What to do if the chest in the middle hurts. Why does severe sharp or aching chest pain appear in the middle

The main causes of pain between the breasts:

• diseases of the musculoskeletal system: costal chondritis, rib fracture;
• cardiovascular disease: cardiac ischemia caused by atherosclerosis of the heart vessels; unstable / stable angina pectoris; cardiac ischemia caused by coronary vasospasm (angina pectoris); mitral valve prolapse syndrome; cardiac arrhythmia; pericarditis.
• gastrointestinal diseases: gastroesophageal reflux, esophageal spasm, stomach and duodenal ulcer, gall bladder disease;
• anxiety conditions: vague anxiety or "stress", panic disorder;
• pulmonary diseases: pleurodinia (pleuralgia), acute bronchitis, pneumonia;
• neurological diseases;
• uncharacteristic definite or atypical pain between the breasts.

Pain between the breasts is not limited to a specific age group, but is more common in adults than in children. The highest percentage is observed among adults over 65 years old, and in second place are male patients aged 45 to 65 years.

Frequency of diagnosis, by age and gender

	Age Group (years)	The most common diagnoses
		1. Gastroesophageal reflux
		2. Muscle pain in the chest wall
		3. Rib chondritis
		2. Muscle pain in the chest wall
	65 and more
		2. "Atypical" pain between the breasts or coronary arterial disease
		1. Rib chondritis
		2. Anxiety / stress
		1. Muscle pain in the chest wall
		2. Rib chondritis
		3. “Atypical” pain between the breasts
		4. Gastroesophageal reflux
		1. Angina pectoris, unstable angina pectoris, myocardial infarction
		2. “Atypical” pain between the breasts
		3. Muscle pain in the chest wall
	65 and more	1. Angina pectoris, unstable angina pectoris, myocardial infarction
		2. Muscle pain in the chest wall
		3. “Atypical” pain between the breasts or costal chondritis

No less difficult is the position of the doctor in the initial interpretation of pain, when he tries to connect it with the pathology of one or another organ. The observation of clinicians of the last century helped them formulate assumptions about the pathogenesis of pain - if an attack of pain occurs for no reason and stops on its own, then the pain is likely to be functional. The works devoted to a detailed analysis of pain between the breasts are few; the groupings of pain offered in them are far from perfect. These shortcomings are due to objective difficulties in analyzing the patient's sensations.

The difficulty in interpreting pain in the chest is also due to the fact that the detected pathology of one or another organ of the chest or musculoskeletal system does not mean that it is the source of pain; in other words, the identification of the disease does not mean that the cause of the pain is precisely defined.

When evaluating patients with pain between the breasts, the doctor must weigh all the relevant options for the potential causes of pain, determine when the intervention is necessary, and make a choice among an almost unlimited number of diagnostic and therapeutic strategies. All this must be done while reacting to the distress experienced by patients who are concerned about the presence of a life-threatening disease. The difficulty in diagnosis is further complicated by the fact that pain between the breasts is often a complex interaction of psychological, pathological and psychosocial factors. This makes it the most common problem in primary care.

When considering pain between the breasts, it is necessary to take into account (at least) the following five elements: predisposing factors; characterization of an attack of pain; duration of pain episodes; characteristic of the actual pain; pain relieving factors.

For all the variety of causes that cause pain in the chest, pain syndromes can be grouped.

Approaches to groups may be different, but they are mainly built on a nosological or organ principle.

Conventionally, the following 6 groups of causes of pain between breasts can be distinguished:

1. Pain caused by heart disease (the so-called heart pain). These pain can be the result of damage or dysfunction of the coronary arteries - coronarogenic pain. In the origin of non-coronarogenic pain, the "coronary component" does not participate. In the future, we will use the terms "heart pain syndrome", "heart pain", understanding their relationship with a particular heart pathology.
2. Pain caused by pathology of large vessels (aorta, pulmonary artery and its branching).
3. Pain due to pathology of the bronchopulmonary apparatus and pleura.
4. Pain associated with pathology of the spine, anterior chest wall and muscles of the shoulder girdle.
5. Pain due to pathology of the mediastinal organs.
6. Pain associated with diseases of the abdominal cavity and diaphragm pathology.

Pain in the chest area is also divided into acute and long-term, with a clear cause and without a visible reason, “non-hazardous” and pain, which are a manifestation of life-threatening conditions. Naturally, it is first necessary to establish whether pain is dangerous or not. “Dangerous” pains include all types of anginal (coronary) pain, pain with pulmonary thromboembolism (PE), stratified aortic aneurysm, and spontaneous pneumothorax. To "non-dangerous" - pain in the pathology of intercostal muscles, nerves, bone and cartilage formations of the chest. “Dangerous” pains are accompanied by a suddenly developed severe condition or severe disorders of the heart or breathing, which immediately allows you to narrow the range of possible diseases (acute myocardial infarction, pulmonary embolism, exfoliating aortic aneurysm, spontaneous pneumothorax).

The main causes of acute pain between the breasts, which are life-threatening:

• cardiac: acute or unstable angina pectoris, myocardial infarction, stratified aortic aneurysm;
• pulmonary: pulmonary embolism; intense pneumothorax.

It should be noted that the correct interpretation of pain between the breasts is quite possible with the usual physical examination of the patient using the minimum number of instrumental methods (conventional electrocardiographic and radiological examination). An erroneous initial idea of \u200b\u200bthe source of pain, in addition to increasing the duration of the examination of the patient, often leads to serious consequences.

