Stitches in the left side of the chest. Pain in the sternum on the left: causes, what could it be? Why does my left breast hurt?

Causes of pain in the sternum on the left can occur due to a number of clear medical problems. Almost eighty percent of all cases are due to pathologists and heart disease. The causes of a serious condition can also be diseases of the digestive tract, respiratory system, diseases of the bones, muscles and skin. Only a qualified physician can determine the pain in the sternum on the left after a detailed examination and diagnosis.

Problems related to the functioning of the heart are classified into coronary and non-coronary types. Coronary abnormalities are ischemia and infarction. This type of disease poses the greatest threat to human health and even life. If you experience symptoms that indicate a heart attack or ischemia, you should urgently seek the help of a doctor.

Attacks of ischemia and infarction

The coronary arteries supply blood to the heart muscle. Changes in its work (thrombus, severe obstruction of the vessel) lead to a sharp deterioration in the functioning of the body. The cells of the organ cannot be enriched with oxygen, so the muscles can atrophy. The best option for the outcome of events may be pathological changes in the structure of the heart muscle.

Acute attacks of heart failure occur due to a number of heart conditions. The causes of the development of diseases of the cardiovascular system may lie in the excessive accumulation of cholesterol inside the coronary arteries. Blood clots can disrupt the patency of blood vessels, leading to an attack.

Risk factors for a heart attack include:

• diabetes;
• bad habits;
• high blood pressure;
• genetic predisposition to diseases of the cardiovascular system;
• elevated blood cholesterol levels.

Women are at risk during menopause. A greater chance of surviving a heart attack occurs due to changes in the hormonal balance that is characteristic of menopause. A decrease in hormones increases the risk of diseases, so older women need to take special drugs that are prescribed by a doctor on an individual basis.

Symptoms of an attack

Usually pain during a heart attack is localized in the center and left side of the sternum. Pain can spread to the following parts of the body:

• left hand;
• left shoulder;
• jaw;
• abdominal region;
• back.

The danger of an attack lies in the fact that the symptoms for each person in this case are individual. Common symptoms for all can be:

• vomit;
• nausea;
• sweating;
• shortness of breath.

It is worth paying attention to the fact that symptoms may differ in women and men. The reasons for this lie in the difference in hormonal levels.

For women, the following symptoms are characteristic:

• heartburn;
• feeling of discomfort in the abdominal cavity;
• apathetic state;
• dizziness.

The list of diagnostic measures includes:

• palpation and examination of the sternum;
• research using an electrocardiogram;
• analysis of the number of enzymes that are involved in the formation of the heart muscle.

An ECG allows you to determine what type of blood vessels the patient has problems with, what are the reasons for this.

Non coronary heart disease

A characteristic feature of non-coronary diseases is the difficulty of diagnosing. Diseases are especially difficult to diagnose in the early stages. The complexity of research and prevention lies in the fact that modern medicine has so far little studied the nature of the problem and its causes. The group of diseases includes:

• pericarditis;
• arterial hypertension;
• myocarditis;
• cardiomyopathy;
• heart defects (congenital and acquired);
• mitral valve prolapse;
• neurocirculatory dystonia (including 4 types of cardialgia);
• angina.

The pericardium is a specific cardiac sac that envelops the heart, performing a number of protective functions. The pericardium limits the heart muscle from other internal organs that are located in the sternum. This organ prevents overstrain of the heart, and also contributes to normal blood filling.

The causes of the pericardium are as follows:

• chronic renal failure;
• incorrect approach to taking certain medications;
• viruses and infections;
• cancerous tumors;
• radiation therapy.

An attack occurs due to acute inflammation of this organ. Inactivity during an attack can lead to tamponade of the heart muscle, in this condition, fluid accumulates around the heart, which leads to a deterioration in cardiac activity. The symptoms of the condition are:

• loss of consciousness;
• acute pain in the chest area;
• labored breathing.

The main symptom of acute pericarditis is a stabbing pain that may increase with each breath. A dangerous feature is that the symptoms of pericarditis often overlap with the manifestation of a heart attack. The pain may subside when bending the body. There may be pain in the throat when swallowing. The temperature changes rapidly, moving from upper to lower limits.

Causes of mitral valve prolapse

Prolapse is a disease that is caused by the pathology of the structure of the mitral valve. The valve is located between the ventricle and the left atrium, so the causes of the development of the disease can threaten a person's life.

Complications of the disease can be:

• violation of the general rhythm of the heart;
• infection of the heart valve;
• violation in the regulation of the mitral valve.

In some cases, this condition can lead to unexpected death. Any signs of the development of the disease is the reason to immediately contact qualified specialists.

angina pectoris

Angina is a condition in which the heart muscle receives a limited amount of oxygen. This is due to the pathological narrowing of blood vessels. Such changes in the blood supply reduce the amount of oxygen.

The acute form of angina pectoris is characterized by constant sharp pains that do not go away even with a normal rhythm of the heart muscle. Sudden episodic angina may occur with intense physical exertion. At rest, the pain subsides, and the heartbeat returns to normal.

Angina pectoris occurs when the heart's main artery becomes partially blocked, narrowed, or spasmed. The most common cause of angina pectoris is coronary heart disease, in which blood clots in atherosclerosis interfere with the free passage of blood vessels. The disease only partially blocks blood flow, but does not completely eliminate it. Arrhythmia, stress and heavy physical exertion can lead to a deterioration in the condition.

Symptoms of angina pectoris can often be compared to a heart attack, but the consequences of angina pectoris are not so dangerous. A person's condition returns to normal after rest, in the event of a heart attack, the structure of the heart muscle is not restored, which can lead to death.

Symptoms of the development of the disease are expressed in the appearance of severe pain in a state of calm. Not only the frequency increases, but also the intensity of heart contractions. To reduce the manifestation of symptoms, you can use three tablets of nitroglycerin, which must be taken at regular intervals.

Diagnosis of angina pectoris can be carried out with complete sedation. Only after the condition improves, it is possible to conduct an analysis for the content of enzymes in the blood. An electrocardiogram can show certain changes in the work of the heart muscle, however, such symptoms can be cured in a simple way later.

Aneurysms

The aorta is the main link between the lungs and the internal organs of a person. Aneurysms are situations in which there is a rupture of the membrane of this vessel. The disease inevitably leads to serious bleeding, the main blow in this case is taken by the heart and abdominal cavity. About thirty percent of patients survive after such a serious rupture of the internal organ.

Aortic dissection can be caused by:

• excessively high chronic pressure;
• heart defects;
• pregnancy;
• ruptures of the internal connective tissue;
• taking drugs without the appointment of a qualified physician;
• elderly age;
• genetic predisposition to heart disease.

Symptoms of the disease quickly manifest themselves, causing severe chest pain. Pain can be given in the back or in the area of ​​​​the shoulder blades. The aorta is the main artery that delivers oxygen with blood to all vital organs, so symptoms may include:

• intermittent pain, characteristic of the state of angina pectoris;
• fainting states;
• pain in the abdominal part;
• dyspnea;
• loss of motor functions of one side of the body;
• numbness of the tongue and limbs.

Digestive ailments that can cause chest pain

Often, changes in the work of the digestive tract can lead to pain in the left chest. Most often, the cause is heartburn, in some cases the symptoms may resemble a heart attack, but this possibility is in fact excluded.

Acid reflux (heartburn) occurs for a number of reasons:

• increased acidity;
• excessive use of writing;
• ailments of the gastrointestinal tract;
• a change in the functionality of the sphincter, which is located inside the stomach;
• scleroderma;
• diabetes diabetes.

Symptoms of heartburn are:

• persistent dry cough;
• hoarseness;
• sharp pain in the left chest;
• neck, back and chest pain;
• pain during the process of swallowing food;
• active salivation;
• blood loss in the esophagus;
• chest pressure;
• discomfort in the chest area;
• pale skin;
• excessive sweating;
• sore throat;
• vomiting and nausea;
• acid or bitter taste in the mouth.

Pain in the left side of the chest, which are provoked by diseases of the respiratory system

The diseases in this group include:

• pulmonary embolism (thrombosis of an artery);
• spontaneous pneumothorax;
• pneumonia.

Pulmonary embolism is characterized by the presence of a blood clot in one of the main arteries of the heart. The vessel provides the lungs with oxygen, so the appearance of a blood clot can be fatal. Risk factors include:

• cancerous tumors;
• excessive fullness, obesity of internal organs;
• fractures of the tibia;
• minimal body activity;
• pregnancy;
• genetic predisposition to the development of the disease;
• development of arrhythmia;
• transferred heart attacks;
• persistent heart failure.

