Cardiologist: chest pain is not always associated with heart disease

Pain in the heart area when inhaling

Pain in the heart when inhaling usually occurs unexpectedly. In addition, it may intensify immediately after a person changes body position, or it may weaken. This is due to several factors, among which diseases and excessive physical activity are not the least important.

Many people who have experienced these sensations note increasing pain, which is accompanied by fatigue of the whole body. In order to understand the causes of the disease, an outpatient analysis should be carried out, which will give a clear explanation of what caused the pain.

Chest pain: is it always the heart?

It can be a sign of life-threatening conditions, so it is important to know its main characteristics in order to promptly seek medical help. Pain in the heart area. What is it like? Is it always an indicator of heart pathology?

Natalya Aleksandrovna Shelest, a cardiologist at Clinic Expert Irkutsk, talks about the characteristics of pain in the heart area and the possible causes of their occurrence.

— Natalya Alexandrovna, is chest pain always a sign of cardiac pathology?

- No not always. Chest pain, along with diseases of the cardiovascular system, can also manifest as diseases of the bones, joints, muscles (Tietze syndrome, anterior scalene muscle syndrome, fibromyositis, dorsopathy), changes in the lungs and pleura (pleurisy, spontaneous pneumothorax, pulmonary infarction, tumors ), digestive tract organs (esophagitis, cardiospasm, diaphragmatic hernia, gastric and duodenal ulcers, cholecystitis), some neurological disorders (herpes zoster, neurocirculatory dystonia), breast diseases.

Among the pathologies that cause chest pain, there are both life-threatening ones that require immediate intervention (in particular, myocardial infarction, dissecting aortic aneurysm, thromboembolism of the pulmonary artery and its branches, pneumothorax), and less serious pathologies - for example, anterior chest wall syndrome , anxiety-depressive state. They, of course, also require correction, but they are not classified as emergency conditions.

— For what reasons can true pain in the heart appear?

— The cause of such pain can be increased blood pressure, increased heart rate, heart rhythm disturbances, and excessive physical and emotional stress. Alcohol abuse, smoking, large meals, and drug use can also cause heart pain.

— If a patient complains of pain in the heart when taking a deep breath, what could this mean?

— First of all, about diseases of the musculoskeletal system - intercostal neuralgia, fibromyalgia, inflammation of the sternocostal joints (Tietze syndrome), chest injuries. The appearance of pain in the heart area in these pathologies is caused by irritation or pinching of the intercostal nerves, excursion (movement) of the chest as a result of the act of inhalation and exhalation, and changes in body position.

A number of pulmonary diseases, such as pneumothorax, pleurisy, pneumonia, can also be accompanied by pain when inhaling; often additional symptoms are fever, shortness of breath and tachycardia.

— What if pain in the heart appears at rest?

— In this case, there is a high probability of developing serious pathology, in particular, dissecting aortic aneurysm, pulmonary embolism, cardiac tamponade.

Sometimes banal muscle pain in the chest can also bother a person at rest due to excessive static loads or incorrect position of the torso.

— Which doctor should you consult for pain in the heart area?

— If pain in the heart occurs for the first time, taking you by surprise, and is accompanied by a deterioration in health, a person should immediately contact any doctor nearby and explain what is bothering him. Regardless of qualifications and specialization, each doctor is able to figure out what to do in a particular case, provide first aid if necessary and refer to the right specialist.

If the patient can get to the clinic, he should contact a therapist. He will decide on the necessary stages of medical care, including consultation with specialized specialists - a cardiologist, gastroenterologist, neurologist, surgeon and other doctors.

— What characteristics of chest pain require emergency medical care?

— Chest pain should always be treated with caution. It is important not to miss conditions such as acute coronary syndrome, an attack of angina pectoris (popularly “angina pectoris”). They are characterized by paroxysmal compressive, bursting, pressing, burning pain behind the sternum and/or in the left half of the chest (precordial region), can spread to the axillary and subscapular region on the left, to the left arm and shoulder, to the left half of the neck and lower jaw, lasting no more than 10 minutes, may be accompanied by a feeling of lack of air, shortness of breath. It should be remembered that most often these symptoms appear against the background or immediately after physical or emotional stress. There is a rapid effect from taking nitroglycerin within 5 minutes.

