Chest pain on the left
Chest pain on the left is pain of a compressive, stabbing, pressing nature, which are localized in the left half of the chest. Most often, the symptom is caused by coronary and non-coronary heart diseases, pain is observed with inflammation of the left lung and pleura, collagenoses, gastrointestinal pathology. To determine the cause of the pain syndrome, ECG, ultrasound of the heart, chest radiography, clinical and bacteriological studies are performed, invasive diagnostic methods are used. Nitroglycerin and NSAIDs are used to relieve pain, etiotropic drugs are selected after the detection of the underlying disease.
Causes of chest pain on the left
Coronary heart disease
Myocardial infarction
Inflammatory heart diseases
Cardiomyopathy
Arrhythmia
Heart defects
Hypertension
Dissecting aortic aneurysm
TELA
Systemic connective tissue diseases
Respiratory diseases
Hernia of the esophageal orifice of the diaphragm
Pathology of the abdominal organs
Depression
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of chest pain on the left
Coronary heart disease
Currently, coronary heart disease is a common cause of pain of this localization. With a stable form, the pain syndrome begins during physical activity, brisk walking. According to the duration of the distance traveled, after which the symptoms develop, the functional class of stable angina is determined. Unpleasant sensations are caused by insufficient blood supply to the myocardium. Pain in the left side of the chest has a compressive, oppressive nature, forcing the patient to stop walking or other physical work. The symptom is accompanied by chest tightness, inability to take a deep breath. Characterized by the irradiation of pain in the shoulder blade, left arm.
With a complicated course of coronary heart disease and unstable angina, attacks of pain on the left behind the sternum are noted more often, not always due to physical activity. In severe situations, pain syndrome is observed at rest, it is accompanied by cyanosis, shortness of breath. Angina attacks last from 5 to 30 minutes and are well stopped by taking nitroglycerin. The duration of chest pain for more than half an hour against the background of a rapidly deteriorating condition is a formidable symptom that requires immediate medical attention.
Myocardial infarction
Soreness in the left side of the chest resembles a typical angina attack, but lasts 30 minutes or more. The pain of myocardial infarction is not stopped by nitroglycerin, the patient is getting worse by the minute. There is a sharp pallor of the skin and cyanosis of the nasolabial triangle, cold sticky sweat appears on the forehead. The pain is so severe that it becomes difficult to breathe, fainting often develops. If a person remains conscious, he may experience a strong feeling of fear and panic. If untimely assistance is provided, the pathology can end fatally.
Inflammatory heart diseases
Non-coronarogenic causes cause acute stabbing or constant pulling pains to the left of the sternum, the intensity of which depends on the degree of prevalence of the inflammatory process. With infectious endocarditis, pain develops against the background of general weakness and sweating, an increase in body temperature to febrile. The heart aches constantly, the discomfort increases with deep breaths, but does not change during physical exertion. In elderly people and patients with immunodeficiency, the symptoms are erased, painful sensations are accompanied by shortness of breath and heaviness in the chest.
A similar clinic is found in myocarditis. With infectious and allergic inflammation of the heart muscle, symptoms appear 2-3 weeks after tonsillitis or angina. Moderate pains in the chest on the left, a feeling of palpitation and interruptions in the work of the heart are bothering. In acute myocarditis, soreness occurs simultaneously with fever, weakness, and nocturnal hyperhidrosis. The chronic process is characterized by moderate discomfort from the heart, shortness of breath and increased fatigue.
Cardiomyopathy
The severity of the pain syndrome depends on the form of the disease. With hypertrophic cardiomyopathy, periodic stabbing or compressing pains are observed near the sternum on the left, the appearance of which does not depend on external factors. With dilated cardiomyopathy, there is aching pain in the heart, which increases during habitual physical activity. A person periodically feels shortness of breath and lack of air, in the morning they are worried about weakness and dizziness. As the pain increases, signs of heart failure increase — swelling on the shins, ascites.
Arrhythmia
Cardiac arrhythmias are manifested by periodic stabbing or compressing pain in the chest on the left, which usually begin without precursors and exogenous effects. The pain with arrhythmia is sharp and strong, the patient freezes in one position for a short time, grabs the heart area with his hand. At the same time, tachycardia and heartbeat are detected. As a result of the inefficiency of blood circulation, there is a sharp weakness and darkening in the eyes, pallor of the skin, a pre-fainting condition. Often the symptoms disappear on their own after a few minutes.
Heart defects
Anatomical defects in the structure of the heart and the outputting vessels cause anginal pain in the chest — compressing or pressing, with irradiation to the clavicle area, poorly relieved by nitroglycerin. In addition to the pain syndrome, signs of circulatory insufficiency are revealed: shortness of breath during exercise, dry cough, swelling of the cervical veins. In children, chest pain on the left may be caused by congenital malformations that manifest as the child grows. Causes provoking cardiac pain syndrome:
Mitral valve prolapse.
Acquired defects: mitral, aortic, tricuspid, combined forms.