It is worth paying attention to the fact that this disease is not associated with diseases of the cardiovascular system. Women who smoke and use hormonal contraceptives are the first to fall into the risk group. This combination is especially dangerous for women whose age exceeds thirty-five years.

The symptoms of the disease are:

• rapid breathing;
• severe difficulty in breathing;
• sharp pain in the center of the sternum, which increases with each breath.

Diagnostic procedures include:

• conducting an electrocardiogram;
• a detailed description of the symptoms and their comparison;
• checking the condition of the chest on an x-ray;
• conducting a blood test to determine the amount of oxygen;
• CT scan.

Pneumonia as a cause of chest pain

Pneumonia is an infectious disease of the respiratory tract that is caused by inflammation of the lining of the lungs. The causes of the development of the disease can be:

• viral infection;
• bacterial infection;
• fungal infection.

Severe pain in pneumonia occurs with a long intermittent cough, as well as a deep breath. The most common is unilateral chest pain.

Side symptoms are:

• mucous secretions from the lungs;
• decrease in respiratory functions;
• increase in body temperature.

Diagnosis can be made with a statoscope, a chest x-ray, and a physical examination of the patient. Timely detection of the fact of the disease can save a person from serious consequences and constant pain in the sternum area.

Even a patient taking medications needs constant medical supervision. Modern antibiotics help to quickly get rid of inflammation and symptoms of the disease. The acute form of pneumonia is always accompanied by pain in the chest area. In severe cases, doctors prescribe painkillers that can greatly alleviate suffering during the illness.

Often, people with pneumonia are hospitalized in a medical facility, where they constantly arrive under the supervision of specialists. Complications after pneumonia can be very diverse.

The main causes of pain in the upper chest:

• diseases of the musculoskeletal system: costal chondritis, rib fracture;
• cardiovascular diseases: cardiac ischemia caused by atherosclerosis of the heart vessels; unstable / stable angina; cardiac ischemia caused by coronary vasospasm (angina pectoris); mitral valve prolapse syndrome; cardiac arrhythmia; pericarditis.
• gastrointestinal diseases: gastroesophageal reflux, spasm of the esophagus, gastric and duodenal ulcer, gallbladder disease;
• anxiety states: vague anxiety or "stress", panic disorders;
• pulmonary diseases: pleurodynia (pleuralgia), acute bronchitis, pneumonia;
• neurological diseases;
• uncharacteristic defined or atypical pain in the upper chest.

Pain in the upper chest is not limited to a certain age group, but is more common in adults than in children. The highest percentage is observed among adults over 65 years of age, and in second place are male patients aged 45 to 65 years.

Frequency of diagnosis, by age and sex

No less difficult is the position of the doctor in the initial interpretation of pain, when he tries to connect it with the pathology of one or another organ. Observation of clinicians of the last century helped them formulate assumptions about the pathogenesis of pain - if an attack of pain occurs without a reason and stops on its own, then the pain is likely to be functional. The works devoted to the detailed analysis of pains in the top part of a breast are not numerous; the groupings of pains proposed in them are far from perfect. These shortcomings are due to objective difficulties in analyzing the patient's sensations.

The complexity of interpreting pain in the chest is also due to the fact that the detected pathology of one or another organ of the chest or musculoskeletal formation does not mean that it is the source of pain; in other words, the identification of a disease does not mean that the cause of pain is precisely determined.

When evaluating patients with upper chest pain, the clinician must weigh all relevant options for potential causes of pain, determine when intervention is needed, and choose from an almost limitless number of diagnostic and therapeutic strategies. All this must be done while responding to the distress experienced by patients concerned about the presence of a life-threatening illness. The difficulty in diagnosis is further complicated by the fact that upper chest pain is often a complex interplay of psychological, pathological, and psychosocial factors. This makes it the most common problem in primary care.

When considering upper chest pain, there are (at a minimum) five elements to consider: predisposing factors; description of the attack of pain; duration of painful episodes; characterization of the actual pain; pain relieving factors.

With all the variety of causes that cause pain in the chest, pain syndromes can be grouped.

Approaches to groupings may be different, but basically they are built according to the nosological or organ principle.

Conventionally, 6 following groups of causes of pain in the upper chest can be distinguished:

1. Pain caused by heart disease (so-called heart pain). These pains can be the result of damage or dysfunction of the coronary arteries - coronary pain. The "coronary component" does not take part in the origin of non-coronary pain. In the future, we will use the terms "heart pain syndrome", "heart pain", understanding their connection with a particular pathology of the heart.
2. Pain caused by pathology of large vessels (aorta, pulmonary artery and its branches).
3. Pain caused by pathology of the bronchopulmonary apparatus and pleura.
4. Pain associated with the pathology of the spine, anterior chest wall and muscles of the shoulder girdle.
5. Pain caused by pathology of the mediastinal organs.
6. Pain associated with diseases of the abdominal organs and pathology of the diaphragm.

Pain in the chest area is also divided into acute and long-term, with an obvious cause and without an apparent cause, "non-dangerous" and pain that is a manifestation of life-threatening conditions. Naturally, first of all it is necessary to establish whether the pain is dangerous or not. "Dangerous" pains include all types of anginal (coronary) pains, pain in pulmonary embolism (PE), dissecting aortic aneurysm, spontaneous pneumothorax. By "non-dangerous" - pain in the pathology of the intercostal muscles, nerves, bone and cartilage formations of the chest. "Dangerous" pains are accompanied by a suddenly developed serious condition or severe disorders of the heart or respiratory function, which immediately allows you to narrow the range of possible diseases (acute myocardial infarction, pulmonary embolism, dissecting aortic aneurysm, spontaneous pneumothorax).

The main causes of acute pain in the upper chest, which are life-threatening:

• cardiological: acute or unstable angina pectoris, myocardial infarction, dissecting aortic aneurysm;
• pulmonary: pulmonary embolism; tension pneumothorax.

It should be noted that the correct interpretation of pain in the upper chest is quite possible with the usual physical examination of the patient using a minimum number of instrumental methods (conventional electrocardiographic and x-ray examination). An erroneous initial idea of ​​the source of pain, in addition to increasing the period of examination of the patient, often leads to serious consequences.

History and physical examination findings to determine causes of upper chest pain

Cardialgia (non-anginal pain). Cardialgia, caused by certain diseases of the heart, are very common. By its origin, significance and place in the structure of the incidence of the population, this group of pains is extremely heterogeneous. The causes of such pain and their pathogenesis are very diverse. Diseases or conditions in which cardialgia is observed are as follows:

1. Primary or secondary cardiovascular functional disorders - the so-called cardiovascular syndrome of the neurotic type or neurocirculatory dystonia.
2. Diseases of the pericardium.
3. Inflammatory diseases of the myocardium.
4. Dystrophy of the heart muscle (anemia, progressive muscular dystrophy, alcoholism, beriberi or starvation, hyperthyroidism, hypothyroidism, catecholamine effects).

As a rule, non-anginal pains are benign, as they are not accompanied by coronary insufficiency and do not lead to the development of ischemia or myocardial necrosis. However, in patients with functional disorders leading to an increase (usually short-term) in the level of biologically active substances (catecholamins), the likelihood of ischemia still exists.

Pain in the upper chest of neurotic origin. We are talking about pain in the region of the heart, as one of the manifestations of neurosis or neurocirculatory dystonia (vegetative-vascular dystonia). Usually these are pains of a aching or stabbing nature, of varying intensity, sometimes long-term (hours, days) or, conversely, very short-term, instantaneous, penetrating. The localization of these pains is very different, not always constant, almost never retrosternal. Pain may increase with physical exertion, but usually with psycho-emotional stress, fatigue, without a clear effect of the use of nitroglycerin, they do not decrease at rest, and, sometimes, on the contrary, patients feel better when moving. The diagnosis takes into account the presence of signs of a neurotic state, autonomic dysfunction (sweating, dermographism, subfebrile condition, pulse and blood pressure fluctuations), as well as young or middle age of patients, mostly female. These patients have increased fatigue, decreased exercise tolerance, anxiety, depression, phobias, fluctuations in pulse, blood pressure. In contrast to the severity of subjective disorders, an objective study, including using various additional methods, does not reveal a specific pathology.

