Pain behind the sternum: possible causes, to which doctor to apply
The appearance of pain behind the sternum can be caused both by a banal stomach disorder and by serious emergency conditions: pulmonary embolism, myocardial infarction or destruction of the aortic aneurysm. If this is a true heart attack or pulmonary embolism with emboli, the patient has very little time to provide him with medical care.Therefore, finding out the cause of unpleasant sensations in the chest is often a really vital task.
Of course, a person who feels pain behind the sternum is unlikely to determine on his own how serious it all is.This is the prerogative of doctors.However, it is up to each adult to be guided by when and to what doctor.Table of contents: Causes of pain behind the sternum What kind of doctor should I use for chest pain?Features of chest pain in gastrointestinal diseases Chest pain with psychoneurological disorders Chest pain with respiratory system diseases Examination for chest pain
Causes of chest pain
In the chest are organs of the cardiovascular, digestive, respiratory, nervous and endocrine systems.With the development of the pathological process in any of them, a person can feel the pain behind the sternum.
The most common cardiovascular and vascular causes of chest pain:
- Myocardial infarction - extensive or local death of a portion of the heart muscle in conditions of a sharp lack of oxygen.
- Angina of the is reversible ischemia of the myocardium, accompanied by severe pain.
- Thromboembolism of the pulmonary artery - blockage of the pulmonary artery or its branching by small thrombi originating from the large veins of the lower extremities.
- The dissecting aortic aneurysm is the destruction of the aortic wall, which is accompanied by massive blood loss.
- Pericarditis - acute or chronic inflammation of the cardiac "bag"( connective tissue covering the main organ of the cardiovascular system).
- Myocarditis is an inflammation of the myocardium, which most often develops after a number of infectious ailments.
Diseases of the respiratory system in which the chest aching:
- Pneumonia - pneumonia.It can have a viral, bacterial and autoimmune nature.
- Pleurisy is an inflammatory process of the pleura.
- Viral or bacterial tracheobronchitis .
Gastroenterological causes of chest pain:
- Esophagitis - inflammation of the esophagus.
- Achalasia of the esophagus is an enlargement of the lower part of the esophagus and cardiac opening due to neuromuscular disorders.
- Gastritis - inflammation of the stomach.
- Gastric ulcer .
- Gastroesophageal reflux is a very painful irritation of the tender mucous membrane of the esophagus with acid contents of the stomach.
- Herniated aperture of the diaphragm .With this pathology, the diaphragm can not fully separate the thoracic and abdominal cavities, so that part of the esophagus and the upper part of the stomach penetrate through the esophageal opening into the thoracic cavity.
Diseases of the nervous system that cause chest pain:
- Intercostal neuralgia is an inflammation of the nerves passing between the ribs.
- Cardioneurosis - disharmony in the heart, caused by a malfunction of the nervous system.With this pathology, organic changes in the heart are not detected, that is, there is no ischemia, conduction disturbances and other such abnormalities.
- Osteochondrosis of the spine in the cervicothoracic region.This disease is very often accompanied by a pinch and inflammation of the roots of the nerves, which leads to the appearance of painful sensations.
In addition, the pain behind the sternum can be the result of a number of other pathologies:
- injuries of the chest;
- stretching and ligaments in the pectoral muscles after excessive physical exertion;
- inflammation of the cartilaginous and bone tissue of the ribs and sternum;
- stress, neurasthenia;
- tumor processes in the thorax.
As can be seen from the information provided, the pain behind the sternum is not a condition that can be ignored and tolerated. This symptom signals that medical care is needed, and if there is a suspicion of myocardial infarction, pulmonary embolism or aortic aneurysm dissection - immediate.
What kind of doctor should I use for chest pain?