Congenital “white” defects: defects of the atrial and interventricular septum, coarctation of the aorta, open ductus arteriosus.
Congenital “blue” defects: tetrad of Fallot, Ebstein anomaly.
Hypertension
Chest pains develop in the late stages of hypertension, when degenerative changes occur in the heart muscle and coronary vessels. Pain syndrome is usually associated with spasm and obliteration of the arteries feeding the heart, and is manifested by compressive sensations that do not have a clear localization. With a hypertensive crisis, the pain increases, accompanied by a rapid heartbeat, flashing “flies” in front of the eyes. Frequent dull or pressing pains in the heart are often caused by the secondary addition of atherosclerosis.
Dissecting aortic aneurysm
The severity of symptoms in a delaminating aneurysm correlates with the degree of damage to the aorta. When only the inner shell of the vessel is ruptured, patients experience sharp chest pain on the left and a pre-fainting state. In the case of continued rupture and dissection of the aortic membranes, severe pain occurs in the chest cavity, which radiate into the back, the area of the upper arm. The pain syndrome is so intense that a person often loses consciousness due to shock. Continued bleeding causes a drop in blood pressure, collapse and deep fainting.
TELA
With massive thromboembolism of large trunks of the pulmonary artery, a sharp stabbing pain in the chest suddenly appears without a clear localization. Pain syndrome in PE is accompanied by a feeling of lack of air, shortness of breath, cyanosis of the skin. If no help is provided, loss of consciousness and cardiac arrest occur. Blockage of small vessels and focal ischemia of the lung are the causes of moderate chest pain, which increases and reaches its maximum after a few days. Soreness in case of a lung infarction is combined with hemoptysis, severe cough, which indicates the development of infarct-pneumonia.
Systemic connective tissue diseases
Many rheumatic processes occur with heart damage, which causes the appearance of pain on the left of the chest. Painful sensations with collagenoses occur periodically, have a pressing, stabbing or compressing character. The irradiation of the pain syndrome is uncharacteristic. The symptom is not related to stress or other external factors. The pain is accompanied by palpitations, shortness of breath, fatigue. Most often, a similar clinical picture occurs with rheumatism. Less often, systemic lupus erythematosus, dermatomyositis, and vasculitis cause similar symptoms.
Respiratory diseases
Visceral pain is often associated with inflammatory lesions of the left lung, pleura and bronchial tree. In this case, constant soreness is typical, which is aggravated during coughing attacks, deep breathing. Other signs of the infectious process are also typical — sputum discharge, febrile body temperature. The most common causes that cause a feeling of soreness in the chest on the left:
Bronchitis. With purulent inflammation, mild chest pains are bothered, accompanied by discomfort behind the sternum and a sore throat. Pain occurs against the background of a deep cough with the release of scanty sputum.
Pneumonia. With the focal form of the disease, moderate dull pains are felt in the chest on the left, which are aggravated by coughing. Croup pneumonia is characterized by severe diffuse chest pains, which are accompanied by high fever, difficulty breathing.
Pleurisy. For inflammation of the pleura, a pain syndrome with localization in the lower lateral surface of the chest on the left is typical. Soreness increases with coughing and trunk movements, patients take a forced position on the sick side.
Tuberculosis. Pain sensations of medium intensity, spilled. When the pleura is involved in the pathological process, the pain increases and acquires a clear localization. The symptom is combined with shortness of breath, cough, scanty sputum, characterized by profuse night sweating.
Hernia of the esophageal orifice of the diaphragm
With small sizes of hernial protrusion, periodic discomfort occurs in the middle of the sternum and to the left of it. As the size of the hernia increases, there are sharp pains in the chest and epigastrium, which develop after eating, lifting weights, against the background of stress. The duration of the symptom is from minutes to several hours. Simultaneously with the pain, dysphagia increases, even swallowing water becomes difficult. Constant intense pain on the left is typical for hernia infringement, which requires urgent medical attention.
Pathology of the abdominal organs
The proximity of nerve endings and spinal cord segments responsible for visceral innervation explains why it hurts in the chest area on the left when the digestive system is affected. Such pain can bother with acute pancreatitis and splenitis, since these organs are located in the abdominal cavity on the left, directly under the diaphragm. Symptoms sometimes occur with hematomas and ruptures of the spleen. Pain syndrome is also caused by organic causes – the inflammatory process spreads from the abdominal organs to the chest through the diaphragm.
Depression
Heart pain is one of the “masks” of a depressive state, which is provoked by disorders of autonomic innervation and the development of cardioneurosis. Symptoms appear for no apparent reason, are determined in people of any age, more often in women. The pain is variable, usually appearing in the early morning hours. Patients with depression tend to describe their discomfort for a long time and in detail. Pain is often preceded by a feeling of “sinking of the heart”, heaviness in the chest. The pain syndrome cannot be stopped with standard cardiotropic drugs.
Rare reasons
Pathology of nervous structures: intercostal neuralgia, shingles.