Sometimes among these symptoms of neurotic origin, the so-called hyperventilation syndrome is revealed. This syndrome is manifested by an arbitrary or involuntary increase and deepening of respiratory movements, tachycardia, arising in connection with adverse psycho-emotional influences. This may cause pain in the upper chest, as well as paresthesia and muscle twitching in the limbs due to the resulting respiratory alkalosis. There are observations (incompletely confirmed) indicating that hyperventilation can lead to a decrease in myocardial oxygen consumption and provoke coronary spasm with pain and ECG changes. It is possible that it is hyperventilation that can cause pain in the region of the heart during exercise testing in individuals with vegetative-vascular dystonia.

To diagnose this syndrome, a provocative test with induced hyperventilation is performed. The patient is asked to breathe more deeply - 30-40 times per minute for 3-5 minutes or until the patient's usual symptoms appear (pain in the upper chest, headaches, dizziness, shortness of breath, sometimes fainting). The appearance of these symptoms during the test or 3-8 minutes after its completion, with the exclusion of other causes of pain, has a definite diagnostic value.

Hyperventilation in some patients may be accompanied by aerophagia with the appearance of pain or a feeling of heaviness in the upper part of the epigastric region due to distension of the stomach. These pains can spread upward, behind the sternum, into the neck and the area of ​​the left shoulder blade, simulating angina pectoris. Such pains are aggravated by pressure on the epigastric region, in the supine position, with deep breathing, they decrease with belching with air. With percussion, an expansion of the Traube space zone is found, including tympanitis over the area of ​​\u200b\u200babsolute dullness of the heart, with fluoroscopy - an enlarged gastric bladder. Similar pains can occur when stretching the gases of the left corner of the colon. In this case, the pain is often associated with constipation and is relieved after a bowel movement. A thorough history usually allows the true nature of the pain to be determined.

The pathogenesis of cardiac pain in neurocirculatory dystonia is unclear, due to the impossibility of their experimental reproduction and confirmation in the clinic and experiment, in contrast to anginal pain. Perhaps, in connection with this circumstance, a number of researchers generally question the presence of pain in the heart with neurocirculatory dystonia. Similar trends are most common among representatives of the psychosomatic trend in medicine. According to their views, we are talking about the transformation of psycho-emotional disorders into pain.

The origin of pain in the heart in neurotic states is also explained from the standpoint of the cortico-visceral theory, according to which, when the vegetative devices of the heart are stimulated, a pathological dominant appears in the central nervous system with the formation of a vicious circle. There is reason to believe that pain in the heart with neurocirculatory dystonia occurs due to a violation of myocardial metabolism against the background of excessive adrenal stimulation. At the same time, a decrease in the content of intracellular potassium, activation of dehydrogenation processes, an increase in the level of lactic acid and an increase in myocardial oxygen demand are observed. Hyperlactatemia is a well-proven fact in neurocirculatory dystonia.

Clinical observations indicating a close relationship between pain in the region of the heart and emotional influences confirm the role of catecholamines as a trigger for pain. This position is supported by the fact that intravenous administration of izadrin to patients with neurocirculatory dystonia causes pain in the region of the heart such as cardialgia. Obviously, catecholamine stimulation can also explain the provocation of cardialgia with a test with hyperventilation, as well as its occurrence at the height of respiratory disorders with neurocirculatory dystonia. This mechanism can also be confirmed by the positive results of treating cardialgia with breathing exercises aimed at eliminating hyperventilation. A certain role in the formation and maintenance of pain in the heart syndrome in neurocirculatory dystonia is played by the flow of pathological impulses coming from hyperalgesia zones in the muscles of the anterior chest wall to the corresponding segments of the spinal cord, where, according to the "gateway" theory, the summation phenomenon occurs. In this case, a reverse flow of impulses is noted, causing irritation of the thoracic sympathetic ganglia. Of course, the low threshold of pain sensitivity in vegetative-vascular dystonia also matters.

In the occurrence of pain, such still insufficiently studied factors as impaired microcirculation, changes in the rheological properties of the blood, and an increase in the activity of the kinincallikrein system can play a role. It is possible that with the long-term existence of severe vegetative-vascular dystonia, its transition to coronary artery disease with unchanged coronary arteries, in which pain is caused by spasm of the coronary arteries, is possible. In a targeted study of a group of patients with proven coronary artery disease with unchanged coronary arteries, it was found that all of them suffered from severe neurocirculatory dystonia in the past.

In addition to vegetative-vascular dystonia, cardialgia is also observed in other diseases, but the pain is less pronounced and usually never comes to the fore in the clinical picture of the disease.

The origin of pain in pericardial lesions is quite understandable, since there are sensitive nerve endings in the pericardium. Moreover, it has been shown that irritation of certain areas of the pericardium gives different localization of pain. For example, irritation of the pericardium on the right causes pain along the right mid-clavicular line, and irritation of the pericardium in the region of the left ventricle is accompanied by pain spreading along the inner surface of the left shoulder.

Pain in myocarditis of various origins is a very common symptom. Their intensity is usually low, but in 20% of cases they have to be differentiated from pain caused by coronary artery disease. Pain in myocarditis is probably associated with irritation of the nerve endings located in the epicardium, as well as with inflammatory myocardial edema (in the acute phase of the disease).

Even more uncertain is the origin of pain in myocardial dystrophies of various origins. Probably, the pain syndrome is due to a violation of myocardial metabolism, the concept of local tissue hormones, convincingly presented by N.R. Paleev et al. (1982) may also shed light on the causes of pain. In some myocardial dystrophies (due to anemia or chronic carbon monoxide poisoning), pain can be of mixed origin, in particular, the ischemic (coronary) component is essential.

It is necessary to dwell on the analysis of the causes of pain in patients with myocardial hypertrophy (due to pulmonary or systemic hypertension, valvular heart disease), as well as in primary cardiomyopathies (hypertrophic and dilated). Formally, these diseases are mentioned in the second heading of anginal pain caused by an increase in myocardial oxygen demand with unchanged coronary arteries (the so-called non-coronary forms). However, under these pathological conditions, in some cases, unfavorable hemodynamic factors occur, causing relative myocardial ischemia. It is believed that the angina-type pain observed in aortic insufficiency depends primarily on low diastolic pressure and, consequently, low coronary perfusion (coronary blood flow is realized during diastole).

With aortic stenosis or idiopathic myocardial hypertrophy, the appearance of pain is associated with impaired coronary circulation in the subendocardial regions due to a significant increase in intramyocardial pressure. All pain sensations in these diseases can be designated as metabolically or hemodynamically caused anginal pain. Despite the fact that they do not formally refer to IHD, one should keep in mind the possibility of developing small-focal necrosis. However, the characteristics of these pains often do not correspond to classical angina pectoris, although typical attacks are also possible. In the latter case, the differential diagnosis with CAD is particularly difficult.

In all cases of detection of non-coronary causes of the origin of pain in the upper chest, it is taken into account that their presence does not at all contradict the simultaneous existence of IHD and, accordingly, requires an examination of the patient in order to exclude or confirm it.

Pain in the upper chest due to pathology of the bronchopulmonary apparatus and pleura. Pain often accompanies a variety of pulmonary pathologies, occurring in both acute and chronic diseases. However, it is usually not a leading clinical syndrome and is quite easily differentiated.

The source of pain is the parietal pleura. From pain receptors located in the parietal pleura, afferent fibers go as part of the intercostal nerves, so the pain is clearly localized on the affected half of the chest. Another source of pain is the mucous membrane of the large bronchi (which is well proven with bronchoscopy) - afferent fibers from the large bronchi and trachea are part of the vagus nerve. The mucous membrane of the small bronchi and lung parenchyma probably does not contain pain receptors, so pain in the primary lesion of these formations appears only when the pathological process (pneumonia or tumor) reaches the parietal pleura or spreads to large bronchi. The most severe pains are noted during the destruction of the lung tissue, sometimes acquiring high intensity.

The nature of pain sensations to some extent depends on their origin. Pain in the parietal pleura is usually stabbing, clearly associated with coughing and deep breathing. Dull pain is associated with distension of the mediastinal pleura. Severe constant pain, aggravated by breathing, moving the arms and shoulder girdle, may indicate tumor growth into the chest.

The most common causes of pulmonary-pleural pain are pneumonia, lung abscess, tumors of the bronchi and pleura, pleurisy. With pain associated with pneumonia, dry or exudative pleurisy, auscultation may reveal wheezing in the lungs, pleural friction noise.

Severe pneumonia in adults has the following clinical features:

• moderate or severe respiratory depression;
• temperature 39.5 °C or higher;
• confusion;
• respiratory rate - 30 per minute or more;
• pulse 120 beats per minute or more;
• systolic blood pressure below 90 mm Hg. Art.;
• diastolic blood pressure below 60 mm Hg. Art.;
• cyanosis;
• over 60 years old - features: confluent pneumonia, is more severe with concomitant severe diseases (diabetes, heart failure, epilepsy).

