Chest pain

synonym

Chest pain, Sternum pain
engl .: chest pains

Definition of chest pain

Chest pain is a combination of pain, the cause of which either arises in the chest and can be localized there or arises in other areas of the body and radiates into the chest.

Epidemiology / frequency distribution

Most middle-aged patients complain of chest pain. In small children the symptom complex is not yet present, while in children between 12 and 14 years of age it is a percentage of 1,4% increases. 3.7% of 45-64 year olds and 2.8% of patients over 74 years old complain of chest pain. Women and men suffer from it about equally often, with women complaining of symptoms at a later age.

Causes / forms

Chest pain can be felt by the patient in very different ways in terms of strength and pain. For example, those affected can over dull pain in the chest area or over Tension in the chestcomplain of cutting and burning complaints in this area. The severity of the complaints ranges from slight pain that can only be triggered in certain situations to The greatest pain that causes fear of deathwhich the patients have mostly never had in this form before.

Chest pain from taking the pill

When taking the pill various side effects can occur, including chest pain.
There are fundamental differences between the most diverse contraceptives - while condoms are based on a mechanical protection principle, the pill causes hormonal changes in women that prevent fertilization.
Depending on the composition of the active ingredients in the pill, different hormones are influenced. The mostly prescribed micro-pill, a further development of the birth control pill, contains both progestins and estrogens.
The latter act on the female breast. They promote the storage of fat and water in the breast tissue. This becomes larger and there can be painful tension in the corresponding area of ​​the skin, but also internally in the tissue.

If the side effects are too severe, it should be considered with the attending gynecologist whether it makes sense to switch to another preparation. The mini pill, which is often confused with the micro pill, for example, does not contain any estrogens and only affects the progestin level. This affects the consistency of the Cervical mucus (Cervical mucus) and thus mechanically prevents the penetration of sperm.
Progestins lack the corresponding effect on the female breast.

Chest pain from nerve damage

As Nerve pain (in technical language Neuralgia or neuropathic pain called) are referred to as pain caused by a Peripheral nerve damage arise. This can be done by mechanical pressure, for example in the course of a Herniated disc of the thoracic spine, or through Metabolism disorders, for example by a Diabetes mellitus arise. Inflammatory processes, such as those in the Multiple sclerosis can cause nerve pain. Possible, albeit clearly less common, are also damage by Radiation or chemical burns.

Here you can different nerve parts to be damaged. On the one hand, they can Nerve fibers be directly affected. This arises for reasons that have not yet been clarified Beginning a kind of Numbness in the supply area of ​​the nerve, which later often in Sensation of pain can turn.

Damage to the myelin sheath, which isolates the nerve from surrounding tissue and other nerves, is far more common. Typically, this is characterized by a sudden sharp (neuralgiform) pain, which is caused by the jumping of electrical impulses.

Ultimately, neuralgia, which is also known as intercostal neuralgia on the chest, can also result from a circulatory disorder in the nerve, for example from pressure on the nerve or metabolic disorders. This usually disappears as soon as the mechanical pressure is removed. This is arguably the most likely cause of neuropathic chest pain.

The mechanical irritation of the nerves (in this case the Rami mammarii of the Intercostal nerves) is mostly due to an entrapment between the ribs and the muscles in between. Pain can be triggered by movement or by usually non-painful touch in the skin area supplied by the nerves.

A causal treatment is always the ideal solution for nerve pain. In the case of chest pain, however, this is difficult because the cause can often not be fully clarified. A number of medications can be used for symptomatic treatment. Antidepressants (e.g. amitriptyline, venlafaxine or citalopram) are primarily used for this. Anticonvusants (e.g. carbamazepine), which are also prescribed for the treatment of epileptic seizures, and opioids are also effective. For some time now, capsaicin, the substance responsible for the spiciness in chillies, has been used in combination with local anesthetics with a good long-lasting effect.

Read more on the subject under: Chest pain caused by nerves

Chest pain from nerve inflammation

The Nerve inflammation or neuritis represents a inflammatory disease one (Mononeuritis) or multiple nerves (in this case Polyneuritis called). Is the inflammation on the Nerve root at the exit of the nerve from the Spinal cord is localized by a Radiculitis (from lat. Radicle, 'small root ") spoken.

The causes of nerve inflammation diverse. Very often infectious processes, especially Virus infections, or traumatic events. Also toxic or metabolic causes, for example in the context of a Diabetes mellitus or one Alcohol abuseare not uncommon. The cause continues to come allergic backgrounds or Circulatory disorders in question.

