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Chest pain: cause, diagnosis and treatment
Chest pain is a very common complaint in which most people involuntarily think of a heart disease. However, tension, diseases of the respiratory tract, stomach and esophagus can also be felt as chest pain. In the case of severe and / or recurring pain, a medical examination should urgently be carried out to rule out more serious health risks.
Chest Pain: A Brief Overview
Chest pain describes a wide range of possible painful complaints in the chest area. This can be caused by a number of factors, but a distinction must be made between suffering that affects both men and women and pain that only occurs in the female breast (for example, milk congestion in nursing mothers). This article mainly deals with the non-gender-specific complaints, which are also summarized in the medical literature under the term chest pain. The symptoms can come from harmless causes such as tension, but also from life-threatening diseases such as a heart attack. Here is a brief overview of the symptoms:
- symptom: Pulling, stinging or oppressive pain in the chest, which appears either selectively, over a large area or depending on certain movements. The pain can also be related to breathing or radiate to surrounding areas of the body.
- Possible causes: Muscle tension, damage to the skeletal system, heart disease, respiratory tract disease, inflammation of the chest area, esophagus disease, nerve pain, shingles, cancer, psychosomatic causes.
- emergency: If the pain in the neck, arms, abdomen and / or back radiates and additional symptoms such as severe tightness in the chest, paleness of the face, excessive sweating, shortness of breath and nausea occur, an acute heart attack could be present. An emergency doctor must be called immediately!
Emergency: Call an ambulance immediately with these complaints
If you or someone in your area shows chest pain with the following symptoms, an ambulance must be called immediately:
- The pain is very severe and comes from deep in the chest.
- The pain radiates into the upper abdomen, back, neck and / or shoulders and arms (mainly on the left side).
- A feeling of tightness and tightness spreads in the chest.
- Accompanying symptoms such as paleness, excessive sweating, shortness of breath and nausea occur.
- Those affected become very scared or show signs of a panic attack.
Chest pain as a symptom
The pain in the chest area can occur in different intensities and localizations. Some patients suffer from stinging, pulling pain on only one side of the chest, others have more discomfort in the central area of the chest and others suffer from pain that radiates from almost the entire chest from the center. The occurrence of chest pain primarily depends on the cause of the complaint.
The location and type of pain provide first indications
The way and the place where the pain occurs provide first indications of the cause. But the symptoms are not always clear. Ultimately, a doctor needs to make the diagnosis. The following overview shows which complaints indicate which causes:
- Spot pressure pain indicates muscle tension or muscle hardening (myogelosis).
- If the symptoms occur more often when inhaling and exhaling, are sometimes accompanied by coughing or breathing difficulties and run through the entire chest area, there may be a disease of the lungs or the respiratory tract.
- Burning pain in the central chest area as well as rising pain from the abdomen towards the neck indicate a disease of the esophagus.
- Pain along the ribs and pressure pain at the cartilage attachments are an indication of impairment of the skeletal system.
- Radiating pain in the central chest area often indicates cardiovascular disease.
- If a severe chest pain is accompanied by chest tightness, shortness of breath, sweat attacks and fear of death as well as accompanied by a rapid heartbeat or stumbling and panic, a heart attack may be present. Call the emergency doctor immediately!
Causes of the chest pain
The causes of chest pain can be of many different types. This section shows common symptoms that trigger chest pain.
Although many sufferers immediately fear a heart disease as a trigger, tension is often the only cause of the complaints. If the diseases described above can be ruled out in the course of the medical diagnosis, a closer examination of the muscles is worthwhile. For example, the pectoralis major muscle and the pectoralis minor muscle are tense in many people due to their unfavorable posture in everyday life. Here, for example, sitting at the computer with shoulders slightly tilted forward leads to an incorrect strain on the muscles. Excessive training of the chest muscles can also cause the chest pain. For example, bodybuilders tend to exercise the pectoral muscles more often, neglecting the back muscles as their counterparts. The pectoral muscles tense and are increasingly sensitive to pressure. Excessive strength training can also cause painful irritation in the area of the muscle attachments on the sternum.