Anamnesis and physical examination data to determine the causes of pain between the breasts

Medical history
	Heart	Gastrointestinal	Musculoskeletal
Predisposing factors	Male gender. Smoking. High blood pressure. Hyperlipidemia. Myocardial infarction in a family history	Smoking. Alcohol consumption	Physical activity. A new type of activity. Abuse Repeating actions
Characteristic of a pain attack	With high levels of stress or emotional stress	After eating and / or on an empty stomach	When active or after
Pain duration		From a few minutes to several hours	Hours to days
Pain characteristic	Pressure or burning	Pressure or boring pain	Sharp, local, caused by movements
Pain Relieving Factors	Nitropreparations under the tongue	Eating Antacids. Antihistamines	Recreation. Analgesics. Nonsteroidal anti-inflammatory drugs
Supporting data	With angina attacks, rhythm disturbances or noise are possible	Soreness in the epigastric region	Pain on palpation at paravertebral points, at the sites of exit of the intercostal nerves, pain of the periosteum

Cardialgia (non-anginal pain). Cardialgia due to certain heart diseases is very common. In terms of origin, significance and place in the structure of the incidence of the population, this group of pains is extremely heterogeneous. The causes of such pain and their pathogenesis are very diverse. The diseases or conditions in which cardialgia is observed are as follows:

1. Primary or secondary cardiovascular functional disorders - the so-called cardiovascular syndrome of the neurotic type or neurocirculatory dystonia.
2. Pericardial Disease
3. Inflammatory myocardial diseases.
4. Dystrophy of the heart muscle (anemia, progressive muscular dystrophy, alcoholism, vitamin deficiency or starvation, hyperthyroidism, hypothyroidism, catecholamine effects).

As a rule, non-anginal pains are benign, since they are not accompanied by coronary insufficiency and do not lead to the development of ischemia or myocardial necrosis. However, in patients with functional disorders that lead to an increase (usually short-term) in the level of biologically active substances (catecholamines), the likelihood of developing ischemia still exists.

Pain between the breasts of neurotic origin. We are talking about pain in the heart, as one of the manifestations of neurosis or neurocirculatory dystonia (vegetative-vascular dystonia). Usually these are pains of aching or stitching nature, of different intensity, sometimes long (hours, days) or, conversely, very short-term, instant, piercing. The localization of these pains is very different, not always constant, almost never retrosternal. Pain can intensify during physical exertion, but usually with psycho-emotional stress, fatigue, without a clear effect of nitroglycerin, they do not decrease at rest, and sometimes, on the contrary, patients feel better when moving. The diagnosis takes into account the presence of signs of a neurotic state, autonomic dysfunction (sweating, dermographism, low-grade fever, fluctuations in heart rate and blood pressure), as well as young or middle-aged patients, mainly females. These patients have increased fatigue, decreased exercise tolerance, anxiety, depression, phobias, pulse fluctuations, and blood pressure. In contrast to the severity of subjective disorders, an objective study, including using various additional methods, does not reveal a specific pathology.

Sometimes, among these symptoms of neurotic origin, the so-called hyperventilation syndrome is detected. This syndrome is manifested by voluntary or involuntary increase and deepening of respiratory movements, tachycardia, arising in connection with adverse psychoemotional influences. In this case, pain between the breasts, as well as paresthesia and muscle twitching in the limbs may occur in connection with the occurring respiratory alkalosis. There are observations (incompletely confirmed), indicating that hyperventilation can lead to a decrease in myocardial oxygen consumption and provoke coronary spasm with pain and ECG changes. It is possible that it is hyperventilation that can cause pain in the region of the heart during a physical exercise test in individuals with vegetative-vascular dystonia.

To diagnose this syndrome, a provocative test with induced hyperventilation is performed. The patient is asked to breathe more deeply - 30-40 times per minute for 3-5 minutes or until the usual symptoms for the patient appear (pain between the chests, headaches, dizziness, shortness of breath, sometimes fainting). The appearance of these symptoms during the test or 3-8 minutes after its completion with the exclusion of other causes of pain has a very definite diagnostic value.

Hyperventilation in some patients may be accompanied by aerophagia with the appearance of pain or a feeling of heaviness in the upper part of the epigastric region due to distention of the stomach. These pains can spread upward, behind the sternum, into the neck and region of the left shoulder blade, simulating angina pectoris. Such pain intensifies with pressure on the epigastric region, while lying on the stomach, with deep breathing, and decreases with belching of air. With percussion, an expansion of the Traube space zone is found, including tympanitis over the region of absolute dullness of the heart; with fluoroscopy, an enlarged gastric bladder. Similar pains can occur when the gases in the left corner of the colon are distended. In this case, the pain is often associated with constipation and is relieved after bowel movements. A thorough history usually allows one to determine the true nature of the pain.

The pathogenesis of cardiac pain during neurocirculatory dystonia is unclear, due to the impossibility of their experimental reproduction and confirmation in the clinic and experiment, in contrast to anginal pain. Perhaps, in connection with this circumstance, a number of researchers generally question the presence of pain in the heart with neurocirculatory dystonia. Similar trends are most common among representatives of the psychosomatic direction in medicine. According to their views, we are talking about the transformation of psycho-emotional disorders into pain.

The origin of pain in the heart in neurotic conditions is also explained by the cortico-visceral theory, according to which, with irritation of the autonomic devices of the heart, a pathological dominant in the central nervous system arises with the formation of a vicious circle. There is reason to believe that heart pain with neurocirculatory dystonia occurs as a result of impaired myocardial metabolism due to excessive adrenal stimulation. At the same time, there is a decrease in the content of intracellular potassium, activation of dehydrogenation processes, an increase in the level of lactic acid and an increase in the oxygen demand of the myocardium. Hyperlactatemia is a well-proven fact in neurocirculatory dystonia.

Clinical observations, indicating a close relationship of pain in the heart and emotional influences, confirm the role of catecholamines as a trigger for pain. This position is supported by the fact that when intravenously administering isadrine to patients with neurocirculatory dystonia, they experience pain in the heart area such as cardialgia. Obviously, catecholamine stimulation can also explain the provocation of cardialgia breakdown with hyperventilation, as well as its occurrence at the height of respiratory disorders in neurocirculatory dystonia. This mechanism can also be confirmed by the positive results of the treatment of cardialgia with breathing exercises aimed at eliminating hyperventilation. A certain role in the formation and maintenance of cardiac pain in neurocirculatory dystonia is played by the flow of pathological impulses coming from hyperalgesia zones in the area of \u200b\u200bthe muscles of the anterior chest wall to the corresponding segments of the spinal cord, where, according to the “portal” theory, the phenomenon of summation arises. In this case, a reverse flow of impulses is noted, causing irritation of the thoracic sympathetic ganglia. Of course, the low threshold of pain sensitivity in vegetative-vascular dystonia also matters.