NB! All patients with signs of severe pneumonia should be immediately referred to hospital! Referral to hospital:

• severe form of pneumonia;
• patients with pneumonia from socioeconomically disadvantaged backgrounds, or who are unlikely to follow doctor's orders at home; who live very far from a medical facility;
• pneumonia in combination with other diseases;
• suspicion of atypical pneumonia;
• patients who do not respond well to treatment.

Pneumonia in children is described as follows:

• retraction of the intercostal spaces of the chest, cyanosis and inability to drink in young children (from 2 months to 5 years) is also a sign of severe pneumonia, which requires an urgent referral to a hospital;
• pneumonia should be distinguished from bronchitis: the most valuable symptom in the case of pneumonia is tachypnea.

Pain in case of damage to the pleura almost does not differ from those in acute intercostal myositis or trauma to the intercostal muscles. With spontaneous pneumothorax, there is an acute unbearable pain in the upper chest associated with damage to the bronchopulmonary apparatus.

Pain in the upper chest, difficult to interpret due to its uncertainty and isolation, is observed in the initial stages of bronchogenic lung cancer. The most excruciating pain is characteristic of the apical localization of lung cancer, when damage to the common trunk of CVII and ThI nerves and the brachial plexus almost inevitably and rapidly develops. The pain is localized mainly in the brachial plexus and radiates along the outer surface of the arm. On the side of the lesion, Horner's syndrome (narrowing of the pupil, ptosis, enophthalmos) often develops.

Pain syndromes also occur with mediastinal localization of cancer, when compression of the nerve trunks and plexuses causes acute neuralgic pain in the shoulder girdle, upper limb, and chest. This pain gives rise to an erroneous diagnosis of angina pectoris, myocardial infarction, neuralgia, plexitis.

The need for differential diagnosis of pain caused by damage to the pleura and bronchopulmonary apparatus, with coronary artery disease arises in cases where the picture of the underlying disease is fuzzy and pain comes to the fore. In addition, such differentiation (especially in acute unbearable pain) should be carried out with diseases caused by pathological processes in large vessels - pulmonary embolism, dissecting aneurysm of various parts of the aorta. Difficulties in identifying pneumothorax as a cause of acute pain are due to the fact that in many cases the clinical picture of this acute situation is erased.

Pain in the upper chest associated with the pathology of the mediastinal organs is caused by diseases of the esophagus (spasm, reflux esophagitis, diverticula), mediastinal tumors and mediastinitis.

Pain in diseases of the esophagus usually has a burning character, is localized behind the fudin, occurs after eating, and is aggravated in a horizontal position. Such usual symptoms as heartburn, belching, and swallowing disorders may be absent or be mildly pronounced, and retrosternal pain, which often occurs during exercise and is inferior to the action of nitroglycerin, comes to the fore. The similarity of these pains with angina pectoris is complemented by the fact that they can radiate to the left half of the chest, shoulders, arms. With a more detailed questioning, however, it turns out that the pains are more often associated with food, especially plentiful, and not with physical activity, usually occur in the supine position and disappear or are relieved when moving to a sitting or standing position, when walking, after taking antacids, for example, soda, which is uncharacteristic for coronary artery disease. Often, palpation of the epigastric region increases these pains.

Retrosternal pain is also suspicious for gastroesophageal reflux and esophagitis. to confirm the presence of which 3 types of tests are important: endoscopy and biopsy; intraesophageal infusion of 0.1% hydrochloric acid solution; monitoring intraesophageal pH. Endoscopy is important to detect reflux, esophagitis, and to rule out other pathologies. X-ray examination of the esophagus with barium reveals anatomical changes, but its diagnostic value is considered relatively low due to the high frequency of false positive signs of reflux. With the perfusion of hydrochloric acid (120 drops per minute through a probe), the appearance of the usual pains for the patient matters. The test is considered to be highly sensitive (80%), but not specific enough, which requires repeated studies in case of fuzzy results.

If the results of endoscopy and perfusion of hydrochloric acid are unclear, monitoring of intraesophageal pH can be carried out using a radio telemetry capsule placed in the lower part of the esophagus for 24-72 hours. indeed a criterion for the esophageal origin of pain.

Pain in the upper chest, similar to angina pectoris, can also be a consequence of an increase in the motor function of the esophagus with achalasia (spasm) of the cardiac region or diffuse spasm. Clinically, in such cases, there are usually signs of dysphagia (especially when taking solid food, cold liquids), which, unlike organic stenosis, is unstable. Sometimes retrosternal pains of different duration come to the fore. Difficulties in differential diagnosis are also due to the fact that this category of patients is sometimes helped by nitroglycerin, which relieves spasm and pain.

Radiographically, with achalasia of the esophagus, an expansion of its lower part and a delay in it of the barium mass are detected. However, an x-ray examination of the esophagus in the presence of pain is of little information, or rather, of little evidence: false positive results were noted in 75% of cases. Esophageal manometry using a three-lumen probe is more effective. The coincidence in time of onset of pain and increased intraesophageal pressure has a high diagnostic value. In such cases, there may be a positive effect of nitroglycerin and calcium antagonists, which reduce the tone of smooth muscles and intraesophageal pressure. Therefore, these drugs can be used in the treatment of such patients, especially in combination with anticholinergics.

Clinical experience suggests that coronary artery disease is indeed often misdiagnosed in esophageal pathology. In order to make a correct diagnosis, the doctor must look for other symptoms of esophageal disorders in the patient and compare the clinical manifestations and the results of various diagnostic tests.

Attempts to develop a set of instrumental studies that would help distinguish between anginal and esophageal pain were unsuccessful, since this pathology is often combined with angina pectoris, which is confirmed by bicycle ergometry. Thus, despite the use of various instrumental methods, the differentiation of pain sensations is still very difficult.

Mediastinitis and tumors of the mediastinum are infrequent causes of pain in the upper chest. Usually, the need for differential diagnosis with coronary artery disease arises at pronounced stages of tumor development, when, however, there are still no pronounced symptoms of compression. The appearance of other signs of the disease greatly facilitates the diagnosis.

Pain in the upper chest in diseases of the spine. Pain in the chest can also be associated with degenerative changes in the spine. The most common disease of the spine is osteochondrosis (spondylosis) of the cervical and thoracic region, in which there is pain, sometimes similar to angina pectoris. This pathology is widespread, since changes in the spine are often observed after 40 years. With damage to the cervical and (or) upper thoracic spine, the development of a secondary radicular syndrome with the spread of pain in the chest area is often observed. These pains are associated with irritation of the sensory nerves by osteophytes and thickened intervertebral discs. Usually, bilateral pains appear in the corresponding intercostal spaces, but patients quite often concentrate their attention on their retrosternal or pericardial localization, referring them to the heart. Such pains can be similar to angina pectoris in the following ways: they are perceived as a feeling of pressure, heaviness, sometimes radiate to the left shoulder and arm, neck, can be provoked by physical activity, accompanied by a feeling of shortness of breath due to the impossibility of deep breathing. Taking into account the advanced age of patients in such cases, the diagnosis of coronary artery disease is often made with all the ensuing consequences.

At the same time, degenerative changes in the spine and the pain caused by them can also be observed in patients with undoubted coronary artery disease, which also requires a clear distinction between the pain syndrome. Perhaps, in some cases, angina pectoris against the background of atherosclerosis of the coronary arteries in patients with spinal lesions occur reflexively. The unconditional recognition of such a possibility, in turn, shifts the "center of gravity" to the pathology of the spine, reducing the importance of independent damage to the coronary arteries.

How to avoid diagnostic errors and make the correct diagnosis? Of course, it is important to conduct an X-ray of the spine, but the changes detected in this case are completely insufficient for diagnosis, since these changes can only accompany IHD and (or) not be clinically manifested. Therefore, it is very important to find out all the features of pain. As a rule, pain depends not so much on physical activity as on changes in body position. Pain is often aggravated by coughing, deep breathing, may decrease in some comfortable position of the patient, after taking analgesics. These pains differ from angina pectoris in a more gradual onset, longer duration, they do not go away at rest and after the use of nitroglycerin. Irradiation of pain in the left hand occurs along the dorsal surface, in the I and II fingers, while with angina pectoris - in the IV and V fingers of the left hand. Of certain importance is the detection of local pain in the spinous processes of the corresponding vertebrae (trigger zone) when pressed or tapped paravertebral and along the intercostal space. Pain can also be caused by certain techniques: strong pressure on the head towards the back of the head or stretching one arm while turning the head to the other side. With bicycle ergometry, pain in the region of the heart may appear, but without characteristic ECG changes.