In many cases, neuritis is characterized by a paralysis of the muscle supplied by the inflamed nerve. In the case of chest pain caused by nerve inflammation, however, are more likely Numbness and Pain conspicuous in the skin area supplied by the nerves. These can typically normally not painful touch in this skin area. Side effects like Reddening of the skin and a changed sweat secretion can also occur.

A fairly common cause of nerve inflammation are Viruses. Especially with chest pain caused by nerve inflammation, the viral disease is the Shingles (Herpes zoster) to call. This disorder represents a renewed infection with the Chickenpox virus (Varicella zoster virus) which has remained in nerve nodes since the first infection. Above all are affected elderly or people with one weakened immune system.

In more than half of the cases, these are Intercostal nerves concerned which between the ribs (intercostal) and for the supply of the Skin over the chest are responsible. Early symptoms one Herpes zoster can a Burning in the chest and others differently pronounced Pain be. Can join Paresthesia on the skin and general symptoms like Exhaustion and fever. In the following days the typical shingles appear Skin manifestations in the form of painful skin cells on. Treatment is carried out with medication Antivirals.

Burning pain

The heart, lungs, esophagus, and stomach are located in the chest. Burning pain can originate in any of these organs.

Find out all about the topic here:

• Burning in the chest
• Burning behind the breastbone

diagnosis

Although Chest pain can have numerous causes, the symptoms initially represent an urgent need to find the cause, since in addition to the harmless causes, there is always a lequally threatening cause must be assumed. Every patient with chest pain should get one for this reason EKG get to one Heart attack to exclude. The consultation with the patient should provide information about the start, location, duration and type of chest pain as well as concomitant illnesses. Then an EKG should be written and the patient should be physically examined. This includes examining the patient's upper body completely, recognizing injuries, Heart sounds auskultieren in order to possibly Cardiac arrhythmias to find.
Blood pressure measurements to detect derailments and tapping the sternum with a reflex hammer to get one Tietze syndrome Diagnosing should also be done.
The patient's rib cage and ribs can also be tapped with the fingers to get a Intercostal neuralgia to diagnose. Depending on whether the search for the cause remains unsuccessful, the cause should then be sought in the abdominal organs (depress (palpate) and auscultation of the abdomen). In addition to the ECG, a thorough blood test should not be forgotten, in which inflammation values ​​and heart attack enzymes are measured. If you do not come to a result, you can consider having the patient again for a thorough cardiological examination Heart echo and Exercise ECG feed. Psychosomatic aspects should only be considered after the complete exclusion of organic involvement. In the case of chest pain, which is an absolutely emergency situation, the patient must be taken directly to the hospital in an ambulance after an ECG and immediate medication.

Left chest pain

With unilateral pain on the left side of the chest, some causes are more likely than others.
Although the heart is roughly in the middle of the body, it tends towards the left half of the chest. Therefore, pains that affect the heart (see: heart pain) are also perceived more frequently on that side, even if they are ischemic (blood undersupply at Heart attack) or inflammatory origin. A heart attack usually manifests itself as pain behind the breastbone, but it may also just be a feeling of pressure on the chest or a pulling in the left chest. Furthermore, the stomach lies on the left side of the body. Since this can project pain into the chest in various diseases, this happens more on the left or in the middle. (Please refer: Stomach pain left)

Read more on the topic: Heart pain or heart pain

Unilateral organ disease can also be the cause of chest pain (please refer: Chest pain from thoracic organs). With diseases of the lungs, there is the possibility that only one lung is affected, while the other remains healthy for the time being. This can be the case not only with inflammation, but also with other changes. In the case of strong inflammatory processes in the lung tissue that cannot be treated or brought under control, the infection can spread to the pleura - the pleura - and trigger painful pleurisy.
The pleura consists of two layers - one that lies directly against the lungs and one that lies against the inside of the chest - between which there is a gap with fluid. This has the function of keeping the lungs in the unfolded state, which is achieved with the help of negative pressure in the gap.

With pleurisy, which can also be unilateral, every breath hurts. If this continues, the lung tissue can tear, causing the negative pressure to escape and the lungs to collapse (collapsed) - a pneumothorax develops, which in addition to shortness of breath can trigger pain on the corresponding side.

In women, left-sided breast disease can cause chest pain. Muscular or bony changes or injuries can also only occur on the left. A strain or crack in the chest muscles after excessive exercise or heavy hard work are more of a male problem as they are more likely to do weight training.

Read more on the subject at: Left chest pain

therapy

The treatment of chest pain depends entirely on the triggering cause (see corresponding clinical pictures). For muscular or skeletal causes, medication with pain reliever or anticonvulsant medication can be used (e.g. Ibuprofen).