In the occurrence of pain, factors that are still not well understood can play a role, such as a violation of microcirculation, changes in the rheological properties of blood, and an increase in the activity of the kinincallicrein system. It is possible that with the prolonged existence of severe vegetative-vascular dystonia, its transition to ischemic heart disease with unchanged coronary arteries is possible, in which pain is caused by spasm of the coronary arteries. In a directed study of a group of patients with proven coronary artery disease with unchanged coronary arteries, it was found that all of them in the past suffered from severe neurocirculatory dystonia.

In addition to vegetative-vascular dystonia, cardialgia is also observed in other diseases, but the pain is less pronounced and usually never comes to the fore in the clinical picture of the disease.

The origin of pain with damage to the pericardium is quite understandable, since there are sensitive nerve endings in the pericardium. Moreover, it was shown that the irritation of certain zones of the pericardium gives different localization of pain. For example, irritation of the pericardium on the right causes pain in the right mid-clavicular line, and irritation of the pericardium in the left ventricle is accompanied by pain spreading along the inner surface of the left shoulder.

Pain with myocarditis of various origins is a very common symptom. Their intensity is usually low, but in 20% of cases they have to be differentiated from pain due to coronary heart disease. Pain in myocarditis is probably associated with irritation of the nerve endings located in the epicardium, as well as with inflammatory myocardial edema (in the acute phase of the disease).

The origin of pain in myocardial dystrophies of various origins is even more uncertain. Probably, the pain syndrome is caused by a violation of the myocardial metabolism, the concept of local tissue hormones, convincingly presented by N.R. Paleev et al. (1982), may shed light on the causes of pain. In some myocardial dystrophies (due to anemia or chronic carbon monoxide poisoning), pain can be of mixed origin, in particular the ischemic (coronary) component is essential.

It is worth analyzing the causes of pain in patients with myocardial hypertrophy (due to pulmonary or systemic hypertension, valvular heart defects), as well as in primary cardiomyopathies (hypertrophic and dilated). Formally, these diseases are mentioned in the second section of anginal pain, due to an increase in myocardial oxygen demand with unchanged coronary arteries (the so-called non-coronarogenic forms). However, in these pathological conditions, in some cases, adverse hemodynamic factors arise that cause relative myocardial ischemia. It is believed that pain such as angina pectoris observed in aortic insufficiency depends primarily on low diastolic pressure and, consequently, on low coronary perfusion (coronary blood flow occurs during diastole).

With aortic stenosis or idiopathic myocardial hypertrophy, the appearance of pain is associated with impaired coronary circulation in the subendocardial departments due to a significant increase in intramyocardial pressure. All pain in these diseases can be described as metabolically or hemodynamically caused anginal pain. Despite the fact that they are not formally related to coronary heart disease, it should be borne in mind the possibility of the development of small focal necrosis. However, the characteristic of these pains often does not correspond to classical angina pectoris, although typical seizures are possible. In the latter case, the differential diagnosis with ischemic heart disease is especially complicated.

In all cases of detection of non-coronarogenic causes of the origin of pain between the breasts, it is taken into account that their presence does not at all contradict the simultaneous existence of coronary heart disease and accordingly requires a patient examination to exclude or confirm it.

Pain between the breasts due to pathology of the bronchopulmonary apparatus and pleura. Pain quite often accompanies a variety of pulmonary pathologies, occurring in both acute and chronic diseases. However, it is usually not a leading clinical syndrome and is quite easily differentiated.

The source of pain is the parietal pleura. From pain receptors located in the parietal pleura, afferent fibers go as part of the intercostal nerves, so the pain is clearly localized on the affected half of the chest. Another source of pain is the mucous membrane of large bronchi (which is well proven by bronchoscopy) - afferent fibers from large bronchi and trachea are part of the vagus nerve. The mucous membrane of the small bronchi and pulmonary parenchyma probably does not contain pain receptors, so pain during the primary lesion of these formations appears only when the pathological process (pneumonia or tumor) reaches the parietal pleura or spreads to the large bronchi. The most severe pains are observed during the destruction of the lung tissue, sometimes acquiring high intensity.

The nature of the pain to some extent depends on their origin. Pain in lesions of the parietal pleura is usually stitching, clearly associated with coughing and deep breathing. Dull pain is associated with stretching of the mediastinal pleura. Severe persistent pain, aggravated by breathing, movement of the arms and shoulder girdle, may indicate tumor invasion into the chest.

The most common causes of pulmonary pleural pain are pneumonia, lung abscess, tumor of the bronchi and pleura, pleurisy. For pain associated with pneumonia, dry or exudative pleurisy during auscultation, wheezing in the lungs, pleural friction noise can be detected.

Severe pneumonia in adults has the following clinical signs:

• moderate or severe inhibition of respiratory function;
• a temperature of 39.5 ° C or higher;
• confusion of consciousness;
• respiratory rate - 30 per minute or more;
• pulse 120 beats per minute or more;
• systolic blood pressure below 90 mm Hg. st .;
• diastolic blood pressure below 60 mm Hg. st .;
• cyanosis;
• older than 60 years - features: confluent pneumonia, is more severe with concomitant serious diseases (diabetes, heart failure, epilepsy).

NB! All patients with signs of severe pneumonia should be immediately referred for inpatient treatment! Direction to the hospital:

• severe form of pneumonia;
• patients with pneumonia from socially and economically disadvantaged segments of the population, or who are unlikely to fulfill the doctor's prescription at home; who live very far from a medical facility;
• pneumonia in combination with other diseases;
• suspicion of SARS;
• patients who do not have a positive reaction to treatment.

Pneumonia in children is described as follows:

• retraction of the intercostal spaces of the chest, cyanosis and inability to drink in young children (from 2 months to 5 years) also serves as a sign of severe pneumonia, which requires an urgent referral to a hospital;
• pneumonia should be distinguished from bronchitis: the most valuable sign in the case of pneumonia is tachypnea.

Pain sensations in lesions of the pleura almost do not differ from those in acute intercostal myositis or trauma to the intercostal muscles. With spontaneous pneumothorax, acute unbearable pain between the chests associated with damage to the bronchopulmonary apparatus is observed.

