur, pulse asymmetry or blood pressure in the arms are symptoms of thoracic aortic dissection. Swelling and tenderness of the lower extremity are indicative of deep vein thrombosis and thus a possible pulmonary embolism. Chest pain on palpation occurs in 15% of patients with acute myocardial infarction, this symptom is not specific for diseases of the chest wall.

Additional research methods

The minimum examination of a patient with chest pain includes pulse oximetry, ECG, and chest x-ray. Adults are often tested for markers of myocardial injury. The results of these tests, together with the data of the anamnesis and physical examination, allow a presumptive diagnosis to be made. A blood test is often not available at the initial examination. Separate normal indicators of markers of myocardial damage cannot be the basis for excluding heart damage. In the event that myocardial ischemia is likely, studies should be repeated several times, as well as

Pain in the chest can be manifested by diseases of the heart, respiratory organs, gastrointestinal tract, spine, mediastinum, central nervous system. All internal organs of a person are innervated by the autonomic nervous system, the trunks of which extend from the spinal cord. When approaching the chest, the nerve trunk gives off branches to individual organs. That is why sometimes pains in the stomach can be felt as pains in the heart - they are simply transmitted to the common trunk, and from it to another organ. Moreover, the spinal nerve roots contain sensory nerves that innervate the musculoskeletal system. The fibers of these nerves are intertwined with the fibers of the nerves of the autonomic nervous system, and therefore a perfectly healthy heart can respond with pain in various diseases of the spine.

Finally, chest pains may depend on the state of the central nervous system: with constant stress and high neuropsychic stress, a malfunction occurs in its work - neurosis, which can also manifest itself as pain in the chest.

Some chest pains are unpleasant, but not life-threatening, but there are chest pains that need to be removed immediately - a person's life depends on it. In order to understand how dangerous chest pain is, you need to see a doctor.

Chest pain caused by obstruction of the coronary (heart) arteries

The coronary arteries carry blood to the heart muscle (myocardium), which works non-stop throughout life. The myocardium cannot even do without a new portion of oxygen and nutrients delivered with the blood for even a few seconds; its cells immediately begin to suffer from this. If the blood supply is interrupted for several minutes, then myocardial cells begin to die. The larger the coronary artery suddenly becomes obstructed, the larger the area of the myocardium is affected.

Spasms (compression) of the coronary arteries usually occur against the background of coronary heart disease (CHD), the cause of which is partial blockage of blood vessels by atherosclerotic plaques and narrowing of their lumen. Therefore, even a slight spasm can block the access of blood to the myocardium.

A person feels such changes in the form of a sharp penetrating pain behind the sternum, which can radiate to the left shoulder blade and to the left hand, up to the little finger. The pain can be so severe that the patient tries not to breathe - respiratory movements increase the pain. With severe attacks, the patient turns pale, or, conversely, blushes, his blood pressure, as a rule, rises.

Such chest pains can be short-lived and occur only with physical or mental exertion (angina pectoris), or they can occur on their own, even during sleep (rest angina). It is difficult to get used to angina attacks, so they are often accompanied by panic and fear of death, which further increases the spasm of the coronary vessels. Therefore, it is so important to clearly know what to do during an attack and have everything you need at hand. The attack ends as suddenly as it began, after which the patient feels a complete loss of strength.

The peculiarity of these pains is that in no case should a person endure them - they must be removed immediately. You can’t do without consulting a doctor here - he will prescribe both the course of the main treatment and the medicine that needs to be taken when pain occurs (the patient should have it with him at all times). Usually, in emergency cases, a nitroglycerin tablet is taken under the tongue, which relieves pain within 1 to 2 minutes. If after 2 minutes the pain has not disappeared, then the pill is taken again, and if this does not help, then you should immediately call an ambulance.

What can happen if you endure chest pain? The cells of the myocardial area, which is supplied by the affected artery, begin to die (myocardial infarction) - the pain intensifies, becomes unbearable, a person often has a pain shock with a sharp decrease in blood pressure and acute heart failure (the heart muscle does not cope with its work). It is possible to help such a patient only in a hospital setting.