Thus, the diagnosis of radicular pain requires a combination of radiological signs of osteochondrosis and the characteristic features of pain in the upper chest that do not correspond to coronary artery disease.

The frequency of muscular-fascial (muscular-dystonic, muscular-dystrophic) syndromes in adults is 7-35%, and in some professional groups it reaches 40-90%. In some of them, heart disease is often misdiagnosed, since the pain syndrome in this pathology has some similarities with pain in cardiac pathology.

There are two stages of the disease of muscular-fascial syndromes (Zaslavsky E.S., 1976): functional (reversible) and organic (muscular-dystrophic). In the development of muscular-fascial syndromes, there are several etiopathogenetic factors:

1. Injuries of soft tissues with the formation of hemorrhages and sero-fibrinous extravasates. As a result, compaction and shortening of the muscles or individual muscle bundles, ligaments, and a decrease in the elasticity of the fascia develop. As a manifestation of an aseptic inflammatory process, connective tissue is often formed in excess.
2. Microtraumatization of soft tissues in some types of professional activity. Microtraumas disrupt tissue circulation, cause muscular-tonic dysfunction with subsequent morphological and functional changes. This etiological factor is usually combined with others.
3. Pathological impulsation in visceral lesions. This impulse, which occurs when the internal organs are damaged, is the cause of the formation of various sensory, motor and trophic phenomena in the integumentary tissues, innervationally associated with the altered internal organ. Pathological interoceptive impulses, switching through the spinal segments, go to the corresponding affected internal organ - connective tissue and muscle segments. The development of musculo-fascial syndromes associated with cardiovascular pathology can change the pain syndrome so much that diagnostic difficulties arise.
4. Vertebrogenic factors. When receptors of the affected motor segment are irritated (receptors of the fibrous ring of the intervertebral disc, posterior longitudinal ligament, joint capsules, autochthonous muscles of the spine), not only local pain and muscle-tonic disorders occur, but also various reflex responses at a distance - in the area of ​​integumentary tissues, innervationally connected with affected vertebral segments. But far from all cases, there is a parallelism between the severity of radiographic changes in the spine and clinical symptoms. Therefore, the radiographic signs of osteochondrosis cannot yet serve as an explanation for the development of muscular-fascial syndromes solely by vertebrogenic factors.

As a result of the influence of several etiological factors, muscular-tonic reactions develop in the form of hypertonicity of the affected muscle or muscle group, which is confirmed by electromyography. Muscle spasm is one of the sources of pain. In addition, impaired microcirculation in the muscle leads to local tissue ischemia, tissue edema, accumulation of kinins, histamine, and heparin. All these factors also cause pain. If muscular-fascial syndromes are observed for a long time, then fibrous degeneration of muscle tissue occurs.

The greatest difficulties in the differential diagnosis of muscular-fascial syndromes and pain of cardiac origin are found in the following syndromes: shoulder-scapular periarthritis, scapular-costal syndrome, anterior chest wall syndrome, interscapular pain syndrome, pectoralis minor syndrome, anterior scalene syndrome. Anterior chest wall syndrome is observed in patients after myocardial infarction, as well as in non-coronary heart lesions. It is assumed that after a myocardial infarction, the flow of pathological impulses from the heart spreads through the segments of the vegetative chain and leads to degenerative changes in the corresponding formations. This syndrome in persons with a known healthy heart may be due to traumatic myositis.

More rare syndromes, accompanied by pain in the anterior chest wall, are: Tietze's syndrome, xifoidia, manubriosternal syndrome, scalenus syndrome.

Tietze's syndrome is characterized by severe pain at the junction of the sternum with the cartilages of the II-IV ribs, swelling of the costal-cartilaginous joints. It is observed mainly in middle-aged people. Etiology and pathogenesis are unclear. There is an assumption about aseptic inflammation of the costal cartilages.

Xifoidia is manifested by a sharp pain in the upper part of the sternum, aggravated by pressure on the xiphoid process, sometimes accompanied by nausea. The cause of the pain is unclear, perhaps there is a connection with the pathology of the gallbladder, duodenum, stomach.

With manubriosternal syndrome, acute pain is noted above the upper part of the sternum or somewhat laterally. The syndrome is observed in rheumatoid arthritis, but occurs in isolation, and then it becomes necessary to differentiate it from angina pectoris.

Scalenus syndrome - compression of the neurovascular bundle of the upper limb between the anterior and middle scalene muscle, as well as the normal I or additional rib. Pain in the region of the anterior chest wall is combined with pain in the neck, shoulder girdle, shoulder joints, sometimes there is a wide area of ​​irradiation. At the same time, vegetative disorders are observed in the form of chills, pallor of the skin. Difficulty breathing, Raynaud's syndrome.

Summarizing the above, it should be noted that the true frequency of pain of this origin is unknown, therefore, it is not possible to determine their specific weight in the differential diagnosis of angina pectoris.

Differentiation is necessary in the initial period of the disease (when they first think about angina) or if the pain caused by the listed syndromes is not combined with other signs that allow them to correctly recognize their origin. At the same time, pains of this origin can be combined with true coronary artery disease, and then the doctor must also understand the structure of this complex pain syndrome. The need for this is obvious, since the correct interpretation will affect both treatment and prognosis.

Pain in the upper chest due to diseases of the abdominal organs and pathology of the diaphragm. Diseases of the abdominal organs are often accompanied by pain in the region of the heart in the form of a syndrome of typical angina pectoris or cardialgia. Pain in peptic ulcer of the stomach and duodenum, chronic cholecystitis can sometimes radiate to the left half of the chest, which causes diagnostic difficulties, especially if the diagnosis of the underlying disease has not yet been established. Such irradiation of pain is quite rare, but its possibility should be taken into account when interpreting pain in the region of the heart and behind the sternum. The occurrence of these pains is explained by reflex effects on the heart during lesions of internal organs, which occur as follows. Interorgan connections were found in the internal organs, through which axon reflexes are carried out, and, finally, polyvalent receptors were found in blood vessels and smooth muscles. In addition, it is known that, along with the main borderline sympathetic trunks, there are also paravertebral plexuses that connect both borderline trunks, as well as sympathetic collaterals located parallel and on the sides of the main sympathetic trunk. Under such conditions, afferent excitation, heading from any organ along the reflex arc, can switch from centripetal to centrifugal paths and thus be transmitted to various organs and systems. At the same time, viscero-visceral reflexes are carried out not only by reflex arcs that close at various levels of the central nervous system, but also through autonomic nerve nodes on the periphery.

As for the causes of reflex pains in the region of the heart, it is assumed that a long-term painful focus disrupts the primary afferent impulse from the organs due to a change in the reactivity of the receptors located in them and in this way becomes a source of pathological afferentation. Pathologically altered impulsation leads to the formation of dominant foci of irritation in the cortex and subcortical region, in particular in the hypothalamic region and in the reticular formation. Thus, the irradiation of these irritations is carried out with the help of central mechanisms. From here, pathological impulses are transmitted by efferent pathways through the underlying parts of the central nervous system and then through the sympathetic fibers reach the vasomotor receptors of the heart.

Diaphragmatic hernias can also be causes of retrosternal pain. The diaphragm is a richly innervated organ mainly due to the phrenic nerve. It runs along the front inner edge m. scalenus anticus. In the mediastinum, it goes along with the superior vena cava, then, bypassing the mediastinal pleura, reaches the diaphragm, where it branches. The most common hernia of the esophageal opening of the diaphragm. Symptoms of diaphragmatic hernias are varied: usually it is dysphagia and pain in the lower parts of the chest, belching and a feeling of fullness in the epigastrium. When the hernia is temporarily introduced into the chest cavity, there is a sharp pain that can be projected onto the lower left half of the chest and extends into the interscapular region. The concomitant spasm of the diaphragm can cause pain reflected due to irritation of the phrenic nerve in the left scapular region and in the left shoulder, which suggests "heart" pain. Given the paroxysmal nature of the pain, its appearance in middle-aged and elderly people (mainly in men), a differential diagnosis should be made with an attack of angina pectoris.

Pain can also be caused by diaphragmatic pleurisy and much less often by subphrenic abscess.

In addition, when examining the chest, shingles can be detected, palpation can reveal a fracture of the rib (local tenderness, crepitus).

Thus, in order to find out the cause of pain in the upper chest and make the correct diagnosis, the general practitioner should conduct a thorough examination and questioning of the patient and take into account the possibility of the existence of all the above conditions.