Pain between the breasts, difficult to interpret due to its uncertainty and isolation, is observed in the initial stages of bronchogenic lung cancer. The most excruciating pain is characteristic of apical localization of lung cancer, when damage to the common trunk of CVII and ThI nerves and brachial plexus develops almost inevitably and quickly. The pain is localized mainly in the brachial plexus and radiates along the outer surface of the arm. On the side of the lesion, Horner's syndrome often develops (pupil narrowing, ptosis, enophthalmos).

Pain syndromes also occur with mediastinal localization of cancer, when compression of the nerve trunks and plexuses causes acute neuralgic pain in the shoulder girdle, upper limb, and chest. This pain gives rise to an erroneous diagnosis of angina pectoris, myocardial infarction, neuralgia, plexitis.

The need for differential diagnosis of pain caused by damage to the pleura and bronchopulmonary apparatus, with coronary heart disease occurs in cases where the picture of the underlying disease is unclear and pain comes to the fore. In addition, such differentiation (especially in acute intolerable pains) should be carried out with diseases caused by pathological processes in large vessels - PE, stratifying aneurysm of various parts of the aorta. The difficulties in identifying pneumothorax as the cause of acute pain are due to the fact that in many cases the clinical picture of this acute situation is erased.

Pain between the breasts associated with pathology of the mediastinal organs is caused by diseases of the esophagus (spasm, reflux esophagitis, diverticulum), mediastinal tumors, and mediastinitis.

Pain in diseases of the esophagus usually has a burning character, localized in the sternum, occur after eating, intensify in a horizontal position. Common symptoms such as heartburn, belching, and swallowing disorders may be absent or mild, and chest pains, often occurring during physical exertion and inferior to nitroglycerin, come to the fore. The similarity of these pains with angina pectoris is complemented by the fact that they can radiate to the left half of the chest, shoulders, arms. With a more detailed questioning, however, it turns out that the pains are more often associated with food, especially plentiful, and not with physical exertion, usually occur in the supine position and pass or ease when moving to a sitting or standing position, when walking, after taking antacids, for example soda, which is uncharacteristic for coronary heart disease. Palpation of the epigastric region often increases these pains.

Chest pain is also suspicious for gastroesophageal reflux and esophagitis. to confirm the presence of which 3 types of tests are important: endoscopy and biopsy; intraesophageal infusion of a 0.1% hydrochloric acid solution; monitoring of esophageal pH. Endoscopy is important to detect reflux, esophagitis and to exclude another pathology. An X-ray examination of the esophagus with barium reveals anatomical changes, but its diagnostic value is considered relatively low due to the high frequency of false positive signs of reflux. When perfusion of hydrochloric acid (120 drops per min through a probe), the appearance of pains common to the patient is important. The test is considered highly sensitive (80%), but not specific enough, which with fuzzy results requires repeated studies.

If the results of endoscopy and perfusion of hydrochloric acid are unclear, monitoring of the intraesophageal pH can be carried out using a radiotelemetric capsule placed in the lower part of the esophagus for 24-72 hours. The coincidence in time of the onset of pain and a decrease in pH is a good diagnostic sign of esophagitis, i.e. really a criterion for the esophageal origin of pain.

Pain between the breasts, like angina pectoris, can also be a consequence of an increase in the motor function of the esophagus with achalasia (spasm) of the cardiac section or diffuse spasm. Clinically, in such cases, there are usually signs of dysphagia (especially when taking solid foods, cold fluids), which, unlike organic stenosis, is unstable. Sometimes chest pains of different durations come to the fore. The difficulties of differential diagnosis are also due to the fact that nitroglycerin, which relieves spasm and pain, sometimes helps this category of patients.

Radiologically, with achalasia of the esophagus, an expansion of its lower part and a delay in it of barium mass are detected. However, an X-ray examination of the esophagus in the presence of pain is uninformative, or rather unproven: false-positive results were noted in 75% of cases. Esophageal manometry using a three-lumen probe is more effective. The coincidence in the time of onset of pain and increased intraesophageal pressure is of high diagnostic value. In such cases, a positive effect of nitroglycerin and calcium antagonists may appear, which reduce smooth muscle tone and intraesophageal pressure. Therefore, these drugs can be used in the treatment of such patients, especially in combination with anticholinergics.

Clinical experience indicates that with pathology of the esophagus, ischemia is often quite often mistakenly diagnosed. For the purpose of a correct diagnosis, the doctor should look for other symptoms of a violation of the esophagus from the patient and compare clinical manifestations and the results of various diagnostic tests.

Attempts to develop a complex of instrumental studies that would help distinguish between anginal and esophageal pains were unsuccessful, since a combination of this pathology with angina pectoris is often found, which is confirmed by bicycle ergometry. Thus, despite the use of various instrumental methods, the differentiation of pain sensations is still very difficult at present.

Mediastinitis and mediastinal tumors are rarely the causes of pain between the breasts. Typically, the need for differential diagnosis with coronary heart disease occurs at the expressed stages of tumor development, when, however, there are still no pronounced symptoms of compression. The appearance of other signs of the disease greatly facilitates the diagnosis.

Pain between the breasts with diseases of the spine. Pain in the chest can also be associated with degenerative changes in the spine. The most common disease of the spine is osteochondrosis (spondylosis) of the cervical and thoracic, in which there is pain, sometimes similar to angina pectoris. This pathology is widespread, since after 40 years, changes in the spine are often observed. With damage to the cervical and (or) thoracic spine, the development of secondary radicular syndrome with the spread of pain in the chest area is often observed. These pains are associated with irritation of sensitive nerves by osteophytes and thickened intervertebral discs. Usually, bilateral pains appear in the corresponding intercostal space, but patients quite often concentrate on the retrosternal or pericardial localization, referring them to the heart. Such pains can be similar to angina pectoris in the following ways: they are perceived as a feeling of pressure, heaviness, sometimes radiating to the left shoulder and arm, neck, can be provoked by physical exertion, accompanied by a feeling of shortness of breath due to the impossibility of deep breathing. Given the advanced age of patients in such cases, a diagnosis of coronary heart disease is often made with all the ensuing consequences.

