Internal Medicine

Chest pain

General

Chest pain (chest pain) is a common symptom that can have many causes.
These range from harmless muscle diseases to diseases of the gastrointestinal tract and life-threatening heart attacks. Given the diversity of diseases, diagnosis and correct therapy are often difficult.

This could also be of interest to you: Pain when breathing, stinging in the chest when breathing

Causes and symptoms

Numerous diseases can be the reason for the main symptom "chest pain" or pulling in the chest. The various diseases often have a special pain character, which makes the diagnosis somewhat easier.

Read more on the topic: Pain in the heart region, symptoms of a heart attack

Heart and vascular diseases:

Some heart and vascular diseases can cause chest pain. These are usually life-threatening diseases and must always be taken seriously.

Angina pectoris or heart attack are often described as a feeling of tightness or pressure behind the breastbone. Often the pain radiates to the neck, lower jaw, and left arm. Pain triggers are usually physical or emotional stress, which lead to an increase in heart rate.
Due to the rapid heartbeat, the heart muscle is no longer adequately supplied with blood, as the coronary vessels are narrowed by arteriosclerosis. In the event of a real heart attack, the heart muscle no longer recovers on its own, but has to be treated with a cardiac catheter and an intervention.
One speaks of stable angina pectoris if the pain subsides after a short period of time and with the help of medication. Acute, breath-dependent pain can also occur with pulmonary embolism. This is especially the case when a large vessel in the lungs is suddenly blocked by a blood clot. Coughing and shortness of breath also occur. A pulmonary embolism typically results from coughing heavily or pressing the toilet.

Inflammation of the pleura can also cause severe chest pain.

Read more on this topic at: Heart pain

Chest pain can have many different causes.

Another vascular disease that causes chest pain is aortic dissection. This suddenly leads to a tear in the main artery. This tear can create a real hole in the main artery, or it can only appear in the first layer of the wall layers of the aorta. In this case, the blood does not flow into the free chest cavity, but forms a bulge in the aorta. However, this bulge can tear at any time and lead to massive blood loss. Such a tear leads to severe chest pains, which radiate into the back, stomach and legs. If the vessel wall tears completely, the patient will bleed to death within a very short time. Only a quick operation and closure of the vessel can potentially save lives.

Read more on this topic: Aortic dissection

Pericardium and pleura:

Pleurisy (pleurisy) can result from a lung infection. The germs spread through the lungs to the pleura. Pleurisy is very uncomfortable and leads to breath-dependent, sharp pain and coughing. If you inhale deeply or cough, the pain increases. As a result, the patient is usually very short of breath and no longer fully ventilates his lungs. This leads to delayed healing of the lungs. The duration of such pleurisy depends heavily on the severity of the disease.

You might also be interested in: Pain on inhalation

The therapy therefore consists of antibiotic therapy for the inflammation and adequate pain therapy so as not to impair breathing. A pneumothorax is a tear in the pleura, which leads to a collapse of the lungs. The tear changes the pressure in the chest and the lungs on the affected side collapse. There are two types of peumothorax. In a tension pneumothorax, a layer of the wall of the pleura lies over the tear. This leads to a constant influx of air into the chest, but the air can no longer leave the chest. Acute severe pain and shortness of breath occur. If the pneumothorax is not relieved early on, the heart and adjacent vessels are displaced by the air. The patient becomes unconscious and can die.
A pneumothorax that still allows air to escape to the outside also leads to severe pain and shortness of breath. However, the vessels are not displaced and the other lungs can initially sufficiently compensate for the gas exchange. Pneumothorax is often caused by an accident.
Inflammation of the pericardium (pericarditis) also leads to sharp pain in the chest. Due to the position of the heart in the body, the pain increases when lying down and when lying on the left side. When sitting and lying on your right side, the pain decreases in intensity. Viruses are usually the cause of pericardial inflammation, usually following an infection. In the event of a critical rise in blood pressure (hypertensive crisis), severe chest pain and pressure behind the breastbone can suddenly occur.

The symptoms of the symptoms mentioned do not always have to be accompanied by severe pain, but can, especially in older people, only be noticeable by a feeling of pressure, a pulling in the left breast or a stinging in the chest area.