A sign of the transition of an angina attack to myocardial infarction is the increase in pain and the lack of effect from the use of nitroglycerin. The pain in this case has a pressing, squeezing, burning character, begins behind the sternum, and then can spread to the entire chest and abdomen. The pain can be continuous or in the form of repeated attacks one after another, increasing in intensity and duration. There are cases when the pain in the chest is not very strong and then patients often suffer myocardial infarction on their legs, which can cause an instant disruption of the heart and death of the patient.

There are also atypical (atypical) forms of myocardial infarction, when the pain begins, for example, in the region of the anterior or posterior surface of the neck, lower jaw, left arm, left little finger, left shoulder blade, etc. Most often, such forms are found in older people and are accompanied by weakness, pallor, cyanosis of the lips and fingertips, heart rhythm disturbances, and a drop in blood pressure.

Another atypical form of myocardial infarction is the abdominal form, when the patient feels pain not in the region of the heart, but in the abdomen, usually in its upper part or in the region of the right hypochondrium. Such pain is often accompanied by nausea, vomiting, loose stools, and bloating. The condition is sometimes very similar to intestinal obstruction.

Chest pain caused by changes in the central nervous system

Chest pain can also occur with other diseases. One of the most common diseases that cause frequent and prolonged pain in the chest is cardioneurosis, which develops against the background of a temporary functional disorder of the central nervous system. Neuroses are the body's response to various mental shocks (intense short-term or less intense, but long-lasting).

Pain in cardioneurosis can be of a different nature, but most often they are constant, aching and are felt in the region of the apex of the heart (in the lower part of the left half of the chest). Sometimes pain in cardioneurosis can resemble pain in angina pectoris (short-term acute), but they do not decrease from taking nitroglycerin. Often, attacks of pain are accompanied by reactions from the autonomic nervous system in the form of redness of the face, moderate palpitations, and a slight increase in blood pressure. With cardioneurosis, there are almost always other signs of neuroses - increased anxiety, irritable weakness, etc. Helps with cardioneurosis elimination of psycho-traumatic circumstances, the correct regimen of the day, sedatives, in case of sleep disorders - sleeping pills.

Sometimes cardioneurosis is difficult to distinguish from coronary heart disease (CHD), the diagnosis is usually established on the basis of careful observation of the patient, since there may be no changes on the ECG in either case.

A similar picture can be caused by changes in the heart during menopause. These disorders are caused by a change in the hormonal background, resulting in neurosis and a violation of metabolic processes in the heart muscle (climacteric myocardiopathy). At the same time, pain in the heart is combined with the characteristic manifestations of menopause: flushing of blood to the face, bouts of sweating, chills and various sensitivity disorders in the form of "goosebumps", insensitivity of certain areas of the skin, etc. Just like with cardioneurosis, pain in the heart is not relieved by nitroglycerin, sedatives and hormone replacement therapy help.

Pain in the chest caused by inflammatory processes in the region of the heart

The heart has three layers: outer (pericardium), middle muscular (myocardium) and inner (endocardium). An inflammatory process can occur in any of them, but pain in the heart is characteristic of myocarditis and pericarditis.

Myocarditis (an inflammatory process in the myocardium) can occur as a complication of some inflammatory (eg, purulent tonsillitis) or infectious-allergic (eg, rheumatism) processes, as well as toxic effects (eg, certain drugs). Myocarditis usually occurs a few weeks after the disease. One of the most common complaints of patients with myocarditis is pain in the region of the heart. In some cases, chest pain may resemble the pain of angina pectoris, but they last longer and do not go away with nitroglycerin. In this case, they may well be confused with pain in myocardial infarction. Pain in the heart may not occur behind the sternum, but more to the left of it, such pain appears and intensifies during physical exertion, but it is also possible at rest. Chest pain may recur many times during the day or be almost continuous. Often chest pain is stabbing or aching in nature and does not radiate to other parts of the body. Often pain in the heart is accompanied by shortness of breath and attacks of suffocation at night. Myocarditis requires careful examination and long-term treatment of the patient. Treatment primarily depends on the cause of the disease.