At the same time, degenerative changes in the spine and the pain caused by them can be observed in patients with undoubted coronary heart disease, which also requires a clear distinction between the pain syndrome. It is possible that in a number of cases angina attacks against coronary arteriosclerosis in patients with spinal lesions also occur reflexively. Unconditional recognition of this possibility, in turn, transfers the "center of gravity" to the pathology of the spine, reducing the value of independent damage to the coronary arteries.

How to avoid a diagnostic error and make the correct diagnosis? Of course, radiography of the spine is important, but the changes detected in this case are completely insufficient for diagnosis, since these changes can only be accompanied by coronary artery disease and (or) not clinically manifest. Therefore, it is very important to find out all the features of pain. As a rule, pains depend not so much on physical activity as on changes in body position. The pain is often aggravated by coughing, deep breathing, and may decrease in some comfortable position of the patient, after taking analgesics. These pains differ from angina pectoris by a more gradual onset, a longer duration, they do not go away at rest even after the use of nitroglycerin. Irradiation of pain in the left hand occurs on the dorsal surface, in the I and II finger, while with angina pectoris - in the IV and V finger of the left hand. Of particular importance is the detection of local tenderness of the spinous processes of the corresponding vertebrae (trigger zone) when pressed or striated paravertebrally and along the intercostal space. Pain can also be caused by certain methods: a strong pressure on the head towards the back of the head or stretching out one hand while turning the head to the other side. With bicycle ergometry, pain may appear in the heart, but without characteristic ECG changes.

Thus, the diagnosis of radicular pain requires a combination of radiological signs of osteochondrosis and the characteristic features of pain between the breasts that do not correspond to IHD.

The frequency of muscle-fasciapular (muscle-dystonic. Muscular-dystrophic) syndromes in adults is 7-35%, and in some professional groups it reaches 40-90%. With some of them, a heart disease is often mistakenly diagnosed, since the pain syndrome with this pathology has some similarities with the pain with heart pathology.

There are two stages of the disease of muscular-fascial syndromes (Zaslavsky E.S., 1976): functional (reversible) and organic (muscular-dystrophic). In the development of muscular-fascial syndromes, there are several etiopathogenetic factors:

1. Injuries of soft tissues with the formation of hemorrhages and gray-fibrinous extravasates. As a result, compaction and shortening of muscles or individual muscle bundles, ligaments, and a decrease in fascia elasticity develops. As a manifestation of an aseptic inflammatory process, connective tissue is often formed in excess.
2. Microtrauma of soft tissues in some types of professional activity. Microtraumas disrupt tissue circulation, cause muscular-tonic dysfunction with subsequent morphological and functional changes. This etiological factor is usually combined with others.
3. Pathological impulse with visceral lesions. This impulse that occurs when damage to the internal organs is the cause of the formation of various sensory, motor and trophic phenomena in the integumentary tissues, innervated by an altered internal organ. Pathological interoceptive impulses, switching through the spinal segments, go to the corresponding affected internal organ of the connective tissue and muscle segments. The development of muscular-fascial syndromes associated with cardiovascular pathology can alter the pain syndrome so much that diagnostic difficulties arise.
4. Vertebrogenic factors. With irritation of the receptors of the affected motor segment (receptors of the fibrous ring of the intervertebral disc, posterior longitudinal ligament, joint capsules, autochthonous muscles of the spine), not only local pains and muscular-tonic disorders occur, but also various reflex responses at a distance - in the area of \u200b\u200bintegumentary tissues, innervatedly connected with affected vertebral segments. But far from in all cases there is a parallelism between the severity of x-ray changes in the spine and clinical symptoms. Therefore, the radiographic signs of osteochondrosis cannot yet explain the cause of the development of muscular-fascial syndromes solely by vertebrogenic factors.

As a result of exposure to several etiological factors, muscle-tonic reactions develop in the form of hypertonicity of the affected muscle or muscle group, which is confirmed by an electromyographic study. Muscle spasm is one of the sources of pain. In addition, a violation of microcirculation in the muscle leads to local tissue ischemia, tissue edema, the accumulation of kinins, histamine, heparin. All these factors also cause pain. If muscle-fascial syndromes are observed for a long time, then fibrous degeneration of muscle tissue occurs.

The greatest difficulties in the differential diagnosis of muscular-fascial syndromes and pain of cardiac origin are encountered with the following syndromes: shoulder-scapular periarthritis, scapular-rib syndrome, anterior chest wall syndrome, interscapular pain syndrome, pectoralis minor syndrome, anterior scalene muscle syndrome. Syndrome of the anterior chest wall is observed in patients after myocardial infarction, as well as with nekoronarogenny damage to the heart. It is believed that after a myocardial infarction, the flow of pathological impulses from the heart propagates through the segments of the vegetative chain and leads to dystrophic changes in the corresponding formations. This syndrome in people with a knownly healthy heart can be due to traumatic myositis.

More rare syndromes accompanied by pain in the anterior chest wall are: Titz syndrome, xyphoidia, manubriosternal syndrome, scalenus syndrome.

Titz syndrome is characterized by sharp pain at the junction of the sternum with cartilage of the II-IV ribs, swelling of the costal-cartilage joints. It is observed mainly in middle-aged people. The etiology and pathogenesis are unclear. There is an assumption of aseptic inflammation of the costal cartilage.

Xyphoidia is manifested by sharp pain between the breasts, aggravated by pressure on the xiphoid process, sometimes accompanied by nausea. The cause of the pain is unclear, perhaps there is a connection with the pathology of the gallbladder, duodenum, stomach.

With manubriosternal syndrome, acute pain is noted over the upper part of the sternum or slightly more laterally. The syndrome is observed with rheumatoid arthritis, however, it occurs in isolation and then there is a need to differentiate it from angina pectoris.

Scalenus syndrome - compression of the neurovascular bundle of the upper limb between the anterior and middle scalene muscle, as well as the normal I or additional rib. Pain in the anterior chest wall is combined with pain in the neck, shoulders, shoulder joints, and a wide area of \u200b\u200birradiation is sometimes noted. At the same time, vegetative disorders in the form of chills, pallor of the skin are observed. Shortness of breath, Raynaud's syndrome are noted.