Psychogenic causes should be addressed by a resident specialist for further treatment psychiatry respectively.

When can chest pain occur?

Chest pain when breathing

Chest pain that may occur when breathing from the lung, from Pleura, of the surrounding muscle- and Bone structures or from annoy originate.
Many inflammatory respiratory diseases result in painful breathing. Mostly these are limited to an uncomfortable pulling sensation when inhaling and exhaling deeply, but strong coughing can also cause pain (please refer: Pain when coughing).
A lung infection in itself does not usually cause pain.

However, if it is not treated and it may spread further. It can happen that the pleura, the pleura, is also affected. One layer of the pleura surrounds the entire lung and the other layer rests on the inside of the chest.
Between the layers is the pleural space, which is filled with pleural fluid, and ensures that the lungs open when breathing moves. With severe pneumonia, the pleura can also become inflamed and painful pleurisy (pleurisy).
With every breath, the inflamed tissue is irritated again and causes pain. Muscles can also become inflamed. If this happens to parts of the respiratory muscles, for example the intercostal muscles, the inflammation leads to painful breathing.

The lung tissue, including the pleura, can be damaged by inflammation or by traumatic effects (Accident etc.) tear. The negative pressure in the pleural space, which otherwise holds the lungs open, is lost and it collapses (collapses and can no longer be used for breathing). Suddenly stabbing pain that is partly dependent on breathing occurs. Another traumatic change can be a Broken rib be.
This can also cause chest pain when breathing: on the one hand through the damaged tissue with nerve contact, on the other hand through the pricking of bone fragments into the surrounding tissue or the lungs.

A Intercostal neuralgia (Intercostal = between the ribs; neuralgia = nerve pain) can also be the reason for chest pain while breathing. The causes of such neuralgia are controversial and a plausible explanation cannot always be found. The intercostal nerves, which run between the ribs, are overly sensitive and react with pain to every movement - including breathing.

Chest pain during pregnancy

The pregnancy means a change for every expectant mother.

The body tries to prepare itself in the best possible way for the care of an adolescent person in the womb. There are also changes that are supposed to regulate the diet after childbirth.
A cardiovascular system disease that is principally associated with chest pain does occur - the Pregnancy hypertension - but does not cause chest pain. There is a risk of being affected by the enormous conversion of the female body bronchial asthma trains. Women who were ill before pregnancy are particularly susceptible to this. At the bronchial asthma The air-carrying paths in the lungs narrow and an attack can lead to shortness of breath. In connection with this, those affected often describe chest pain.

The risk of one Gallstone disease getting sick is increased in pregnancy. A gallstone, which can vary in size, settles in the bile duct. As a result, the muscles surrounding those cramp, which leads to so-called biliary colic, a martial, extremely strong pain. Although the gallbladder and bile duct are located in the abdominal cavity, they can still project the pain into the thorax due to their proximity to the chest.

Processes in the female breast (Mom) can also cause chest pain. During pregnancy, the hormone levels readjust. This influences the structure of the mother's breast.
The mammary glands are trained further and adjust to future production. The tissue is stressed as a result - the skin can feel tight and sensitive to pressure.

Another possible source of chest pain is if the mammary glands are inflamed. Although this does not arise until after birth, it is caused by the act of breastfeeding. While drinking, the baby transfers bacteria to the nipple, which migrate and cause inflammation of the mammary gland - puerperal mastitis.

Chest pain during and after ovulation

Ovulation (ovulation) is temporally at the center of the female cycle.
Before ovulation, in the periovulatory phase, the level of estrogen in the woman's blood continues to rise. This not only leads to the maturation of the egg, but also has an effect on the female breast.

The estrogen reached its highest point shortly before or during ovulation and therefore had the greatest effect on the breast tissue. In this, the hormone promotes the storage of adipose tissue and water, which tensions the skin over the breast and can make the breast painful. After ovulation, the estrogen level drops sharply, but increases again slightly and continuously after a short time.
This second increase can also have the same effect on breast tissue as described. The chest pain can of course also be independent of the cycle and still occur during or after ovulation. However, most women perceive that the cause of the pain is of a different origin.

Chest pain when breastfeeding

The female breast can both during and after Breastfeeding process pain. The chest pain has various causes. Some women are more sensitive to the breast than others. Sucking the baby can be perceived as very painful. If the baby gets teeth relatively early, chest pain from unwanted biting can occur.