Gastrointestinal tract:

Inflammation of the esophagus (Esophagusacidic gastric juice (reflux) is a very common disease. The pain occurs in the neck and in the area of the sternum. Sometimes the symptoms are difficult to separate from heart disease. The pain is often greatest when lying down and after eating and can be accompanied by heartburn. Since chronic esophagitis can cause changes in the epithelium and the development of esophageal cancer, diagnosis and therapy are essential.
If the esophagus is previously damaged, high pressure conditions, for example vomiting, can lead to a rupture of the esophagus. This disease is very rare and is accompanied by sudden onset of severe chest pain.

Muscles, nerves and bones:
The most common causes of chest pain are muscle tension and changes in the spine. The pain is dependent on movement.
In addition, the numerous small nerves under the ribs can become inflamed (intercostal neuralgia) and each cause pain. In contrast to muscle pain, nerve pain is not dull, but rather electrifying and burning. This pain also typically occurs with shingles. This is an infection of certain nerve tracts by herpes zoster. If a nerve supply area in the chest area is affected, belt-shaped, burning pain occurs there. The disease can lead to consequential damage and paralysis. For this reason, rapid therapy with antivirals is necessary.

Tietze syndrome is a rare disease. This is a disease of the costal cartilage at the base of the breastbone. This is accompanied by pain and swelling in the anterior thorax area. The pain is movement-dependent and can be triggered by pressure, which distinguishes it from angina pectoris. The exact cause is still unclear, but the disease is attributed to inflammation.
Bechterew's disease is a progressive stiffening of the spine, which leads to deep-seated pain. These occur mainly at night and are particularly pronounced in the thoracic and lumbar spine area. The disease is progressive and cannot be cured. For this reason, regular physiotherapy is necessary.

Psychology:
Chest pain can also be triggered psychologically. This is especially true in very stressful situations. The pain is usually accompanied by acute shortness of breath and a significantly increased heart rate (Tachycardia) ahead. With rest and calming down, the pain and other symptoms usually resolve quickly.

Diagnosis

To accurate diagnosis the chest pain must be frequent numerous investigations be performed. Often a precise anamnesis with a detailed description of the Pain character groundbreaking for further investigations.
In which Suspected heart or vascular disease has to be Cardiac catheter be carried out for clarification. A Aneurysm can be done with the help of a Computed Tomography represent. Also one Echocardiography can provide evidence of heart disease.
Causes in Gastrointestinal tract can be through a Gastroscopy detect. Here one falls irritated esophagus in the endoscope.
Muscular or neurological causes are through a physical examination representable.
Bony changes are through a X-ray representable. A laboratory examination usually does not stay away. It can provide clues for inflammation, a heart attack or an infection.

therapy

The therapy of the individual diseases is very different. Heart and vascular diseases are to be taken very seriously and must be part of a Cardiac catheter by inserting Stents or the Expansion of the vessels be treated.
Inflammatory diseases through Viruses or bacteriawhich triggers the Shingles and the Pericarditis must be medicated Antibiotics or Antivirals be treated. Depending on the severity of the disease, the therapy is inpatient.
A chronic inflammation of the esophagus must also be taken seriously due to the increased risk of cancer. The therapy consists in the daily intake of Proton pump inhibitors and one healthy diet. Muscular tension can result physiotherapy be solved.

Summary

Chest pains are a common symptom With numerous causes. For this reason, the diagnosis and correct therapy is often difficult.
The attending physician is therefore on the exact anamnesis instructed by the patient.
Since chest pain can be relatively harmless, but can also be a symptom of a life-threatening illness, new or changing chest pain is always the case to be clarified by a doctor.
So it is possible one Pulmonary embolism or one Heart attack to be recognized early and treated. To Diagnosis become imaging procedures (Ultrasonic, Computed Tomography and Magnetic resonance imaging) and used. These enable localization and diagnosis.

The therapy is then very different. With numerous diseases, especially with heart and vascular diseases and inflammation of the esophagus, a daily, consistent and lifelong Taking medication necessary.