Summarizing the above, it should be noted that the true frequency of pain of a similar origin is unknown, therefore, it is not possible to determine their specific gravity in the differential diagnosis of angina pectoris.

Differentiation is necessary in the initial period of the disease (when they primarily think of angina pectoris) or if the pain caused by the listed syndromes does not combine with other signs that make it possible to correctly recognize their origin. However, pain of a similar origin can be combined with true coronary artery disease and then the doctor must also understand the structure of this complex pain syndrome. The need for this is obvious, since the correct interpretation will affect both treatment and prognosis.

Pain between the breasts caused by diseases of the abdominal cavity and diaphragm pathology. Diseases of the abdominal cavity are often accompanied by pain in the heart in the form of a typical angina pectoris or cardialgia. Pain with peptic ulcer of the stomach and duodenum, chronic cholecystitis can sometimes radiate to the left half of the chest, which causes diagnostic difficulties, especially if the diagnosis of the underlying disease has not yet been established. Such irradiation of pain is quite rare, but its possibility should be taken into account when interpreting pain in the region of the heart and behind the sternum. The occurrence of these pains is explained by reflex effects on the heart with lesions of the internal organs, which occur as follows. In the internal organs, interorganic connections were found through which axon reflexes are realized and, finally, polyvalent receptors in vessels and smooth muscles are revealed. In addition, it is known that along with the main border sympathetic trunks, there are also paravertebral plexuses connecting both border trunks, as well as sympathetic collaterals located parallel to and on the sides of the main sympathetic trunk. Under such conditions, afferent excitation, heading from any organ along a reflex arc, can switch from centripetal to centrifugal paths and thus be transmitted to various organs and systems. At the same time, viscero-visceral reflexes are carried out not only by reflex arcs that are closed at various levels of the central nervous system, but also through the autonomic nerve nodes on the periphery.

As for the causes of reflex pains in the heart region, it is suggested that a long-existing painful focus disrupts the primary afferent pulsation from the organs due to a change in the reactivity of the receptors located in them and thus becomes a source of pathological afference. Pathologically altered impulsation leads to the formation of dominant foci of irritation in the cortex and subcortical region, in particular in the hypothalamic department and in the reticular formation. Thus, the irradiation of these irritations is accomplished using central mechanisms. Hence pathological impulses are transmitted efferently through the underlying parts of the central nervous system and then through the sympathetic fibers reach the vasomotor receptors of the heart.

Diaphragmatic hernias can also cause chest pain. The diaphragm is a richly innervated organ mainly due to the phrenic nerve. It runs along the front inner edge of m. scalenus anticus. In the mediastinum, it goes along with the superior vena cava, then, bypassing the mediastinal pleura, reaches the diaphragm, where it branches. More common hernia of the esophageal opening of the diaphragm. Symptoms of diaphragmatic hernias are diverse: usually it is dysphagia and pain in the lower chest, belching and a feeling of fullness in the epigastrium. When a hernia is temporarily implanted in the chest cavity, severe pain is observed that can be projected onto the lower left half of the chest and spreads to the interscapular region. Concomitant spasm of the diaphragm can cause pain reflected in the left scapular region and in the left shoulder, reflected due to irritation of the phrenic nerve, which suggests "heart" pain. Given the paroxysmal nature of the pain, its appearance in middle-aged and elderly people (mainly men), a differential diagnosis should be made with an attack of angina pectoris.

Pain can also be caused by diaphragmatic pleurisy and much less often - subphrenic abscess.

In addition, when examining the chest, shingles can be detected, palpation can reveal a rib fracture (local pain, crepitus).

Thus, to determine the cause of pain between the breasts and to make the correct diagnosis, the general practitioner should conduct a thorough examination and questioning of the patient and take into account the possibility of the existence of all the above conditions.

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

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

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

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

So, the cause of chest pain can be:

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

Chest pain in lung disease

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

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

Chest pain in injuries

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

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

Instability of the thoracic spine directly affects chest pain. The most basic disease is osteochondrosis. Osteochondrosis is an inflammatory process of cartilage in the joints. This ailment can be caused by improper posture, the location of the spine in an uncomfortable position for him, associated with stationary work or a sedentary lifestyle.

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

Usually the disease does not appear immediately, begins, like any damage to cartilage with pain at the beginning of the movement, disappearing after movement for a certain period of time. Many do not attach importance to these symptoms, which is mistaken, the disease progresses, more unpleasant symptoms appear. Since the thoracic spine is inactive, the loads on it are not large, so even the appearance of an intervertebral hernia in this area is most likely to go unnoticed, unless, of course, one of the many nerve roots is clamped.

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 located directly in the localization zone. Often such sensations can be an echo of diseases of even those organs that are located in the abdominal cavity. To begin the correct effective treatment, it is necessary to establish the cause precisely and to proceed from it in the future, and not to 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 are, of course, all kinds of heart problems. For example, angina pectoris, coronary artery disease and even myocardial infarction. In any of these cases, a person feels pain on the left side, but it can give in different places and can be felt, including in the middle of the chest. The painful sensations are very strong and have a stabbing character. It seems to a person that thousands of needles are thrust into him. Such symptoms are extremely dangerous, since heart disease can even be fatal.

If the pain occurs abruptly and unexpectedly, then you can even lose consciousness. At this moment, the pulse in a person noticeably quickens, 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. Normalize the human condition will help nitroglycerin, which instantly dilates blood vessels.

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

Sometimes pain in the middle of the sternum leads to various problems with the gastrointestinal tract. For example, diaphragmatic abscess, duodenal ulcer or stomach. Because of them, stomach pain can give off 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 can identify other symptoms of a disease.

• For example, if a person began to appear pain due to problems with the gastrointestinal tract, then additional symptoms will be pain in the stomach or in the left hypochondrium, frequent sensation of 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, coughing, sore throat and sore throat, often elevated body temperature, become additional symptoms. If the diagnosis is confirmed, then the treatment will ultimately be aimed precisely at eliminating lung problems.
• 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 have shortness of breath even with minimal physical exertion, it will be hard to breathe.