If your chest hurts from above, then you should find out and eliminate the causes of such a symptom. They can be varied, and they are worth knowing.

In any case, you will not be able to establish the exact causes of pain in the upper chest on your own, this should be done by a doctor, moreover, after a thorough and comprehensive examination. But in order for him to make assumptions and move in the right direction, you should help him take an anamnesis, that is, draw up a detailed picture of the condition and analyze the symptoms.

• To begin with, evaluate the nature of the pain, which can be aching, sharp, dull, stabbing, pulling, cutting.
• Then try to remember exactly when the symptom began to appear or after what actions or events it occurs, if it is of a periodic nature. So, pain can develop or intensify after stress, intense physical exertion, after eating, after an illness or injury, before menstruation in women.
• It is worth identifying the accompanying symptoms that accompany pain. There may be discomfort, changes in heartbeat, respiratory disorders, stiffness of movements, fever, general malaise or weakness, digestive disorders, abnormal discharge from the nipples.

Important: if you describe your condition in detail, then an accurate diagnosis by a specialist will be much faster and easier.

Respiratory or cardiovascular problems

The chest is a complex structure, and it houses many vital organs, such as the stomach, heart, and lungs. And if one of them fails, it can make itself felt and manifest itself in the form of pain localized in the upper chest.

Consider the possible causes of pain in the upper chest:

• Myocardial infarction. It is believed that with such a serious disease, pain is localized under the breast, but this is not so. Different parts of the heart muscle can be affected, in addition, sometimes the pain spreads to other areas of the body, for example, to the shoulder blades and even the shoulders. With a heart attack, the main symptom may be accompanied by heart rhythm failures, respiratory disorders, panic, weakness, loss of consciousness. Timely medical assistance is urgently needed.
• Angina. With this disease, the main symptom is pain, localized in the chest and spreading to the neck, shoulder blades, shoulders and even the jaw. They usually occur after stress or physical exertion, are quite acute in nature and fade away after stabilization of the patient's condition in about twenty minutes.
• Pericarditis. This is the name of the defeat of the serous cardiac membranes (parietal or visceral leaf of the pericardium). With the disease under consideration, pains in the chest area (including in its upper quadrants), increased heart rate, cough, malaise, shortness of breath, and weakness are periodically manifested.
• Aortic aneurysm. In this condition, the diameter of the aorta increases, and the most dangerous and complex type is a dissecting aneurysm, in which the inner layer is stratified, which forms a false passage (blood circulates through it, further stretching the wall). Symptoms include pain localized in the chest (their location depends on the location of the deformed part of the artery), difficulty breathing, shortness of breath, cough, hoarseness. A dangerous complication is rupture of the aorta, which can be fatal.
• Rheumatic heart disease is a heart disease of a rheumatic nature, in which swelling, severe pain in the chest, shortness of breath, jumps in blood pressure, increased heart rate and other symptoms are observed.
• Some diseases of the pleura or lungs, for example, tracheitis, pleuralgia, pleurisy. If the pains in the lungs do not develop very often, then the pleura is literally permeated with nerve fibers, and therefore intense sensations often arise in this part. In acute tracheitis (the so-called inflammation of the trachea), pain is also likely, but it manifests itself to a greater extent during a cough. Many inflammatory diseases impair respiratory function and are accompanied by respiratory failure.

Violations in the functioning of the mammary glands

If the upper part of your chest hurts, then the reasons for the development of such a symptom may lie in the violation of the functioning of the mammary glands. These organs are very sensitive, have a complex structure and contain many nerve fibers, so pain is a common occurrence. They can be triggered by the following conditions or diseases:

1. Mastopathy. This disease is very common and is characterized by a pathological change in the ratio of breast tissues, as well as their growth. Pain can be localized in different parts, but often they are accompanied by the presence of palpable nodules and seals, discharge from the nipples, a feeling of fullness, discomfort or heaviness, breast engorgement and an increase in its size.
2. Various neoplasms: both benign and malignant. Tumors can be localized in different parts of the breast, including its upper quadrants. If the size of the neoplasm is significant, then it can be detected during self-examination. Symptoms such as pain, abnormal discharge from the nipples, heaviness, changes in the shape or size of the mammary glands are likely.
3. Lactostasis can only develop in lactating women and is caused by stagnation of milk. If the accumulation has formed in the upper quadrant of the breast, then the pain will be localized in this area. And such a symptom may be accompanied by hyperemia, general malaise, fever.
4. Mastitis usually also occurs during breastfeeding and is characterized by inflammation of the tissues of the mammary glands due to the penetration of pathogenic microorganisms into them (they can enter through cracks in the nipples). With this disease, pain is accompanied by redness, purulent or bloody discharge from the nipples, local or general fever, and fever.

Other causes of pain

Pain in the upper chest can be associated with other problems. You should start with disorders of the digestive tract. Since the stomach and esophagus are located precisely in the chest, in case of malfunctions in the work of these organs, pain sensations can be localized in the area under consideration. Gastroesophageal reflux, gastritis or stomach ulcers, spasm or injury of the esophagus can lead to the development of pain syndrome. In diseases of the digestive tract, belching, an unpleasant aftertaste in the mouth, reflux of gastric juice, and a burning sensation in the retrosternal space are often observed.

There are many nerve fibers and endings in the chest, and some of them are located between the ribs and can be irritated. The sudden and sharp pains connected with it are shown at intercostal neuralgia, neuritis. They can allegedly “shoot through” the chest or the entire upper body, give it to the shoulders, neck, arms.

Osteochondrosis of the thoracic spine, accompanied by stiffness of movements, can lead to pain. Also, the symptom under consideration is due to other conditions and diseases, for example, muscle strain or rupture of their fibers as a result of intense training, injuries.

If you are concerned about pain in the upper chest, then consult a doctor and be sure to find out the causes of the problem. To get rid of an unpleasant or even painful symptom, you need to act on the factors that provoked its occurrence. But only a specialist can prescribe treatment after a complete examination.

Pain in the left chest, which appears occasionally or constantly torments - this is an occasion to think about the state of your health and undergo a diagnostic examination. Most often, women consider this chest pain on the left to be "cardiac", put validol under the tongue or drink heart drops. In fact, there are large nerve branches above the left breast, originating from the spinal cord. They are closely related to the radicular nerves of the vertebrae and the plexus that innervates the stomach. All these structures are part of a single autonomic nervous system. That is why pain in the left side of the chest can be a symptom of various problems:

• with heart
• respiratory organs
• peripheral nerves
• bony structures of the spine
• organs of the gastrointestinal tract

Sometimes a pulling, dull pain in women occurs due to a malfunction of the nervous system, when a woman experiences prolonged stress or has suffered a severe nervous shock. In any case, pain over the left breast signals that there are health problems that require adjustment by a specialist. Let's look at some diseases.

The scourge of the present has become tumor diseases of the mammary glands caused by hormonal problems. A woman's health depends on the balance of the main sex hormones - estrogen, progesterone, gestogen and prolactin, which regulate the menstrual cycle, maintain the normal tone of the cardiovascular and nervous systems. With an imbalance, one of the hormones constantly affects the tissues of the mammary gland, causing their pathological growth and degeneration - tumor diseases occur.

1. Mastopathy. This is the name of benign changes in the tissues of the mammary gland in women, caused by an increase in the release of estrogen or prolactin. As a rule, the disease covers only one breast, although there are also bilateral mastopathy. Fibrous formations or cysts filled with fluid appear in the thickness of the tissues. The disease itself does not pose a threat, but requires constant monitoring or treatment in order to prevent malignant degeneration of cells. The symptoms of mastopathy include: chest pain on the left, heaviness, burning and discomfort in the mammary gland, tissue swelling, fluid discharge from the nipple. The pain is aggravated by movement or touch. Most often, it appears in the premenstrual phase of the cycle.
2. Mastitis. Inflammation of the mammary gland, which develops under the influence of infectious agents. Postpartum mastitis occurs as a result of Staphylococcus aureus entering the ducts of the mammary glands. The first symptom is chest pain on the left, then the temperature rises, signs of intoxication are observed, and purulent discharge from the chest appears.
3. Mammary cancer. Chest pain never occurs in the early stages of the development of the pathological process, it appears when there are active processes of metastasis and tissue destruction. At the same time, the body experiences constant intoxication, the woman loses body weight, experiences nausea and general weakness. The most important symptom of the early manifestation of the disease is the appearance of a seal in the tissues of the gland, which is surrounded by strands of connective tissue. There may be retraction of the nipples, a change in the color of the areola and skin, asymmetry of the breasts, the mammary gland is very painful.