Heart diseases such as hardening of the arteries and coronary heart disease are also possible triggers of the symptoms. Heart valve disease or heart muscle inflammation can also be associated with chest pain. In the worst case, the symptoms can be traced back to a heart attack or heart attack. Circulatory problems, high blood pressure or low blood pressure as well as a fast or irregular pulse can indicate cardiovascular problems.
Chest pain when breathing
The cause can be, for example, lung diseases such as bronchitis, pneumonia, tuberculosis, pulmonary embolism or lung cancer. Some diseases, such as pulmonary embolism or tuberculosis, can also lead to bloody expectoration. If this symptom occurs, an emergency doctor should be called immediately. Another trigger is the so-called pneumothorax. As a result of an injury or lung disease, air gets between the lungs and the lung skin. This can severely affect breathing and even lead to the collapse of the lungs. If you suffer from shortness of breath and sharp pain and if your chest moves unbalanced or only one-sided when breathing, you should also call an ambulance immediately.
Inflammation in the chest area
A pleurisy also leads to massive chest pain. Inflammation of the esophagus is another possible trigger for painful stinging in the chest. Another possible cause is pericarditis. This manifests itself more through sharp pains in the chest area. Radiating pain rarely occurs with this inflammation.
Diseases of the esophagus
The chest pain can also result from heartburn or reflux disease. The stomach acid gets into the esophagus, which has no protective mucous membrane. The result is burning pain that rises from the stomach to the neck. If the mobility of the esophagus is restricted, swallowing problems and painful regurgitation may occur. If you experience severe pain after vomiting or vomiting blood, it could be an esophageal tear or cancer of the esophagus. In both cases, an ambulance must be called immediately.
Damage to the skeletal system
Furthermore, malposition of the spine may be associated with chest pain. Fractures or bruises on the ribs also lead to severe chest pain, which is perceived rather superficially. Such complaints are also manifested by severe pain when touched.
Nerve pain and shingles
Those affected also perceive nerve pain along the intercostal nerves as chest pain. The pain typically increases when coughing or laughing and runs like a belt along the ribs. This nerve pain, known as intercostal neuralgia, is usually due to a disease of the lungs, spine, ribs or pleura. However, shingles (herpes zoster) can also cause the symptoms.
Finally, a so-called cardiac neurosis can also be considered if all other organic causes have been excluded by various doctors. Affected people focus their attention on the physical events in the area of the chest. Every deviation and every slight stinging is felt as severe pain. In medicine, this form of pain is also summarized under the term functional heart complaints. An anxiety disorder or depression can also be painful to the chest.
The female breast
Breast disease in women can cause a burning sensation in the breast. Hormone fluctuations during the period can also lead to pulling or pressing pain in the breasts or cause sensitive breasts. In some cases, a breast abscess or breast cancer may be responsible for the symptoms.
If there is a painful swelling in the area of the sternum at the level of the second and third ribs without accompanying inflammation symptoms, the so-called Tietze syndrome is used in medical circles. The causes of this have not yet been finally clarified, but the complaints usually heal completely after a few months. In addition, the so-called Roemheld syndrome, a stomach disorder in which gas accumulations in the intestine and in the stomach can lead to heart problems that are painful in the chest.
Diagnosis of chest pain
At the beginning of the medical examination there should be a detailed medical history, in which the patients are not only asked about the occurrence, duration, intensity and location of the condition, but also report about possible previous illnesses. Here, ideally, there are already first indications of the underlying cause. In addition, in the case of rib bruises or fractures and impairments of the chest muscles by scanning the chest area, a relatively reliable diagnosis can usually be made. In the case of other underlying diseases, further diagnostic methods, such as a blood test or imaging methods (x-rays, magnetic resonance imaging, computer tomography, ultrasound) are required. If the chest pain is due to a heart disorder, this can be determined using an electrocardiogram (ECG) or a 1-hour troponin test.
