Pain in the chest
Chest pain is a relatively common symptom that scares the patient, and the causes may vary, from slight changes toward serious states.
Pain is caused by the disease of several organs and systems in the chest of the heart and blood vessels, digestive organs, breathing, due to changes in the chest wall and may be psychogenicly nature.
The most severe and serious problems come from the cardiovascular system, such as angina pectoris, myocardial infarction, and damage to the aortic wall.
Angina pektoris is chest pain caused by changes in the blood vessels of the heart (narrowing due to fat deposits or spasm), which is manifested as: pain, tightness, weight or pressure behind the pectoral bone, can spread upward towards the neck, to the left shoulder, toward the stomach. It is followed by dizziness, sweating, heart palpitations, difficulty breathing, lasting 5-15 minutes. It is provoked by: physical effort, mental stress, abundant meal, exposure to cold, and resting on sleep or nitroglycerin.
Hardships can become more frequent, more intense, and can also occur in rest.
Myocardial infarction is due to spasm or blockage of the heart arteries by thrombus, and then the blood flow to that part of the heart muscle ceases. The infarct looks like angina pectoris, but the pain is more intense and longer. It Occur after stress, greater physical effort, a leap of pressure, or begins without a cause. It is a very intense pain that lasts more than 30 minutes in the form of tightness, pressure, burning or annealing, localized behind the chest bone, spreading to the left hand and shoulder, or to both sides of the chest, in the neck, fork, back. In myocardial infarction, the lower wall pain is in the stomach area, accompanied by nausea and vomiting, by stuttering. Patients have a sense of lack of air, choking, weakness, fear, excited and restless, sweating with cold, sticky sweat, pale skin.
The characteristic of the infarction is that it does not pass on nitroglycerin or hibernation, urgent hospital treatment is required.
Some patients (up to 20%), who have a high threshold for pain or diabetics, do not have to have a sence of pain – sometimes we see on the ECG signs of an earlier myocardial infarction and the patient does not know when it happened.
Changes in the heart valves (prolaps mitralne valule, aortna stenoza) give pain to the heart and chest, choking, weakness, puffing and skipping of the heart, dizziness, or loss of consciousness.
Pericarditis-inflammation of the hearta, it gives pain in the form of clamping behind the chest bone that spreads to the neck, shoulders, muscles at the top of the back. It is amplified by deep breathing, coughing, lying on the back, and it is reduced in a sitting position or bending. When it outflow into the pericardium, then the pain decreases, and accelerated and difficult breathing occur, coughing, and hoarseness.
Aorta-the largest blood vessel that can spread rapidly (rising aneurysm) or comes to its splitting, wall splitting (dissection), gives a very intense, centrally localized pain in the form of tearing with the spread of the forward and back, neck, both hands, does not change with change body position is not breathing, it requires urgent surgical treatment. If affected arteries that come out of the aorta can cause sudden loss of consciousness, seizure, pulse and pressure are immeasurable.
This condition requires urgent hospital treatment.
Stomach hernia and reflux disease (returning acidic contents from the stomach to the esophagus) are followed by heartburn, pain behind the chest bone in the form of baking, annealing, which extends up and down, into the neck, jaw and both sides of the chest. It worsens after a meal, an abundant meal, lying down and sagging, and disappears by straightening and taking medicines to reduce acidity (Ranisan, Omeprol, Gelusil lac).
It should be noted that gastric hernia (the aperture on the diaphragm is somewhat larger, so the stomach filled with food at laying and bending moves upwards towards the chest cavity and exerts a pressure on the heart) -positive heartbeat and pain that resembles agine pectoris.
Inflammation of the esophagus (viruses, fungi), ulcers, spasms, painful food swallowing.
Pain in spasm of esophagus is intense and resembles angina pectoris and also passes on nitroglycerin, which makes it difficult to distinguish this from heart disease.
Inflammation of the trachea produces pain in the form of an anomaly behind the upper part of the pectoral bone, spreads to the neck, is accompanied by a cough, lasts for a few days or weeks and calms down. If it is a tumor, the pain is prolonged and difficult breathing occurs.
Pleura or pulmonary tissue gives pain due to inflammation, tumor, metastasis, adrenal infarction, lung infarction. Pain occurs in one half of the chest, it increases with breathing and cough, reduces lying on the sick side. Adults also suffer from a change in time, pain is like a knife, they can be repeated all their lives. Pain can also be due to tumors, cysts, enlargement of the lymph nodes, pulmonary thromboembolism, and pulmonary hypertension.
Nervous-muscular-bone structure which make up the chest wall can be the cause of pain due to: degenerative changes in the spine, osteoporosis, rib fracture, spine segments movement, nerve pressure that gives back pain to the middle and can resemble angina pectoris, long-term contraction of the muscle (sitting in compulsory stretching, working for a computer) stretching muscles in physical overload – myalgia pain in the intercostal area, pain during taking breath or pressure. Degenerative changes in the connect of the ribs to the chestbone or on the joint of the cartilage and bone part of the rib is shown as pain to the front of the chest bone, pain also occurs at the pressure in that area of the chest.
“Myth about left hand” –the pain that extends to the left hand most often connects with the infarction that scares the patient, but it should be said that the nerve imploses from the heart and esophagus go into common nerves, thus manifesting, also degenerative changes in the shoulder or protrusion of disc between spinal pillar(discus hernia) that presses the nerve can be interpreted as a heartache.
Inflammation of the nerve caused by a herpes virus that changes in the skin in the form of bubbles, involves one half of the chest and the pain occurs a few days before the skin changes and can take a long time after they withdraw. Pain is in the form of an anomaly or sting with a knife, tingling with increased or decreased skin sensitivity.
Pain in the left breast area, sharp and short as a knife or dull swallow and long-lasting with painful sensation in the heart area, is met with overused, emotionally tense, anxiety people.
In allergic reactions to medicines, food, insect stings and the like. redness, blisters and itching of the skin, sometimes choking, the face of the face and lips. The substances created in the body in an allergic reaction can cause changes in the heart arteries, which can lead to heart infarction (Kounis syndrome) and it is manifested by chest pain.
In short, the pain can be of different origin and sometimes it is a dilemma as many symptoms intertwine, therefore it is necessary first to exclude emergency conditions.
A patient who has a pain should contact a doctor who will, through a talk with patient , examination, ECG and supplementary tests, make a final diagnosis and give appropriate therapy.
dr Vranić Sonja
specialist in internal medicine