Diseases that may cause pain in this area

Among the diseases can be:

•   , reflux esophagitis, gastric and duodenal ulcer, diaphragmatic abscess;
• pleurisy, pneumonia, tracheitis and bronchitis;
• thyroid disease;
• angina pectoris, heart failure, and coronary artery 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 immediately eliminate and even relieve chest pain that appeared due to all the diseases described above.

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

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

Sternum pain in 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 break in the muscles, which cause severe pain. As a rule, in these cases, the pain will clearly intensify with deep sharp exhalations and breaths, turns, bends and some other physical exercises.

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

In this case, it is necessary to urgently consult a surgeon, as well as take a picture that will establish the exact cause. Prior to visiting the doctor, the patient should avoid physical activity and be at rest so as not to worsen his condition with careless movement.

Unpleasant sensations after training

If the pain appeared after sports training, then this may be due to several reasons. More often it occurs in beginners in sports who perform exercises on the pectoral muscles, forgetting about safety measures 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 thing is banal overload, then after 2-3 days the pain should go away. Otherwise, consult a doctor.

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

Unexpected chest pain is an important signal of an illness in the organs of the chest or abdominal cavity. It occurs in the form of an attack and may be the first and at first only evidence of a disease that requires medical attention. A patient with such symptoms is subject to close examination, and only based on the correct diagnosis, therapeutic measures are prescribed. We will discuss in more detail why the chest hurts.

  Causes of Chest Pain

Pain in the chest area indicates diseases:

• musculoskeletal nature;
• respiratory system;
• heart and blood vessels;
• the spine;
• nervous system;
• gastrointestinal ailments;

Each human organ is supplied with nerve endings, acting together as an integrative system, the receptors of which are distributed from the spinal cord. In the chest, a branch of the nerve trunks begins in the direction of the organs. This feature allows you to feel the pain of the stomach as a heart malaise. The signal for pain in the stomach comes first to the common trunk, and then to another organ.

  Symptoms of chest pain

Symptomatic symptoms that occur with severe diseases of the chest organs are often almost identical, but still they can be differentiated according to some features:

1. Intolerable pain spreading to the neck or arm indicates the presence of acute ischemia or indicates myocardial infarction. Patients compare ischemic pain with dyspepsia.
2. The pain that occurs during exertion and stops after its completion is associated with angina pectoris.
3. An unpleasant severe pain that radiates to the back may indicate stratification of the thoracic aorta.
4. Baking pain, starting in the epigastric region and moving to the throat, begins to increase when the body is in a supine position - indicates GERD.
5. Fever, severe chills, cough - indicate pneumonia.
6. Pain with severe shortness of breath is most often indicative of pulmonary artery embolism.

  Respiratory diseases

Diseases of the respiratory tract do not really differ in sharp pain (there are no pain receptors in the lung tissue). Pain occurs only with pleurisy. But it should be borne in mind that some malignant formations in the initial stages of the disease are affected by pain in the chest, aggravated by inhalation. In order to fix changes in time, preventive fluorography is needed.

  Chest pain with trauma

Pain symptoms can occur due to trauma. Strong strokes often lead to gusts of muscles or blood vessels, which causes chest pain. The intensification of pain is observed with a sharp breath or turns or tilts of the body. If pain is felt when probing the chest, it may turn out that there is a crack or fracture.

  Persistent chest pain

Constant dull chest pain may indicate less dangerous illnesses than a sharp, sharp attack. Such pain is characteristic of neuralgic diseases and diseases of the spine. In addition, similar symptoms indicate violations in the functioning of the pancreas, stomach. If over time the pain begins to intensify, then the disease progresses.

  When you need to call an ambulance

Some signs of pain may indicate that you should contact your doctor immediately. Procrastination is life threatening. These symptoms include:

• Chest pain with a tearing cough after physical exertion. Possible loss of consciousness.
• Acute pain that does not stop for more than 10 minutes.
• Strong pressure in the chest or burning pain, passing to other organs.
• Sudden sharp pain and blood with coughing or jerking.
• Compression and pain in the chest, together with a rapid heartbeat, protruding sweat, anxiety, dizziness, nausea, or vomiting. You may lose consciousness.

Large organs of our body (heart, esophagus, stomach, lungs) and the network of vessels that entangle them receive and conduct nerve impulses. All this accumulation of nerve cells is concentrated in the thoracic nerve node - the ganglion. Therefore, with pain in any organ, it seems to us that the chest is sore. This is due to the cross-alignment of the conducting nerves in the spinal nodes of the same name. For example, discomfort in the epigastrium can be given to the shoulders, back and arms.

Cardiovascular Causes of Pain

Chest or epigastric pains can be described as dull, sharp, aching, pulling or pressing. Patients often describe discomfort as visceral pain. A strong impulse in the thoracic region can signal a serious pathology - osteochondrosis of the chest. That is why every person needs to know the difference between pain in the heart and pain in osteochondrosis.

There are many diseases in which the sternum hurts. Many of them pose a threat to life.   These include:

• myocardial infarction;
• stable and unstable angina;
• increased pneumothorax;
• partial aortic dissection;
• damage to the esophagus;
• pericarditis;
• pneumonia of any origin;
• pancreatitis
• various malignant tumors in the chest;
• other painful conditions that do not pose a potential threat to life;
• minor thoracic injuries;
• reflux gastroesophageal disease;
• dysphagia;
• cholecystitis;
• not perforated ulcers.

As a rule, neither children nor young people under the age of 35 are susceptible to ischemic heart attack, although a heart attack can occur at an early age. Much more often at this age there are skeletal lesions, scoliosis, muscle or lung diseases.

Chest pain is the most common cause of calling an ambulance. Severe discomfort in this area with diseases of the cardiovascular system may occur when:

• myocardial infarction;
• any angina pectoris;
• obstruction of the pulmonary artery;
• damage to the thoracic aorta;
• pericarditis.

A common example of chest discomfort or pain is angina pectoris. With physical or emotional stress, the heart muscle does not have enough oxygen and pain occurs in the region of the heart, there is a feeling of squeezing and lack of air. Pain is often not perceived as pain - it is compression or discomfort. Such sensations arise precisely at the height of the load or excitement.