Pericarditis is an inflammation of the outer serous membrane of the heart, which consists of two sheets. Most often, pericarditis is a complication of various infectious and non-infectious diseases. It can be dry (without accumulation of inflammatory fluid between the sheets of the pericardium) and exudative (inflammatory fluid accumulates between the sheets of the pericardium). Pericarditis is characterized by dull monotonous chest pain, most often the pain is moderate, but sometimes they become very strong and resemble an angina attack. Pain in the chest depends on respiratory movements and changes in body position, so the patient is tense, breathes shallowly, tries not to make unnecessary movements. Chest pain is usually localized on the left, above the region of the heart, but sometimes spreads to other areas - to the sternum, upper abdomen, under the shoulder blade. These pains are usually combined with fever, chills, general malaise and inflammatory changes in the general blood test (a large number of leukocytes, accelerated ESR). Treatment of pericarditis is long, it usually begins in a hospital, then continues on an outpatient basis.

Other chest pain associated with the cardiovascular system

Often the cause of pain in the chest are diseases of the aorta - a large blood vessel that departs from the left ventricle of the heart and carries arterial blood through the systemic circulation. The most common disease is aortic aneurysm.

An aneurysm of the thoracic aorta is an expansion of the aortic section due to a violation of the connective tissue structures of its walls due to atherosclerosis, inflammatory lesions, congenital inferiority, or due to mechanical damage to the aortic wall, for example, in trauma.

In most cases, aneurysm is of atherosclerotic origin. At the same time, patients may be disturbed by prolonged (up to several days) chest pains, especially in the upper third of the sternum, which, as a rule, do not radiate to the back and left arm. Often the pain is associated with physical activity, does not resemble after taking nitroglycerin.

A terrible consequence of an aortic aneurysm is its breakthrough with fatal bleeding into the respiratory organs, pleural cavity, pericardium, esophagus, large vessels of the chest cavity, out through the skin in case of chest injury. In this case, there is a sharp pain behind the sternum, a drop in blood pressure, shock and collapse.

A dissecting aortic aneurysm is a channel formed in the thickness of the aortic wall due to its dissection with blood. The appearance of a bundle is accompanied by a sharp arching retrosternal pain in the region of the heart, a severe general condition, and often loss of consciousness. The patient needs emergency medical care. An aortic aneurysm is usually treated with surgery.

No less serious disease is thromboembolism (blockage by a detached thrombus - embolus) of the pulmonary artery, which extends from the right ventricle and carries venous blood to the lungs. An early symptom of this debilitating condition is often severe chest pain, sometimes very similar to angina pain, but usually not radiating to other areas of the body and aggravated by inhalation. The pain continues for several hours, despite the introduction of painkillers. The pain is usually accompanied by shortness of breath, cyanosis of the skin, a strong heartbeat and a sharp decrease in blood pressure. The patient needs emergency medical care in a specialized department. In severe cases, a surgical operation is performed - removal of the embolus (embolectomy)

Pain in the chest with diseases of the stomach

Stomach pain can sometimes feel like chest pain and is often mistaken for heart pain. Usually such chest pains are the result of spasms of the muscles of the stomach wall. These pains are more prolonged than those of the heart and are usually accompanied by other characteristic features.

For example, chest pain is most often associated with eating. Pain can occur on an empty stomach and disappear from eating, occur at night, after a certain time after eating, etc. There are also such symptoms of a stomach disease as nausea, vomiting, etc.

Pain in the stomach is not relieved by nitroglycerin, but they can be relieved with antispasmodics (papaverine, no-shpy, etc.) - drugs that relieve spasm of the muscles of internal organs.

The same pain can occur in some diseases of the esophagus, diaphragmatic hernia. - this is an exit through an enlarged opening in the diaphragm (the muscle that separates the chest cavity from the abdominal cavity) of the stomach and some other parts of the gastrointestinal tract. When the diaphragm contracts, these organs are compressed. Diaphragmatic hernia is manifested by the sudden appearance (often this happens at night when the patient is in a horizontal position) of severe pain, sometimes similar to pain in angina pectoris. From taking nitroglycerin, such pain does not go away, but it becomes less when the patient moves to a vertical position.