In case of chest pain, there may be two options for contacting a medical institution: calling an ambulance and going to the doctor on their own after feeling better. Suspicion of myocardial infarction, pulmonary embolism and aortic aneurysm is always an indication for calling "ambulance". All other diseases listed in the previous section do not require calling an emergency medical care machine, that is, the patient can independently remove the attack by a doctor prescribed by the drugs previously and then go to the hospital.How to determine when an ambulance is needed, and when it is possible to do without it?
Characteristics of chest pain indicating a "danger" of the patient's condition:
- The pain arises sharply, suddenly and does not go away at rest.
- Pain lasts more than 15 minutes.
- Pain sensations are not alleviated by nitroglycerin.Here it should be noted that you can not joke with nitroglycerin.This drug can be given only to those patients who know that they have heart problems.
- Pain extends to the arm, neck, scapula, jaw.
The following symptoms should also be cautious:
- Feeling of raspiraniya, pressure in the chest.Sudden appearance of dyspnea, cough.
- .Dizziness, loss of consciousness.
- Cyanosis - blueing of the skin.Severe nausea, vomiting.
- A sharp drop in blood pressure, heart palpitations.
- Asymmetry of the pulse on the hands( when on one wrist it is higher or lower than on the other one).
If a painful attack is accompanied by these symptoms, you must always call an ambulance.
In all other cases, chest pain requires treatment by a general practitioner or general practitioner. He will be able to guess what exactly caused the pain behind the breastbone, and prescribe a treatment or refer the patient to a narrower profile colleague - to the cardiologist, gastroenterologist, pulmonologist, neurologist, vascular surgeon, etc.
Features of chest pain in diseases of the digestive system
If the heart disease clearly shows the relationship between the appearance of pain in the chest and stressful situations or physical exertion, then with ailments of the digestive organs pain is always associated with food intake .Patients with problems with the esophagus, complain that the food, as if stuck at the sternum and belches when bending forward.When reflux the contents of the stomach into the esophagus after eating, there is a burning sensation behind the sternum and an eructation of sour.With a stomach ulcer, the pain has a cutting character and arises again after using irritating mucous membranes dishes, often accompanied by nausea and vomiting.
If there is a hernia of the diaphragm, the pain sensations are dull and dependent on food intake.With tilting forward, lifting weights, straining, coughing, discomfort intensifies.
Chest pain with psychoneurological disorders
In such disorders, there is always a connection between chest pain and emotional distress and overwork.Patients characterize their sensations as follows: as if "lies a stone on the chest," the heart contracts, stings, bounces, jumps out of the chest, a feeling of intense anxiety and panic. When the patient calms down and relaxes, soreness and all other unpleasant sensations pass.
In chest osteochondrosis and intercostal neuralgia, the pain behind the breastbone usually appears during physical exertion, and in certain specific poses, that is, when the affected neural formations are affected.In addition, with intercostal neuralgia can be found especially painful points when feeling the chest.
Chest pain in respiratory system diseases
Pain does not occur by itself.There is always a background - catarrhal disease, chest injury, etc. Painful sensations, as a rule, are associated with the act of breathing and coughing. In addition, patients suffer from shortness of breath, may be fever, spitting.The longer the disease lasts, the more pronounced become signs of respiratory failure - dyspnea increases, cyanosis of the lips and fingertips appears.
Chest pain examination
To determine the cause of pain behind the sternum, the patient first of all needs to make an ECG and chest X-ray .These diagnostic methods can identify heart and lung diseases and determine the further tactics of examining the patient.For example, if there are no changes, the cause of the pain should be sought in another direction - to do fibrogastroscopy, to send the patient to a consultation with a gastroenterologist, neuropathologist, etc.
An in-depth examination of patients with suspicions of cardiac or vascular pathology will consist of the following: ultrasound scanning of the heart and vessels, angiography( coronary angiography and selective imaging of the pulmonary artery), computed tomography of the thoracic organs.In addition, such patients are shown a number of blood tests( clinical, biochemical, tests for specific markers of ischemia and thrombosis, for coagulation).
Zubkova Olga Sergeevna, medical reviewer, epidemiologist-doctor