Pain behind the sternum
Pain behind the sternum is pain that is localized in the middle of the chest. The symptom is accompanied by difficulty breathing, interruptions in the work of the heart. Soreness occurs in diseases of the respiratory and cardiovascular systems, hyperacid conditions, mediastinal tumors. To determine the cause of chest pains, ECG, ultrasound of the heart, radiography, laboratory tests are performed. To stop unpleasant symptoms, antianginal drugs, antacids, anti-inflammatory drugs are prescribed.
Causes of pain behind the sternum
Angina pectoris
Inflammatory heart diseases
Respiratory diseases
Gastroesophageal reflux
Pathology of the esophagus
Neoplasms of the mediastinum
Complications of pharmacotherapy
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain behind the sternum
Angina pectoris
A painful attack with angina begins suddenly during a brisk walk, climbing stairs or other physical activity. A strong pressing pain in the sternum in the middle makes a person stop and grab his heart. Often unpleasant symptoms radiate to the left arm or the collarbone area. Painful sensations squeeze the chest, prevent you from taking a deep breath. The skin turns pale, there is a sharp weakness.
The pain disappears after 5-20 minutes after resting or taking nitroglycerin tablets. The frequency of paroxysms ranges from a couple of times a month to several times a day, they are all similar in duration and nature of the pain syndrome. Acute piercing pains behind the sternum, accompanied by cold sweat, fainting, are more characteristic of myocardial infarction. In such a situation, it is necessary to call an ambulance.
Inflammatory heart diseases
The defeat of the heart muscle is manifested by a moderate pain syndrome, which is localized behind the sternum in the middle. Sensations have a stabbing or compressing character, occur at any time of the day, regardless of the level of physical activity. With endocarditis, the sternum hurts quite often. Soreness is combined with shortness of breath, palpitations. Increased pain occurs with an exacerbation of the inflammatory process, as evidenced by fever and chills.
For myocarditis, dull pains in the center of the sternum and on the left surface of the chest are typical. Also, patients complain of increased fatigue, a feeling of lack of air, dizziness. With pericarditis, severe pain and a feeling of swelling in the chest are bothering, leading to difficulty breathing. Due to the inefficient work of the heart, symptoms increase with minimal physical activity.
Respiratory diseases
When the sternum hurts in the center, this may indicate a lesion of the airways from the trachea to the middle bronchi. Viral and bacterial causes cause inflammation of the epithelial membranes, which is combined with irritation of nerve endings and a feeling of discomfort. With tracheitis and laryngotracheitis, chest pain is mild or moderate, scratching and scratching in the throat are more disturbing.
Bronchitis is characterized by pain in the middle of the chest, which occurs in the midst of the disease. There is a dull pressing pain, which increases during coughing attacks and significantly weakens at rest. The onset of unpleasant sensations is provoked by inhaling cold air, dust entering the respiratory tract. Soreness persists throughout the period of bronchitis — for 1-2 weeks.
There are also allergic causes of pain in the sternum. Most often, the soreness is caused by an attack of bronchial asthma, when discomfort and a feeling of compression in the middle of the chest are felt against the background of bronchial spasm and suffocation. Moderate intensity pain behind the sternum persists for several hours after the paroxysm. Similar clinical manifestations are also found in chronic obstructive pulmonary diseases.
Gastroesophageal reflux
With GERD, the sternum begins to ache 15-20 minutes after the end of the meal, which is due to the injection of hydrochloric acid into the esophagus. Soreness increases when the trunk is tilted forward, wearing tight belts, which contribute to the compression of the stomach and the reflex opening of the lower esophageal sphincter. The discomfort is localized exactly in the center of the chest, in addition to the pain syndrome, there is intense chest burning and heartburn in the throat.
Painful sensations are provoked by errors in the diet — the abuse of carbonated drinks, fried food, strong meat broths. For GERD, morning pains behind the sternum are typical immediately after waking up, since in a horizontal position the acid passively flows into the esophagus. If the symptoms are accompanied by repeated vomiting with admixtures of bile or blood, emergency medical care is necessary.
Pathology of the esophagus
Constant intense pain in the center of the sternum is usually associated with esophageal causes. In acute and chronic esophagitis, there is moderate cutting or burning pain in the middle part of the chest, which increases after eating. For esophageal dyskinesia and esophagospasm, paroxysmal unbearable pains in the sternum exactly in the middle are typical, which usually last from 10 to 20 minutes.
Sharp dagger pain at one point occurs in the case of a terrible disease — rupture of the esophagus. Against the background of an excruciating pain attack, vomiting opens with stomach contents and blood, which does not bring relief. In the future, the pain is localized not only behind the sternum, but also throughout the chest, in the epigastrium. The patient is in a state of shock, cold sweat appears on his forehead, the pressure drops sharply.
Neoplasms of the mediastinum
There are several organs located in the mediastinum: lymph nodes, thymus gland, thoracic duct, venous and arterial vessels. Most often, the sternum hurts with an increase in lymph nodes, which is caused by tumor causes — lymphogranulomatosis and non-Hodgkin’s lymphomas. Moderate dull soreness and a feeling of tightness in the chest are bothering, in the future the symptoms increase due to compression of the respiratory organs.