Severe pain in the chest can also occur with spasms of the gallbladder and bile ducts. Despite the fact that the liver is located in the right hypochondrium, pain can occur behind the sternum and radiate to the left side of the chest. Such pain is also relieved by antispasmodics.

It can be confused with heart pain pain in acute pancreatitis. The pain in this case is so severe that it resembles a myocardial infarction. They are accompanied by nausea and vomiting (this is also common in myocardial infarction). These pains are very difficult to remove. Usually this can only be done in a hospital during intensive treatment.

Chest pain in diseases of the spine and ribs

Pain in the chest, very reminiscent of heart pain, can occur with various diseases of the spine, for example, with osteochondrosis, herniated discs, ankylosing spondylitis, etc.

Osteochondrosis is dystrophic (exchange) changes in the spine. As a result of malnutrition or high physical exertion, bone and cartilage tissue, as well as special elastic pads between individual vertebrae (intervertebral discs), are gradually destroyed. Such changes cause compression of the roots of the spinal nerves, which causes pain. If changes occur in the thoracic spine, then the pain may be similar to pain in the heart or pain in the gastrointestinal tract. The pain may be constant or in the form of attacks, but it always increases with sudden movements. Such pain cannot be relieved with nitroglycerin or antispasmodics, it can only be reduced by pain medications or heat.

Pain in the chest area can occur when the ribs are fractured. These pains are associated with trauma, aggravated by deep inspiration and movement.

Chest pain in lung disease

The lungs occupy a large part of the chest. Pain in the chest can occur against the background of inflammatory diseases of the lungs, pleura, bronchi and trachea, with various injuries of the lungs and pleura, tumors and other diseases.

Especially often, chest pains occur with a disease of the pleura (a serous sac that covers the lungs and consists of two sheets, between which the pleural cavity is located). With inflammation of the pleura, pain is usually associated with coughing, deep breathing and is accompanied by fever. Sometimes such pains can be confused with heart pains, for example, with pains at a pericarditis. Very severe chest pains appear when lung cancer grows into the pleura.

In some cases, air (pneumothorax) or fluid (hydrothorax) enters the pleural cavity. This can happen with a lung abscess, pulmonary tuberculosis, etc. With spontaneous (spontaneous) pneumothorax, there is a sharp sudden pain, shortness of breath, cyanosis, and blood pressure decreases. The patient has difficulty breathing and moving. The air irritates the pleura, causing severe stabbing pain in the chest (in the side, on the side of the lesion), extending to the neck, upper limb, sometimes to the upper abdomen. The patient's chest volume increases, the intercostal spaces expand. Help for such a patient can only be provided in a hospital.

The pleura can also be affected by periodic disease - a genetic disease manifested by periodic inflammation of the serous membranes covering the internal cavities. One of the variants of the course of periodic illness is thoracic, with damage to the pleura. This disease manifests itself in the same way as pleurisy, occurring in one or the other half of the chest, rarely in both, causing the same complaints in patients. Like pleurisy. All signs of an exacerbation of the disease usually disappear spontaneously after 3 to 7 days.

Chest pain associated with the mediastinum

Pain in the chest can also be caused by air entering the mediastinum - a part of the chest cavity, bounded in front by the sternum, behind - by the spine, from the sides - by the pleura of the right and left lungs and from below - by the diaphragm. This condition is called mediastinal emphysema and occurs when air enters from the outside with injuries or from the respiratory tract, the esophagus in various diseases (spontaneous mediastinal emphysema). In this case, there is a feeling of pressure or pain in the chest, hoarseness, shortness of breath. The condition can be severe and requires emergency care.

What to do for chest pain

Chest pain can be of different origin, but very similar to each other. Such pains, similar in sensation, sometimes require completely different treatment. Therefore, when pain occurs in the chest, it is necessary to consult a doctor who will prescribe an examination in order to identify the cause of the disease. Only after that it will be possible to prescribe the correct adequate treatment.

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, pain occurs 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:

in the middle of the chest;
on the left side of the body, slightly above the waist;
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:

x-ray (if necessary);
fluorography;
examination for external manifestations;
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 it was previously noted). All these actions will help doctors to take appropriate measures, and in a short time to improve the patient's condition.