Diagnostics

If you experience chest pain and other symptoms, you should make an appointment with a mammologist, who will conduct a diagnostic examination, which includes:

• visual inspection
• mammography
• Ultrasound of the mammary glands and pelvic organs
• blood tests for hormones and biochemistry
• if necessary, a biopsy of the affected tissues is taken for histological examination

All neoplasms in the mammary gland are associated with the influence of hormones, so it is necessary to consult a gynecologist and endocrinologist. With the beginning of the treatment of diseases of the mammary glands, the pain syndrome disappears.

Physiological is the pain in the mammary gland in adolescence, when there is a hormonal explosion, the same condition is possible during pregnancy. Normally, stabbing pain in the left breast occurs with the onset of breastfeeding, when the swollen tissues are compressed by the dilated milk ducts, it also happens during menopause, when a restructuring occurs associated with the extinction of the reproductive function. As a rule, the mammary gland can get sick against the background of increased nervous excitability and is accompanied by hot flashes and numbness of the fingers.

Heart disease

Pain in the left chest can be the result of various heart diseases, including:

1. Pericarditis is inflammation of the outer muscular layers of the heart. It occurs as a result of various reasons, including as a complication after suffering colds. Pain in pericarditis is sharp and stabbing, can be given behind the sternum. It increases in the prone position and weakens when the body is tilted forward. A woman experiences changes - either a fever in the body, or a sharp chill. After a few days, as the disease progresses, the pericardium fills with fluid and the discomfort subsides. It is better not to ignore it, but to consult a therapist in a timely manner.
2. Myocardial infarction. With a heart attack of the heart muscle itself, the pain is just as sharp and stabbing, often giving to the shoulder blade and left arm. Weakness grows, sweating increases, fear of death arises. In some forms of a heart attack, the symptoms can be erased, so if the left chest hurts from above, then this may be the only symptom of a formidable disease.
3. Mitral valve prolapse. Pain and discomfort do not occur at the beginning, but already in the course of the development of the pathology. As a rule, it happens in attacks to the left, the duration and intensity of which are not affected by physical activity. Along with it, darkening in the eyes, difficulty in breathing and muscle weakness can be observed. Subsequently, life-threatening arrhythmias occur.
4. Angina. Previously, it was called angina pectoris due to the appearance of pressing sensations in the left chest, which is given to the neck. It can ache after overwork and severe nervous overload, is a consequence of a decrease in the blood duct and does not affect the muscles of the heart. If the pain attack lasts more than 15 minutes and does not go away after taking nitroglycerin, you need to call an ambulance.
5. Aortic aneurysm is a pathology of the largest vessel in the body, when its wall protrudes, becomes thinner and there is a risk of extensive bleeding. In threatening conditions of an aneurysm, there is a very strong and sharp pain in the left chest, which is given behind the sternum.

Heart disease is easier to prevent than to treat. It is necessary to undergo electrocardiography once a year, monitor blood pressure, play sports and review the diet in the direction of healthy foods.

Respiratory disease

With pathologies of the respiratory system, pain can also occur in the left side of the chest. They are most often seen with:

1. Pneumonia. The disease affects the lung tissue, the alveoli fill with fluid and begin to put pressure on the sternum, in which the nerve plexus is located. This explains the appearance of pain in the left breast, which is localized in the area of ​​the nipple. Other symptoms of the disease are severe coughing and difficulty breathing.
2. Pulmonary embolism. It occurs as a result of blockage of the artery that conducts blood from the heart to the left lung with a blood clot. The condition worsens sharply, there is a feeling of lack of air, breathing becomes frequent and superficial. Chest pain occurs when you try to take a deep breath.
3. Pleurisy. This is the name of the inflammation of the membrane surrounding the lungs, resulting in the release of pathological exudate, which irritates the nerve endings and causes pain in the chest.

Diseases of the digestive system

Pain in the left chest may accompany diseases of the digestive system:

1. Gastric ulcer. As a result of the development of the disease, there are violations of the integrity of the gastric mucosa. It becomes inflamed and bleeds, irritating the nerve endings that surround the muscular organ in large numbers - there are severe pains on the left. In some cases, the symptoms of the disease are blurred, so fibrogastroscopy is performed for diagnosis.
2. cholecystitis and pancreatitis. With chronic inflammation of the bile ducts and pancreas, aching pain on the left often appears. She can prick and whine in acute attacks.
3. Esophagitis. Occurs when hydrochloric acid is refluxed from the stomach into the esophagus. The tissues of the organ become inflamed, there is a cutting pain in the left chest, which is accompanied by difficulty swallowing and an acid taste in the mouth.

Pathologies of the peripheral nervous system

Pain in the left chest may be of a nervous nature. This happens with diseases such as:

1. Intercostal neuralgia. With prolonged violations of posture and overload, inflammation of the intercostal nerves occurs, which is accompanied by pain in the chest with deep breaths and attempts to change the position of the body. Symptoms of the disease go away on their own after a few days.
2. Cardioneurosis. The disease occurs as a response of the body to a severe nervous shock. At the same time, constant aching pains in the left chest, sudden flushes of blood to the face, high blood pressure, anxiety, weakness and irritability are tormented.

Pathology of the intervertebral discs

This disease is better known as osteochondrosis of the thoracic spine. It is caused by a long stay in the same position, for example, when driving a car, or working in an office. Also, osteochondrosis can occur after physical exertion and weight lifting.

As a result of the prolapse of the disc, the root of the intervertebral nerves, which is associated with the system that innervates the organs of the chest, is compressed and infringed. There is discomfort, constant aching pain in the left chest, which intensifies when moving and trying to change the position of the body. The intensity of such pain in the mammary gland is different:

• Weak, not limiting physical activity, when there is a chronic inflammatory process in the vertebrae.
• Acute, when prickly and aching, arising as an attack, making it difficult to breathe and move the back.

Pain in osteochondrosis may resemble heart pain, but it is given to the abdomen or left side.

The causes of chest pain can also be scoliosis, inflammation of muscle and ligamentous structures. Diseases of the spleen, diaphragm, fibromyalgia can irradiate to this part of the sternum.

So, there are many reasons due to which there is pain in the left chest. Among them are life-threatening conditions. Only a comprehensive examination can explain the cause of pain on the left in the chest. You should not just take painkillers, because you can get rid of a painful symptom only by curing the disease that became its root cause. Don't waste time, go to the doctor!

Pain in the upper part of the sternum occurs for various reasons, and in each individual case, appropriate diagnosis and treatment are carried out. Sometimes it develops against the background of a heart attack, and then emergency medical care must be provided, otherwise serious complications can occur. That is why appropriate examinations should be carried out.

Pain in the upper part of the sternum occurs for various reasons, and in each individual case, appropriate diagnosis and treatment are carried out.Pain may developon the background of a heart attack, and then emergency medical care should be provided. Otherwise, serious complications arise. That is why appropriate surveys should be carried out.

The sternum is relatively close to the heart, which is why, with various cardiovascular diseases, people confuse the resulting pain with pain of a different origin.

Pain in the sternum can occur for a short time, then they talk about acute pain. In other cases, the symptom is present for a long time, as in chronic pain. Unpleasant sensations sometimes occur in and around the sternum or are located behind the bone.

Video: Why does the chest hurt?

Anatomical description of the sternum

The sternum or sternum (sternum) is a long flat bone located in the central part of the chest. It connects to the clavicles and 2-7 pairs of ribs through cartilage and forms the anterior part of the chest.

The word "sternum" comes from the Greek στέρνον, which means "chest". (According to wikipedia.org)

The main function of the sternum is to protect the heart, lungs, and major blood vessels from traumatic injury. It resembles a tie in its shape, and among all the flat bones of the human body, it is the largest and longest.

The sternum consists of three parts:

1. handles
2. The xiphoid process.

Two clavicles (clavicles) are attached to the upper part of the sternum, and the costal cartilages of the first seven pairs of ribs are connected to its edge. The sternopericardial ligaments are attached to the inner surface of the sternum. The top of the sternum is also associated with the sternoclaidomastoid muscle.

The anatomical position of the sternum is defined as tilted, down and forward. The sternum is slightly convex anteriorly and concave posteriorly. It resembles the letter “T” in shape, since it narrows at the point of transition of the handle to the body, after which it again slightly expands to the middle of the body, and then narrows to the lower part, that is, the xiphoid process.

In adults, the sternum averages about 17 cm, while it is larger in men than in women.