If these pains last more than 20 minutes and intensify with renewed exercise, you should definitely call an ambulance. A dangerous condition is also considered a combination of these pains with a decrease in blood pressure, a decrease (less than 50 beats per minute) or an increase (more than 120 beats per minute) in the heart rate, with interruptions in heart rhythm, profuse cold sweating, pallor of the skin, severe weakness, nausea, lightheadedness, or even loss of consciousness. If these symptoms are present, the patient needs immediate medical attention.

— How is diagnosis done for heart pain?

- First of all, we evaluate vital functions - we determine whether the patient is conscious, what are the indicators of breathing, hemodynamics (blood circulation). If there are signs of breathing problems, very low or high blood pressure, or heart rhythm disturbances, then emergency help is needed: calling an ambulance and urgent hospitalization.

The second stage of diagnosis is to identify risk factors for coronary heart disease. If there is angina-type pain, the patient is given a nitroglycerin tablet under the tongue, an electrocardiogram (ECG) is taken, and the clinical effect of the drug taken is assessed. If there is a suspicion of pulmonary embolism, pneumothorax, dissecting aneurysm, it is necessary to take an ECG, perform echocardiography, determine markers of myocardial damage, take a chest X-ray, and assess blood oxygen saturation.

At the next stage of diagnosis (after excluding life-threatening pathologies), they move on to searching for other causes that can cause pain in the heart area. In this case, the complaints are detailed, a more thorough examination is carried out, an algorithm for laboratory and instrumental research is developed: blood tests, Holter ECG, 24-hour blood pressure (BP) monitoring, radiography of the chest and spine, ultrasound of the abdominal organs, fibrogastroduodenoscopy, if necessary CT scan.

— Natalya Alexandrovna, tell our readers about the tactics of treating pain in the heart area.

— Pain in the heart area can occur with a number of pathologies, both cardiac and non-heart related. Therefore, therapeutic measures will depend on the background of what disease these pains are observed.

If pressing, bursting, burning pain in the chest appears, arising from physical or emotional overload, or at rest (which happens much less frequently), it is necessary to stop any load, take a sitting position with your legs down (to reduce the venous return of blood to the heart) and call an ambulance.

You can make an appointment with specialists at Clinic Expert Irkutsk here

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For reference:

Shelest Natalya Alexandrovna

In 2000, she graduated from Irkutsk State Medical University with a degree in General Medicine.

In 2001, she completed her internship at the Irkutsk Institute for Advanced Training of Physicians in Therapy.

In 2002, she received a certificate of professional retraining in cardiology.

He holds the position of cardiologist at Clinic Expert Irkutsk. Receives at the address: st. Kozhova, 9a.

THERE ARE CONTRAINDICATIONS. SPECIALIST CONSULTATION IS REQUIRED

Causes of pain

The feeling of pain in the left side of the chest has a different character. A person may experience sharp and aching pain, periodic and constant, pressing and stabbing. Among the reasons for their appearance are:

• precordial syndrome;
• pinched or irritated intercostal nerves;
• presence of air in the chest;
• dry pleurisy or pericarditis;
• bruises and chest injuries;
• heart pathologies;
• neurotic conditions.

The severity of the condition and its treatment depend on the type of problem. Consultations with a cardiologist, pulmonologist or neurologist may be necessary. We will talk about the features of each pathology further.

Heart diseases

The first thing that is suspected when pain in the chest area appears is heart disease. They can be distinguished from non-cardiac diseases by the following characteristics:

• pain occurs periodically, the duration of each attack is 10-15 minutes;
• More often, heart pathologies cause burning and pressing pain;
• attacks are triggered by stress and physical activity;

• stabbing pain can radiate to the arm, shoulder blade or neck on the left side.

Chest discomfort during breathing occurs due to cardiac pathologies:

• Pericarditis
  - inflammation of the outer lining of the heart muscle, develops for various reasons. It is characterized by the accumulation of fluid in the pericardial cavity and disturbances in the functioning of the cardiac system. The pain is dull and pressing, worsens with swallowing, coughing and deep breathing. Additional symptoms include: a feeling of lack of air, loss of strength, poor appetite, increased body temperature, sweating.

• Angina pectoris
  - a common symptom of dysfunction of the cardiovascular system. Manifests itself in a feeling of discomfort, compression behind the sternum. The attacks appear intermittently and last from 10 to 15 minutes.

• Heart attack
  - a condition requiring immediate medical attention. The patient feels that something is pressing inside, the pain is transmitted to the left arm, neck, and shoulder blade. Nausea and heartburn, chills, and possible fainting also appear.

