Chest pain

Chest pain (Thoracalgia)

Chest pain (thoracalgia) is pain in the chest of various nature and intensity. Soreness often gives in the arm, shoulder blade, collarbone. The symptom occurs with pathological processes in the lungs, mediastinal organs, with damage to the heart, neuromuscular apparatus. Sometimes the chest hurts with diseases of the abdominal organs. To determine the cause of thoracalgia, ultrasound and radiography of the chest organs, EGDS are performed, the abdominal cavity is examined, laboratory tests are prescribed. Analgesics, NSAIDs, and physiotherapeutic methods are used to relieve pain.

General characteristics
Causes of Chest pain
Causes of chest pain on the left
Causes of chest pain on the right
Causes of pain behind the sternum
Causes of breast pain
Causes of pain in the ribs
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
General characteristics
Discomfort and pain in the chest occur with various pathologies of the musculoskeletal system, internal organs and skin, so painful sensations are very variable. By nature, the pain can be dull, pressing, stabbing, compressing. Some patients describe their sensations as intense burning in the sternum. The duration of the pain syndrome varies from a few minutes to several weeks, while the pain remains constant or increases over time. Radiation is often observed in the arm, collarbone, shoulder blade.

Unpleasant symptoms increase when performing sudden movements of the trunk, deep breaths, physical exertion. In case of damage to the nerve trunks, the chest hurts more with palpation, accidental touches, the pain subsides in the supine position. Inflammatory processes of the pleura are characterized by a decrease in discomfort in the position on the patient’s side. Constant pain of moderate intensity and sudden severe pain attacks are indications for seeking medical help.

Causes of Chest pain
Causes of chest pain on the left
In the left half of the chest cavity there is a heart with major vessels, so the pain syndrome is often caused by cardiac pathology. Sensations range from moderate discomfort that develops during physical activity to severe chest pains that force the patient to remain motionless. Most often, chest pain on the left is caused by:

Coronary syndrome: stable and unstable angina, myocardial infarction.
Inflammatory heart diseases: infectious endocarditis, rheumatism, myocarditis.
Disorders of the conduction system of the heart: arrhythmias, extrasystole, paroxysmal tachycardia.
Increased blood pressure.
Cardiac manifestations of collagenoses: systemic lupus erythematosus, dermatomyositis, vasculitis.
Dissecting aortic aneurysm.
Respiratory diseases: left-sided croup or focal pneumonia, left-sided pleurisy, tuberculosis.
Diaphragmatic hernia.
Abdominal organ damage: splenomegaly, acute and chronic pancreatitis, spleen injury.
Rare causes: tumors (lung, bronchi, pleura), stomach ulcer.
Causes of chest pain on the right
The symptom is most often associated with respiratory damage. The pain syndrome is constant, intense, sometimes patients have to take a forced position on their side. The chest begins to hurt more with deep breaths, sharp turns of the trunk, coughing attacks. Common causes of chest pain on the right:

Infectious processes: right-sided bacterial or viral pneumonia, purulent bronchitis.
Pleurisy: dry, exudative.
Injuries: chest contusions, hemothorax and pneumothorax, lung contusion.
Pathologies of the biliary system: cholecystitis, biliary dyskinesia, cholelithiasis.
Liver damage: viral hepatitis, neoplasms, echinococcal cysts.
Causes of pain behind the sternum
When the chest hurts in the middle, and uncomfortable sensations radiate upward along the esophagus, this often indicates pathology of the upper digestive system, but may be a sign of other diseases. Patients note an increase in symptoms with torso bends, sudden movements. The main causes of pain behind the sternum:

Gastroesophageal reflux.
Lesion of the thoracic esophagus: esophagitis, dyskinesia of the esophageal sphincter, esophagospasm.
Pathology of the stomach: hyperacid gastritis, peptic ulcer.
Respiratory system dysfunctions: tracheitis, bronchitis, bronchial asthma.
Heart diseases: endocarditis, myocarditis, pericarditis.
Volumetric formations of the mediastinum: pathology of the thymus (hyperplasia, cyst, thymoma), lymphoproliferative syndromes (lymphogranulomatosis, non-Hodgkin’s lymphomas), granulomatous processes (sarcoidosis, tuberculosis, silicosis).
Complications of pharmacotherapy: long-term use of NSAIDs, corticosteroids, absorbed antacids.
Rare causes: Zollinger-Ellison syndrome, osteochondrosis, intercostal neuralgia.

Causes of breast pain
There are two types of chest pain: cyclical, associated with the menstrual cycle, and non-cyclical, indicating the development of the disease. Pain syndrome with hormonal changes occurs symmetrically from two sides, and local pathological processes usually cause unilateral unpleasant sensations. There are such causes of pain in the mammary glands as:

External factors: incorrectly selected bra, tight clothes in the chest.
Physiological conditions: a few days before the onset of menstrual bleeding, during pregnancy and lactation.
Inflammation of the breast: lactation mastitis, purulent mastitis, breast abscess.
Fibrocystic mastopathy: nodular and diffuse forms.
Nipple damage: inflammation, eczema, Paget’s cancer.
Benign tumors: fibrolipoma, intra-flow papilloma, adenoma.
Malignant neoplasms: intracurrent cancer, tubular carcinoma, papillary cancer.
Complications of pharmacotherapy: pain after taking oral contraceptives, antipsychotics and antidepressants.
Causes of pain in the ribs
In such cases, chest pain occurs on one or both sides, pain is more often sharp, shooting. Soreness increases with the slightest movement, careless touching, wearing tight clothes. Some patients find it difficult to breathe. The most common causes of pain in the ribs are:

Intercostal neuralgia.
Shingles.
Injuries: severe chest bruises, rib fractures.
Rib chondritis (Titze syndrome).
Diseases of the vertebrae: osteochondrosis, intervertebral hernias, kyphoscoliosis.
Muscle damage: fibromyalgia, muscle stretching, physical overstrain.
Osteosarcoma of the ribs.
Diagnostics
Finding out the cause of chest pain is handled by a general practitioner or family doctor. To verify the diagnosis, the musculoskeletal system and internal organs are examined. The main methods are instrumental visualization of anatomical structures, laboratory diagnostics are performed to clarify the cause of thoracalgia. The most informative methods:

Electrocardiography. To exclude or confirm the cardiac etiology of pain in the left side of the chest, an ECG is recorded in standard leads. The expansion and deformation of the complexes, the rise of the ST interval indicate myocardial ischemia. To diagnose arrhythmias, Holter monitoring is carried out.
Ultrasound examinations. Echocardiography (EchoCG) is necessary if the chest hurts on the left side. The contractile function of the heart muscle, ejection fraction, signs of destructive lesions of the valve apparatus are evaluated. Ultrasound of the abdominal cavity is used to detect diseases of the spleen, pancreas or gallbladder that cause thoracalgia.
Radiography. On the radiographs of the OGC, it is possible to detect focal processes in the lung tissue, volumetric formations of the lungs and mediastinum, which are usually an etiological factor of chest pain. Women are prescribed mammography. Overview radiography of the gastrointestinal tract is recommended for the detection of diaphragmatic hernia, ulcerative defects.
Endoscopic methods. To diagnose esophageal injuries that provoke chest pain, EGDS is performed. During the study, the condition of the mucous membrane, the contractility of the cardiac sphincter are studied. In case of severe damage to the respiratory system, bronchoscopy is indicated to examine the mucosa and take the material for back-sowing.
In general and biochemical blood tests, signs of inflammatory processes, pathologies of the liver and biliary system are detected. Bacteriological sowing of sputum and bronchial flushing waters is necessary to establish the type of pathogen. In women, the concentration of sex hormones is determined. If unbearable chest pains are felt and cancer is suspected, a biopsy of a suspicious formation is performed for cytological analysis.

Treatment
Help before diagnosis
In the case of minor discomfort, it is enough to observe rest for a few days, avoid physical exertion and overwork. With pain in the mammary glands before menstruation, patients are recommended to wear soft, comfortable bras, take NSAIDs. With intense pain syndrome or the addition of other pathological symptoms, it is necessary to consult a doctor who will find out why the chest hurts. If the pain is accompanied by loss of consciousness, cyanosis of the skin and cold sweat, a person needs emergency medical care.

Auscultation for chest pain
Auscultation for chest pain
Conservative therapy
Medical tactics depend on the cause of the development of thoracalgia, in the case of diseases of the internal organs, etiotropic treatment is carried out, with unbearable pain, it is supplemented with analgesics. The chest hurts less after applying warm compresses, electrophoresis with anti-inflammatory and analgesic drugs. To eliminate the cause of the pain syndrome, medications of the following groups are used:

Nonsteroidal anti-inflammatory drugs. NSAIDs are the drugs of choice for rheumatic processes, they allow to relieve symptoms and maintain stable remission. In bronchitis and pneumonia, they reduce the production of inflammatory mediators and relieve pain.
Antianginal drugs. If it hurts in the pericardial area of the chest, medications improve blood supply to the myocardium, increase oxygen delivery in the cell. The funds also normalize the heart rate, reduce the risk of heart attack. Calcium channel blockers and beta blockers are used.
Antibiotics. Etiotropic drugs are indicated for pneumonia, purulent bronchitis and pleurisy. They are selected empirically, in the future, the appointments are adjusted after the results of bakposev. Antibiotics reduce the activity of the inflammatory process, due to which the pain in the chest subsides.
Antacids. The products reduce the acidity of gastric juice, therefore they are effective in gastroduodenal reflux and hyperacid conditions. When taking antacids, the irritating effect of hydrochloric acid on the esophageal mucosa decreases, pain is eliminated.
Hormonal drugs. Estrogenic drugs are used to treat severe pain in both mammary glands in the premenstrual period. Hormones of the adrenal cortex are recommended in the case of severe rheumatic diseases, in which the chest and heart ache.
Cytostatics. The drugs are used for various oncological pathologies. Their action is aimed at destroying cancer cells and slowing the growth of tumor tissue. Combinations of 2-3 medications are most effective, the duration of administration depends on the stage and degree of response to chemotherapy.
Surgical treatment
Pain in the chest area associated with complicated fractures of the ribs or spine requires surgical intervention — open reposition of fragments with fixation by the method of bone osteosynthesis. With purulent mastitis, autopsy and drainage, washing of the wound with antiseptics are indicated. Oncological causes of pain syndrome serve as the basis for radical operations. To prevent relapses, the affected organ, the adjacent fiber and regional lymph nodes are removed.

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