A pain attack and discomfort with angina quickly pass after unloading. Discomfort disappears within 5 minutes, and if you stop the attack with nitroglycerin - in 1.5 -2 minutes.

A pain impulse with angina pectoris is sometimes caused by a spasm of the myocardial vessels. Spontaneous or sudden angina is characterized by the same pain as classical angina (tension). Patients often have both types of disease.

An attack of spontaneous angina is effectively neutralized by nitroglycerin. Such a clear and stable effect from taking this drug has important diagnostic value and speaks of the spasmolytic origin of the attack (ischemia).

Chest pain with osteochondrosis

Pain with breast osteochondrosis is of a different nature. The term dorsago experts call "sternal lumbago." The attack begins suddenly and is accompanied by very severe pain, a feeling of tightness of the chest and a lack of air. Sometimes accompanying symptoms occur: stiffness, inhibition of movements, tension of individual muscles.

Often the pain reminds of itself when abruptly getting up after a long stay in a sitting position. Such a pain impulse is not prolonged and subsides quickly.

The situation is different with dorsalgia. Her symptoms are radically opposite. Severe pain does not appear immediately. First, the patient experiences mild discomfort, and then there are prolonged pains of a dull aching character.

With any physical exertion or walking pain intensifies. This condition persists for 15-25 days. A strong impulse occurs when the body is tilted or when inhaling.

Concomitant symptoms are present: stiffness of the limbs and tension in the muscle tissue. The pain syndrome reaches its peak in the late evening or at night. By morning, the pain gradually subsides.

After waking up and lifting, it is necessary to conduct a small warm-up, this will reduce the intensity of pain to light discomfort or tingling.

Diagnosis of osteochondrosis of the chest

The presence of a patient's chest osteochondrosis is evidenced by many obvious symptoms, on the basis of which a specialist diagnoses the disease. Diagnosis is carried out on an outpatient basis. First, when examining the patient, an anamnesis is collected, which allows to differentiate the chronic condition from acute and recurring.

If necessary, the doctor prescribes an x-ray or ultrasound examination of the chest. In special cases, you may need to have a CT scan (computed tomography) or an MRI scan (magnetic resonance imaging) of the cervicothoracic region in order to obtain a clearer picture of the disease.

Damage to the knee joint, and in particular dislocation, is accompanied by the following symptoms:

• Sharp and constant pain in the joint, which intensifies with movement.
• Poor mobility, here either the inability to move the foot, or a limited amplitude.
• Swelling of the knee, indicating a hemorrhage in the tissue and a violation of vascular integrity.
• The lack of sensitivity in the foot is a serious symptom that indicates a large damage to the nerve trunks.

The difference between pain in osteochondrosis from heart pain

Pain in the heart is called angina pectoris. They differ in the following parameters:

• They have a crushing character. Very often, with such a diagnosis, the patient feels pulling discomfort or pressure on a specific area.
• The main place in which pain is particularly acute is the chest in the sternum or throat.
• Many patients with angina pectoris are short of breath.
• Pain arises at the height of the load and causes it to stop.
• Talking about pain, the patient puts a fist or hand on his chest.
• The pain lasts up to 5 minutes, less often - 10-15 minutes.
• The pain is clearly stopped by nitroglycerin or nitrospray.

Osteochondrosis manifests itself differently. The intensity of the pain syndrome decreases with a change in body position. With angina, such actions will not help. To relieve pain, take medications, such as validol. If the pain does not subside after taking the tablets, this is chondrosis.

Why the chest hurts: injuries and fractures

Common causes of chest pain can be injuries  or fractures  in this area. The nature of these discomforts will depend more on the conditions under which the injuries were received.

If the body is damaged during the fall, then the pain will be aching. Moreover, her strength will be relatively high. During a change in body position or physical activity, pain becomes stronger. Closer to night, they can also increase.

If an injury was received in brawl  - the pain is very sharp. Most often, unpleasant sensations do not disappear completely when changing position, but can only reduce their intensity.

If the destructive effect on the body occurred as a result of Accident, then you should be as careful as possible. The body in a traffic accident can fall into a state of shock. Outwardly, this can be determined by the color of the lips or skin. In this case, the pain becomes dull or absent for a long time. This period can last up to ten hours. The danger of such injuries lies in the fact that the patient may not be aware of a fracture and lead a familiar lifestyle. However, soon the shock state will be replaced by acute pain. Most often in such cases, patients should be hospitalized immediately. It is very important to learn about injuries sustained in an accident in a timely manner. Their characteristic symptoms are: brittle joints, bones and spine.

A chest injury is equally important to diagnose in a timely manner. To do this, pay attention to the following characteristic symptoms:

• Pain They have a completely different character, but are concentrated at the point of injury. Pain sensations become more acute when feeling the injured place, a sudden movement or deep breathing. They can also give to the head.
• Pressure. In this case, it will not be stable and may decrease significantly.
• Dizziness.
• Nausea.
• Vomiting

Due to a lack of oxygen in the body, due to a chest injury, a person may lose consciousness. A worse outcome, lethal, is not excluded. Such patients must be hospitalized urgently.

In severe cases, with damage to the vertebrae, surgery is required. It is extremely important to consider whether alcohol is present in the blood, since it acts on the central nervous system and can prolong pain shock.

Causes of chest pain in women

Women often experience chest discomfort. All cases are individual and depend on various factors - hormonal changes in the body during menstruation, pregnancy, ovulation. Pain of this nature does not pose a danger to a woman's body. After 45 years, the cause may be a change in the hormonal background. But this is already due to age.

In addition, pain can occur due to inflammatory processes in the mammary glands, osteochondrosis and poor posture.

Other diseases

The mammary glands, due to their characteristic structure, are affected by changes in the cervical and shoulder regions, and vice versa. That is, if the pain from the chest turns sharply into shoulder pain - this is justified. There is a diagnosis mastitis. And he is very similar to angina pectoris in the specificity of the manifestation of pain. Malignant tumors in the chest are most often detected in women no younger than 55 years old. In this case, the pains are sharp, cutting in nature. They can not only concentrate in one place, but also move to the shoulder.

Symptoms requiring an immediate emergency call