A Milk congestion is feared by many mothers because it is very painful and they are afraid that they will no longer be able to breastfeed the child. However, due to good treatment options, the prognosis is very good. When the milk is blocked, the breast milk produced in the glandular tissue builds up because the fluid that was already present has not or could not drain. The chest becomes hard and painful as a result.

Inflammation of the mammary glands can also lead to pain. The baby transfers pathogens to the nipple when it is drinking. These immigrate there and establish themselves - it comes to one Puerperal mastitis, an inflammation of the mammary gland.

Differentiation between men and women

Chest pain in men

The causes of chest pain in men can be many.
Perhaps the most common fear associated with chest pain is one Heart attack to suffer. In contrast to many women, the symptoms in men often appear as in a textbook:

severe chest pains that seem to slowly wander into arms. However, there are exceptions. The occlusion of a coronary artery does not always have to look like this. In some cases, nausea, stomach or back pain are also the result of a heart attack.

In addition to a heart problem, other organs in the chest must be considered. The lung is an important component that can trigger chest pain through various diseases.
Inflammation plays an important role in this. At a Inflammation in the respiratory system pain can also occur as a result of disease of the surrounding tissue - the pleura and the respiratory muscles. A malignant tumor is also more likely to cause chest pain in men. The connection is that the male sex has, on average, recorded higher tobacco consumption than women. Since tobacco smoking is immediate Lung cancer is more likely to develop painful bronchial carcinoma in men.

Furthermore, it must Digestive system considered a possible trigger of chest pain. Most of this is not in the chest, but it can still cause pain there. The esophagus (Esophagus) runs through the entire chest from the throat to the stomach. It can cause pain in small things like heartburn as well as malignant diseases like an esophageal tumor. The latter cause and how it presents itself symptomatically depends on the location and size of the cancerous ulcer. As in almost all organs, inflammation can also occur Pain when swallowing and thus lead in the chest. Other organs of the digestive system are located in the abdominal cavity, but their location can project pain into the chest. This is the case with one, for example Inflammation of the stomach lining (gastritis) or one Inflammation of the pancreas (Pancreatitis). Pancreatitis occurs more frequently with chronic alcohol abuse, which, like smoking, is a male domain.

Men do weight training or work in a physically demanding job more often than women. This can damage the muscles. These range from the classic "sore muscles" after training to torn muscle bundles that result in a long period of rest. Men are also more often involved in accidents that can lead to bone damage and thus chest pain.

Chest pain in the woman

Many causes of chest pain do not differ between the sexes. An organ disease, muscle or skeletal damage can occur in both women and men.
However, the female breast has to be differentiated. Many diseases that affect her trigger chest pain specifically in women.
Diffuse chest pain in the chest cannot simply be attributed to a cause. However, if the female breast (mom) hurts, it is often easy for the affected woman to locate the origin. (Please refer: Woman's chest pain)

Inflammatory processes can take place in almost every tissue in the body, including the breast (female breast). The is a particularly large part of this Inflammation of the mammary glands. A distinction is made according to the circumstances of the occurrence.
The Puerperal mastitis occurs shortly after birth and is related to breastfeeding. The non-puerperal Form can affect other women as well. It is believed that the inflammation can be triggered by stress, hygienic deficits and various other causes.
Chest pain can be related to the Menstrual cycle stand.
A Mastodynia describes a cycle-dependent pain in the female breast (please refer: Chest pain when ovulating), which has to do with an imbalance in the various hormones.
The form independent of the cycle is mastalgia. Both forms can occur in all women and are mostly natural and harmless. If hardening of the breast tissue should also occur, one could require treatment Mastopathy consist. In general there is a fear of breast cancer among women - Breast cancer, the most common cancer among women.
In the rarest of cases, however, a malignant tumor in the breast is accompanied by chest pain, which reduces the likelihood of its presence in a painful breast. In addition to the pain-causing change, there can of course be a tumor. When examining the origin of the pain, the chest can be palpated for this.

In addition to the comprehensive chapter on the female breast, other diseases can of course also occur in women. The fear of many men of having a heart attack is shared proportionally less by women.
This is due to the fact that on average they suffer from it less often and only later. However, the symptoms are usually different between the sexes. While men often experience devastating chest and arm pain, as well as shortness of breath, a heart attack often raises questions in women. Abdominal pain, pain in the back or neck, and a sore throat are symptoms of a blockage of the coronary arteries in women. Nausea and a feeling of exhaustion can also occur. In many cases there are no chest pain, which is why a heart attack in women is recognized too late on average and the patients die.