Pain in the sternum

Pain in the sternum can occur for various reasons associated with a disorder of various organs and systems of the body, so an assessment of severe and severe pain is essential. The nature and duration of pain may vary depending on the exposure factor.

It is important to understand that although chest pain is considered an unfavorable sign, it should not be a cause for panic. Stress and anxiety often only exacerbate the existing problem. Therefore, being aware of the possible causes of chest pain and managing it can help in dealing with unpleasant situations.

The nature of chest pain:

• sharp
• stabbing
• Aching
• fast passing
• Chronic
• radiating to other parts of the body.

Muscle spasms or tissue injury often result in pain proportional to the severity of the injury. Also, pain is often aggravated during movement and breathing.

When chest pain is due to heart or lung disease, it may be associated with other symptoms such as sweating, difficulty breathing, coughing, etc.

It is important to know that chest pain that is of cardiac origin is mainly pressure pain, usually caused by stress and associated with coronary heart disease, or pressure pain behind the sternum, felt even at rest, caused by myocardial infarction.

In the presence of gastric disorders, abdominal symptoms such as nausea, vomiting, burning sensation in the stomach, abdominal pain or bloating are sometimes even more bothersome than chest pain, which in such cases is an additional symptom.

General characteristics of chest pain

The nature of pain in the sternum varies depending on the cause. The most common symptom is severe pain in the center of the chest, which can radiate with the development of the same myocardial infarction.

Other related symptoms may include:

• Pain or discomfort in the ribs that gets worse with deep breathing or coughing
• Pain in the upper chest
• Pain in the shoulder joint
• Pain when raising the arm
• Injuries to the collarbone that cause bruising, swelling, difficulty breathing, or discomfort in the joints near the sternum.

In the latter case, such manifestations often occur due to excessive bleeding in the region of the affected collarbone.

Patients with severe angina or a heart attack may have other symptoms in addition to (or even in place of) upper chest pain. Most often it is:

• Dyspnea.
• Nausea, vomiting or belching.
• Sweating.
• Cold, clammy skin.
• Irregular or fast heart rate.
• Palpitation.
• Fatigue.
• Dizziness.
• Fainting.
• Stomach upset.
• A vague discomfort in the abdomen.

Sometimes a tingling sensation in the arm (usually the left) or in the shoulder on the left side is determined.

Causes of chest pain

Some of the most common causes of severe and severe pain include:

• Costochondritis
• Clavicle injury
• tendon injury
• hiatal hernia
• Fracture of the sternum
• acid reflux
• Muscle tension or hematoma
• myocardial infarction

Costochondritis

Pathology is the most common among the causes of pain in the sternum and most often occurs when the cartilage between the sternum and the ribs becomes inflamed and begins to irritate.

Costochondritis can sometimes occur as a result of osteoarthritis, but can sometimes develop for no apparent reason.

Symptoms of costochondritis include:

• Pain of an acute nature on the affected side of the sternum.
• Pain that worsens with deep breathing or coughing.
• Discomfort in the places of attachment of the ribs to the sternum.

Costochondritis is not usually a cause for concern. However, people experiencing symptoms of this disease may want to see a doctor if their symptoms worsen or do not go away.

Joint damage

The sternoclavicular joint connects the manubrium of the sternum to the collarbones. Damage to this joint usually contributes to pain and discomfort at the top of the sternum, and in some cases throughout the upper chest.

People experiencing chest pain due to an injury to the sternoclavicular joint often present with the following complaints:

• Mild pain or swelling in the upper chest
• Discomfort or pain when moving the shoulder
• Popping or clicking sensation in the joint

Clavicle bruises

Collarbone contusions, even of minor intensity, can lead to prolonged pain or limited movement in the shoulder and upper chest.

The clavicle does not belong to the composition of the sternum, but it is directly connected with it through cartilage, which ossifies in adults. Collarbone injuries often cause pain in the sternum.

Collarbone bruises often result from a serious injury, such as during sports activities or a car accident. Sometimes the cause of the disorder can be an infection or arthritis, which give complications to various parts of the articular system.

The symptoms of a clavicle injury are as follows:

• Severe pain when raising the arm
• Hematoma or swelling of the upper sternum
• Abnormal positioning or sagging of the shoulder
• Sensation of snapping and eversion in shoulder joint.

hiatal hernia

A hernia-like mass is often not an obvious cause of pain in the upper sternum. In exceptional cases, pathology causes side pain.

A hiatal hernia occurs when part of the stomach enters the chest through a hole in the diaphragm.

Symptoms of hiatal hernia include:

• Frequent belching
• Heartburn
• Vomiting bloody masses
• Feeling the pressure
• Difficulty swallowing

People with intermittent or increasing pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Fracture of the sternum

Like any injury to other parts of the body, a sternum fracture is accompanied by severe and prolonged pain. Fractures of the manubrium of the sternum usually occur as a result of direct exposure to a traumatic factor, such as a car accident or injury during sports training.

People who think they may have a sternum fracture should see a doctor as soon as possible because other organs such as the heart and lungs can also be damaged.

Symptoms of a sternum fracture include:

• Pain when inhaling or when coughing
• Swelling in the area of ​​the affected part of the sternum
• Labored breathing

Muscle tension or hematoma

Many muscles are attached to the sternum and ribs, which are necessary for performing certain movements. These muscles can be stretched or tense when you cough hard or when you have excessive physical activity involving your arms or torso. Injury or injury can lead to hematoma of these muscles, which in turn can cause various discomforts, including pain.

myocardial infarction

People experiencing any kind of chest pain may worry about having a heart attack. However, chest pain is different from the pain associated with a heart attack (myocardial infarction).

As a rule, before a heart attack, you have to experience certain sensations that are harbingers of the onset of myocardial infarction. In contrast, pain in the upper part of the sternum in most cases begins suddenly.

A heart attack is most often manifested by the following symptoms:

• high blood pressure
• Feeling of tightness or pressure in the center of the sternum
• Often determined by restless breathing.

If there is indeed a suspicion that a heart attack has occurred, you should immediately seek medical help, which will avoid not only serious complications, but also death.

Diagnosis of chest pain

A thorough history and clinical examination of the patient can help identify possible causes of chest pain.

Arthritis and joint problems often present with associated inflammation and pain when the affected area is touched. Muscle injury or fibromyalgia may also be identified during a physiological examination of the patient.

Further diagnosis is often based on existing and accompanying symptoms.

• First of all, the blood is examined to detect inflammatory reactions, infections, etc.
• For trauma, bruising, joint damage, arthritis, or costochondritis, an X-ray, CT scan of the bones, or MRI is done.
• This allows you to exclude fractures of bone and tissue damage.
• Additional tests may be considered, such as electrocardiography (ECG), gastroscopy.

In extreme cases, it iscardiac catheterization also known as coronary angiography. It involves using x-rays to inject dye through a small catheter to show the outline of any blockages. Arteriography is usually recommended for people who are considered to be at high risk for coronary artery blockage, based on the results of other factors, such as their heart condition or the results of the tests described above. Arteriography results can help determine the best treatment.

When should you see a doctor?

Although pain in the sternum most often does not bode well, there are some causes associated with a pathological manifestation that require immediate medical attention.

A person should seek emergency medical attention if the pain:

• started due to a serious injury;
• accompanied by symptoms of myocardial infarction;
• is permanent and does not improve over time;
• additionally determined by intense nausea or vomiting of blood.

A person should also see a doctor if the pain in the sternum does not go away even with the prescribed treatment. In such cases, additional testing may be required.

Treatment of chest pain

Treatment for chest pain usually depends on the underlying cause. For pain caused by injuries and muscle tension, ice packs or hot compresses are often used as first aid. In such cases, rest is usually required to help damaged tissues recover faster. Additionally, anti-inflammatory drugs may be used. Physical therapy is also often recommended.

Gastric and acid reflux disease that causes chest pain is most commonly treated with antacids and a bland diet.

Cardiac and pulmonary diseases require special treatment, and some patients may require hospitalization, depending on the severity and severity of pain in the sternum.

Video: 3 tests for chest pain. How to find out what hurts behind the sternum

Sources

1. Sternal Pain - Different Causes - Physiopedia https://www.physio-pedia.com/Sternal_Pain_-_Different_Causes

2. CHEST PAIN – Medfin – General Practitioner Osmo Saarelma, 10/12/2017 https://www.medfin.fi/en/novosti/item/209-bol-v-grudnoj-kletke

3. Patient education: Chest pain (Beyond the Basics). Julian M Aroesty, MDJoseph P Kannam, MD, Mar 2019.