If a set of symptoms of heart disease appears, you must immediately seek help; delay can be life-threatening.

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Causes of traumatic nature

Any injuries to the chest and ribs can cause sharp stabbing pain. A bruise and fracture of the bones of the chest are characterized by the appearance of a pain symptom not only when inhaling and exhaling, but also when changing the position of the body. Sometimes mechanical impact on the sternum causes traumatic pneumothorax.

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Stitching in the heart area, what to do if it is pneumothorax? The diagnosis is characterized by the accumulation of air in the outer lining of the lung. It may be intact or a similar phenomenon is caused by a violation of the structure of the lung tissue, then they speak of spontaneous pneumothorax. Symptoms of the condition include:

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• stabbing, sharp pain, radiating to the arm and neck on the left;
• discomfort increases with physical activity, coughing, laughing, taking a deep breath or diving under water;
• at rest, the pain subsides after a few hours;
• Additional signs include: pale complexion, shortness of breath, panic attacks, and sometimes a dry cough.

The risk group for spontaneous pneumothorax includes adult men under 40 years of age. Sudden changes in pressure, such as flying at high altitude, can cause disruption of the integrity of internal tissue. Only specialists treat the disease.

Pneumothorax can be a consequence of other diseases - tuberculosis, pneumonia, lung tumors.

Dry pleurisy - pathologies of the respiratory system

Often the cause of chest pain is pathology of the respiratory system. The pleura covers the lungs and chest cavity; any inflammatory lesions of this membrane are called pleurisy.

Features of dry pleurisy include:

• the left or right half of the chest constantly hurts;
• symptoms intensify with deep inspiration and coughing; immobilization of the affected side alleviates the condition;
• symptoms of general malaise are noted: temperature ranges from 36.6 to 39? C, chills and fever appear, appetite decreases, the patient feels weak;
• inflammation takes a long time, from 1 to 3 weeks, without proper treatment it develops into a chronic form.

The nature of pleurisy may lie in diseases of the lungs or nearby organs. In the first case, it is tuberculosis, pneumonia or pulmonary abscess. In the second - subphrenic abscess, infectious diseases of the abdominal cavity, pancreatitis and rheumatism.

Intercostal neuralgia

Intercostal neuralgia is of two types. In the first case, inflammation or pinching of the spinal nerve root occurs, in the second - the nerves in the intercostal space. The main symptom of neuralgia is pain localized in the chest; it can radiate to the lower back, neck or under the shoulder blade.

The pain is strong and burning. It gets worse with deep breathing, physical activity, sneezing, coughing, or sudden movements of the body if there is pressure on the nerve. Other signs of the disease include:

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• involuntary muscle contraction;
• changes in skin color and sensitivity in the area of ​​nerve damage;
• the pain may be accompanied by numbness in an area of ​​the body, or the patient feels that this area is burning, stabbing, like needles.

Neuralgia is often confused with cardiac pathologies; it differs in the nature of the pain and its intensification when inhaling and exhaling.

Among the reasons for pinching or inflammation of the nerve root are:

• osteochondrosis;
• Bekhterev's disease;
• spondylitis;
• chest injuries;
• prolonged stress;
• excessive physical activity;
• infectious diseases;
• severe hypothermia;
• changes in hormonal levels;
• spinal injuries or diseases;

• allergic reactions;
• tone of one or more back muscles.

After the examination, the doctor will give recommendations on how to relieve pain, and then determine the nature of the pinched nerve. The diagnosis is not life-threatening, but you can get rid of it only after eliminating the cause.

Neuroses and precordial syndrome

Neurotic conditions can cause sensations of stabbing pain in the heart area. Usually in such cases, patients think about a serious illness; all their sensations are psychosomatic in nature. The patient may also complain of:

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• feeling of a lump in the throat;
• that it is difficult to breathe;
• cardiopalmus;
• nausea;
• stomach ache.

Sensitive people and those who are under constant stress are susceptible to such conditions. Another selective symptom is precordial. The causes of the condition are still not fully understood, but it has its own characteristic features:

• sudden sharp pain in the chest area;
• the duration of the attack is from 0.5 - 3 minutes;
• pain occurs even at rest;
• breathing deeply is difficult;

• The frequency of attacks is always different, sometimes there are several attacks per day.

According to doctors, this syndrome occurs in people under 20 years of age and goes away with age.