The lungs are another source of chest pain. The pain is mostly related to an infection and a subsequent inflammation of tissue of the respiratory system. Furthermore, inflammation of other organs or parts of the chest can lead to pain, such as a pleurisy (pleurisy) or one Esophagitis (Esophagitis). Abdominal organs also occasionally project the pain that occurs there into the chest. The stomach, pancreas and bile ducts are important.

Muscle or bone injuries as well as changes in the skeleton that can trigger chest pain occur more frequently in men, as they increasingly overwhelm their musculoskeletal system. Hard physical work and strength training play a major role here - both of which are more masculine domains.

forecast

Depending on the causative clinical picture, one udifferent prognosis to run out of healing. The most harmless chest pains are certainly caused by clinical pictures of the Musculature and the skeleton and can be caused by pain medication or physical therapy usually be cured completely. A very good prognosis can now also be recorded for involvement of cardiovascular diseases that cause chest pain.

Summary

Chest pain is a common symptom that can have both harmless and life-threatening causes. One should therefore always suspect a dangerous situation in patients.

The most well-known cause of chest pain is, also according to popular opinion, the heart attack, which is described as annihilating pain, previously of the same extent, with pulling in the left arm, in the upper abdomen and in the lower jaw. The patients are scared to death, sweat and need air. Immediate hospitalization is urgently needed.
The angina pectoris attack is a preliminary stage of the heart attack (a narrowing of the vessels of the heart), which is divided into a stable course form (only in motion) and an unstable course form (in movement and rest). The unstable angina pectoris is also an absolute emergency, since it can be assumed that a heart attack is imminent. Here, too, an immediate cardiological check is necessary. In addition to the heart, other organs of the chest can cause chest pain. A tear in the main artery (aorta) leads to sudden, very severe pain, some of which also radiate into the back. Sudden, severe and respiratory-dependent pain that is accompanied by severe shortness of breath indicate a pulmonary embolism. Inflammation of the pleura also leads to breathing-dependent tearing and pulling chest pain. Inflammation of the pericardium, most of which is viral, can also cause severe chest pain, but is usually associated with a high fever. Overstretching and straining the chest wall (Intercostal neuralgia) or inflammatory cartilaginous changes between the ribs and the sternum (Tietze syndrome) can also cause chest pain, which can mostly be provoked and alleviated by appropriate movements. Orthopedic diseases, such as Bechterew disease or chicken breast, can sometimes cause very severe chest pain.

Tears in the esophagus due to alcoholism and frequent vomiting can also cause chest pain, as can inflammation of the gallbladder or pancreas, bloating intestinal situations or refluxing gastric juice (reflux). If no organic causes of chest pain can be found, a psychosomatic form must be assumed. After grief or during a crisis, patients can experience chest pain without an organic cause. But also with psychiatric clinical pictures, such as cardiac neurosis, depression, psychosis and hypochondria, patients should be referred to a specialist in psychiatry.

Children between the ages of 12 and 14 often experience chest pain, but in most cases the cause is not in organs. The cause is often the stretching of the chest wall, Intercostal neuralgia or hormonal influences. Treatment is usually not necessary.

Women and men are equally often affected by chest pain, with women statistically suffering from the symptoms in older age. The frequency peak is between the ages of 45 and 65.

In order to make a diagnosis, the doctor should always first rule out a life-threatening cause such as a heart attack or pulmonary embolism. Every patient with chest pain should therefore have an ECG and possibly a blood count made, on which heart attack and pulmonary embolism can often be seen. If no cause is found, the abdominal organs, blood vessels and skeleton should be examined. Using a reflex hammer, the doctor can test the sensitivity of the cartilage bone boundaries (Tietze syndrome) examine, by patting the chest wall, he can determine intercostal neuralgia. It is important that patients whose overall situation becomes emergency must be transferred to the clinic immediately and should only receive general first aid in the practice. After excluding dangerous cardiovascular chest pain, with a little more rest, further causes can be searched for. If the doctor does not find any organic causes, even after examining the heart by stress ECG and ultrasound, a psychosomatic cause should be assumed and the patient should be reassured and awaited accordingly or a specialist in psychiatry should be consulted if the suffering is too high.

In terms of prognosis, one must consider the disease causing chest pain. The tense causes certainly have the best prognoses and are the most harmless cause. Although the other causes are usually treatable, they are usually followed by months or lifelong therapy and often have to be surgically corrected. Chest pain due to psychosomatic causes has a relatively poor prognosis. This is due to the fact that the reason, the cause and the mechanism of development are not exactly known and therefore cannot be treated in a targeted manner at first.