Thymoma is initially manifested by discomfort in the chest area, periodic reflex cough. As the volume formation increases, the pains become stronger, radiate to the neck and shoulder blades. Patients also complain of sore throat and hoarseness of voice caused by compression of the recurrent nerve. Similar symptoms occur with tuberculosis of the intra-thoracic lymph nodes.
Complications of pharmacotherapy
Pain in the sternum is a frequent side effect of taking sodium bicarbonate and other absorbable antacids. Although these drugs are used to reduce acidity, after 10-20 minutes of their use, the stomach expands, a new portion of acid is thrown into the esophagus (“ricochet effect”). Other causes also lead to chest pains: long-term use of NSAIDs, corticosteroids.
Rare reasons
Granulomatous diseases: sarcoidosis, silicosis.
Osteogenic processes: rib chondritis, osteosarcoma of the sternum, age-related changes in bone tissue.
Heart defects: mitral disease, stenosis or insufficiency of the aortic valve.
Hernia of the esophageal orifice of the diaphragm.
Gastrointestinal pathology: hyperacid gastritis, peptic ulcer, Zollinger-Ellison syndrome.
Intercostal neuralgia.
Diagnostics
Complaints of pain in the sternum are the basis for a visit to a general practitioner. The specialist is engaged in a primary examination to determine the cause of chest pain: collecting data on the time of occurrence and dynamics of the development of the disorder, conducting standard laboratory and clarifying instrumental methods. The greatest diagnostic value are:
Electrocardiography. The removal of an ECG is necessary to confirm or exclude the ischemic cause of pain in the sternum. The expansion and deformation of ventricular complexes, changes in the length of intervals, and their shift relative to the isoelectric axis indicate violations of the heart. To exclude the pathology of the valvular apparatus of the heart, echocardiography is prescribed.
Radiography. On a standard radiograph of the OGC, signs of mediastinal expansion and displacement of organs from the center of the sternum are searched for. An indirect sign of bronchitis is an increase in the bronchial pattern and deformation of the roots of the lungs. For a detailed study of the identified tumor or granulomatous neoplasm, spiral CT of the thoracic cavity is resorted to.
Gastroscopy. The pain that is felt in the sternum right in the middle after eating is an indication for an endoscopic examination of the esophagus and stomach. In the case of GERD, a specialist on examination notices hyperemia and swelling of the esophageal mucosa, erosion or ulcers of the esophagus. The EGDS method is informative for the diagnosis of destructive processes and ruptures of the esophagus.
Laboratory tests. To exclude myocardial infarction, a troponin test is recommended, the level of creatine phosphokinase is determined. Repeated bacteriological sputum culture is necessary if tuberculosis damage to the mediastinal organs is suspected. In a standard clinical blood test, leukocytosis and the presence of immature cells can be detected.
Electrocardiography is a method of differential diagnosis of chest pains
Treatment
Help before diagnosis
In case of an attack of angina pectoris, a person needs to be seated, unbuttoned his collar and freed from clothes that squeeze the chest. It is important to provide fresh air. The sternum in CHD stops hurting after taking nitroglycerin, which patients should always carry with them. If the pain syndrome does not subside within half an hour, an emergency should be called.
To reduce the pain of GERD, it is recommended to eat often and in small portions, avoid physical exertion and bending immediately after eating. It is advised to sleep on a high pillow. In case of respiratory diseases, it is undesirable to be in dusty rooms or rooms with low humidity, so as not to provoke coughing and pain behind the sternum. In case of severe pain in the center of the chest, it is necessary to contact a specialist to find out and eliminate the cause.
Conservative therapy
Medical tactics depend on the pathology against which the pain syndrome has arisen. With pain behind the sternum, etiotropic drugs are mainly prescribed, specific analgesics are indicated for unbearable sensations with the threat of pain shock. To eliminate the etiological factor of unpleasant symptoms , the following medications are used:
Antianginal drugs. Calcium channel antagonists, beta blockers, vasodilators are used in the complex therapy of angina pectoris. Medications dilate coronary vessels and reduce myocardial oxygen demand. They are combined with hypolipidemic drugs.
Nonsteroidal anti-inflammatory drugs. Sharp pain behind the sternum caused by neuralgia or inflammation of the cartilage is well relieved with the help of selective COX-2 inhibitors. The drugs are taken in short courses in the acute period of inflammation to avoid side effects.
Antacids. The products reduce the acidity of gastric juice and reduce its aggressive effect on the mucous membrane of the esophagus. If the sternum hurts a lot, antisecretory medications are additionally recommended, which provide a long-lasting effect.
Expectorant drugs. Effective in the treatment of bronchitis and tracheitis. They provide dilution of sputum and its removal together with pathogenic microorganisms, which reduces cough and chest pain, accelerates recovery.
Surgical treatment
To eliminate pain behind the sternum caused by a heart attack, surgical intervention may be required to revascularize the heart muscle. Balloon angioplasty and stenting of the affected vessel area are performed. Large mediastinal tumors are an indication for thoracotomy and removal of pathologically altered tissue. In case of malignant formations, the method is supplemented with radiation therapy and chemotherapy.