Heart attack diagnosis
In the case of a heart attack in particular, there is usually little time for a diagnosis, so that the correct interpretation of the symptoms described above is particularly important. The patient's life must first be saved before laboratory tests and imaging procedures can be used. Typical signs of a heart attack are severe stabbing chest pain in the central chest area that radiates into the left arm. Some patients also describe the pain as "there is a heavy load on the chest". However, not all patients show complaints. Checking the pulse and blood pressure and listening to the chest with a stethoscope must be sufficient as a basis for the first countermeasures in an emergency. For example, a sign is a drop in blood pressure. In any case, the emergency call should be called, since every minute counts in an infarction to save lives.
A newer method for heart attack diagnosis is the so-called 1-hour troponin test, in which the troponin content in the blood is measured. This protein regulates heart contraction and is released into the blood as a result of heart damage.
Treatment options for chest pain
Depending on the different underlying diseases that can be considered as the trigger, numerous different therapies are available, some of which are presented in treatment guidelines. In the case of diseases of the lungs, esophagus or stomach as the cause of the complaints, the therapeutic measures are usually relatively clearly defined and usually promise reliable treatment. With the treatment of the underlying diseases, the complaints finally disappear. Lung cancer that is recognized too late is an exception here, since the chances of a cure are rather slim, even with the latest medical knowledge. Lung cancer does not cause any symptoms in the early stages and is usually only recognized by chance.
Heart attack treatment
In the event of a heart attack, primary medical care plays a special role. If cardiac arrest has already occurred, cardiopulmonary resuscitation should take place immediately. Rescue workers can also use defibrillators to stop an existing cardiac fibrillation and stabilize the heart's rhythm. Subsequently, the initiation of a lysis therapy or a catheter treatment is provided in order to ensure the blood supply to the heart again to the required extent. The drug treatment of a heart attack is usually based on the administration of a nitroglycerin spray and morphine preparations for pain relief. In addition, a broad mix of other preparations is used, which - depending on the individual clinical picture - should, for example, facilitate blood flow, alleviate pain or serve to calm down. In addition, an operation may be necessary, for example to bypass or implant a pacemaker.
Treatment: muscles and skeletal system
If the chest pain originates from the skeletal system or the muscles, treatment methods such as physiotherapy, massage, acupuncture or osteopathy offer promising therapeutic approaches. There are also some homeopathic remedies and the so-called Schüßler salts available for naturopathic treatment of tension in the chest area. However, the choice of suitable preparations should be left to experienced therapists. Accompanying nutritional therapy can counteract the possibly existing acidity of the organism and thus support the treatment of muscle-related pain. In naturopathy, a balanced acid-base balance is generally considered to be of great importance in avoiding muscle ailments. (fp, vb; updated on February 11, 2019)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters, Dr. med. Andreas Schilling
- Malte Kelm et al .: Pocket guideline: Therapy of acute myocardial infarction in patients with ST segment elevation (STEMI), German Society for Cardiology - Cardiovascular Research e.V., (accessed 10.07.2019), DGK
- Marco Roffi et al .: Pocket guideline: Acute coronary syndrome without ST elevation (NSTE-ACS) (version 2015), German Society for Cardiology - Cardiovascular Research e.V., (accessed 10.07.2019), DGK
- Viola Hach-Wunderle et al .: Guideline S2: Diagnostics and therapy of venous thrombosis and pulmonary embolism, German Society for Angiology - Society for Vascular Medicine, (accessed July 10, 2019), AWMF
- Herbert Koop et al .: S2k guideline 021/013 Gastroesophageal reflux disease, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), (accessed July 10, 2019), AWMF
ICD codes for this disease: R07.4ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.