Diseases of the musculoskeletal system: myalgia and myositis, inflammation of the rib cartilages on the left, chest injuries.
Left-sided pneumothorax.
Defeat of the stomach and esophagus: GERD, hyperacid gastritis, peptic ulcer.
Diagnostics
If the patient begins to have pain in the chest on the left, he needs a therapist’s consultation. First of all, regardless of the patient’s age, the specialist excludes all cardiac causes of pain syndrome, after which instrumental studies of other organs of the thoracic cavity are performed. To clarify the etiological factor of the disease, extended laboratory tests are shown. In diagnostic terms , the most valuable are:
An ECG. electrocardiogram is recorded at the time of a pain attack and signs of myocardial ischemia are detected — an increase in the ST interval, an expansion or a change in the shape of the T-wave. In the case of myocardial infarction, a typical pattern in the form of a “cat’s back” is found on the ECG. To confirm the anginal cause of pain, a troponin test is performed, the level of creatine phosphokinase is determined.
Echocardiography. Ultrasound diagnostics of the heart can reveal signs of inflammatory processes and degenerative changes in the heart valves. The contractility of the left ventricle and the blood ejection fraction are measured to exclude heart failure. Additionally, dopplerography and color mapping of the main vessels are prescribed.
Radiography. If pneumonia is suspected, chest X-rays in the straight and lateral planes are required. If a suspicious shadow appears on the image, it is informative to conduct a CT scan of the thoracic cavity for detailed visualization of the lesion area. X-ray examination also helps to find signs of diaphragmatic hernia.
Ultrasound examination. Ultrasound of the abdominal cavity is necessary to exclude inflammatory processes in the spleen and pancreas. The structure and uniformity of the parenchyma of organs, the presence of focal formations are taken into account. Ultrasound of the veins of the lower extremities is required to detect thrombotic masses — a common cause of PE.
Blood tests. A general blood test is not informative enough, it usually reveals leukocytosis and an increase in ESR, which indicates an acute pathological process in the body. In a biochemical study, attention is paid to the levels of acute-phase indicators. To diagnose atherosclerosis and the ischemic cause of chest pain, the lipid profile is evaluated on the left.
Bacteriological examination. In case of pneumonia or bronchitis, sputum samples should be collected for sowing on nutrient media, then the isolated microorganisms are examined for sensitivity to antibiotics. To confirm the diagnosis of infectious endocarditis, it is necessary to sow pathogens in two or more blood samples taken at intervals of 12 hours.
Invasive diagnostics. To clarify the condition of the vessels, coronary angiography with a contrast agent is shown, during which the patency of the arteries, the presence of atherosclerotic plaques and thrombotic masses are studied. Angiography is used to select the method of myocardial revascularization. With pleurisy, a pleural puncture is performed to take the exudate for analysis.
Echocardiography
Echocardiography
Treatment
Help before diagnosis
A person with pain syndrome needs to be seated, freed from embarrassing clothes, and provided with fresh air. If the patient suffers from cardiovascular pathology, and he is prescribed treatment, in case of an exacerbation, it is necessary to take nitroglycerin or other drugs on the recommendation of a doctor. In all situations when there is pain on the left side of the chest, a specialist’s consultation is required, who will be able to exclude or confirm serious cardiac and respiratory diseases.
Conservative therapy
With severe pain caused by myocardial infarction or PE, narcotic analgesics are indicated, which help prevent the development of pain shock. Further therapy depends on the diagnosis. In case of cardiac pathology, the start time of treatment is important, delay for several hours can cause serious complications. For etiotropic therapy of diseases that manifest pain syndrome in the left breast areas, medications such as:
Antianginal drugs. As a first aid for a painful attack of angina, nitroglycerin is prescribed under the tongue or intravenously. Beta-blockers, calcium antagonists, myotropic antispasmodics enhance blood supply to the myocardium and reduce its oxygen demand.
Anticoagulants. The drugs improve the rheological properties of blood and inhibit the activity of the hemostasis system, thereby reducing the risk of thrombosis and myocardial infarction. Heparin and its low-molecular fractions are used, acetylsalicylic acid is taken for a long time in low doses.
Thrombolytics. The indication for their use is chest pain on the left due to a heart attack in the first 6 hours after the onset of symptoms. The drugs increase the activity of the fibrinolytic system and stimulate thrombus lysis. They contribute to the complete restoration of blood flow in the affected vessel.
Hypolipidemic agents. The drugs normalize the concentration of cholesterol and low-density lipoproteins, which cause the appearance of atherosclerotic deposits in the vessels. They are prescribed long courses in combination with a special diet that provides for the restriction of animal fats.
Antibiotics. For pneumonia and exudative pleurisy, antibacterial agents from the group of cephalosporins, macrolides are effective. In severe croup pneumonia, combinations of two medications are indicated. For the treatment of infectious endocarditis, penicillin preparations are administered in a course of at least 4 weeks.
