Heart pain

definition

Heart pain is a technical term in medicine called angina pectoris. Literally translated, the term describes tightness or oppression that can be felt in the chest. Many people feel this feeling like strong pressure on the sternum. However, this is perceived differently by each person and can also radiate into other parts of the body or be accompanied by other accompanying symptoms.

causes

Heart pain can have many different causes. They differ greatly in their severity and do not necessarily always have to start with the heart.
Here, for example, heartburn, overinflation of the stomach, irritated nerves or stress and fear can be the trigger for heart pain.

If the cause of the heart pain is the heart itself, this is usually due to a lack of blood supply to the heart.
Since the heart is a thick muscle, in some diseases this wall can no longer be completely supplied with oxygen.
For the blood supply to the heart itself, there are the coronary vessels that run around the heart and provide it with oxygen and nutrients. If these coronary vessels are calcified, it is called coronary heart disease.

A blockage or a complete blockage of the vessels is a heart attack.
In both cases, the heart is no longer adequately supplied, which leads to heart pain Angina pectoris to be named.

The inadequate supply can also arise from other heart diseases. For example, especially in older people, there are often deposits on the heart valves that can hinder the flow of blood.
The aortic valve is located directly in front of the junction of the coronary arteries and changes at this point can lead to a reduced blood supply to the heart.

Heart disease such as heart failure, in which the heart no longer has enough strength to properly pump the blood, can lead to an increase in the heart muscle. This makes the layers of the heart muscle thicker until the blood supply is no longer sufficient.

Read more on the subject at: Angina pectoris

Heart pain from tension

Tension can also lead to pain that feels like heartache. The pain can be perceived like heart pain without involving the heart.
Most of the time you will feel a stinging or pulling sensation in the chest. The tense muscle can be either the muscles that connect the ribs or a tension in the diaphragm.

Lying incorrectly at night or lifting heavy objects can trigger such tension in the rib muscles.
The diaphragm is particularly stressed during strenuous sports such as jogging, climbing or when you have a strong cough and can lead to tension in the event of overload.

This muscular pain differs from pain actually emanating from the heart in that it can be precisely localized. Often you can assign the stinging or pain to exactly one point and they feel less like spreading pressure on the chest.

Read more on this topic at: Chest pain from tension

Heart pain from stress and excitement

In the case of heart pain caused by stress and excitement, it is important to find out whether the pain is a purely emotional, psychological cause, or whether it is due to a heart disease that is perceived more intensely when stressed.

In the case of coronary heart disease, i.e. calcification of the coronary arteries, the heart pain is caused by a reduced blood supply and thus a reduced supply of oxygen.
With emotional or physical stress, the heart starts beating faster and stronger. As a result, the heart needs more oxygen, the blood supply is even less sufficient and heart pain occurs.
In addition, the coronary arteries are supplied with blood, especially during the filling phase of the heart. However, if the heart tries to pump more blood into the body in a shorter period of time, the expulsion phase is longer and the heart's filling phase is shortened. As a result, the coronary arteries are less supplied with blood and the oxygen supply to the heart decreases.

If coronary artery disease is the cause of heart pain during stress and excitement, it should be treated. In contrast, purely emotional complaints should be differentiated and the cause at hand should be treated.
However, it should not be forgotten that psychological problems can also lead to organic diseases. This is the case with the so-called Broken Heart Syndrome.

Heart pain on exhalation

If heart pain intensifies when you breathe out, this can have various causes.
Generally speaking, the pressure in the chest is increased when you exhale, as the air is forced out of the lungs by the muscles involved in breathing.

With every disease of the heart that is accompanied by decreased pumping power, the increased pressure, against which the heart has to work harder, can lead to pain.
In addition, the pain in the heart area can also come from the auxiliary breathing muscles themselves or from the lungs.

Especially with diseases such as asthma, chronically constricting lung diseases or a tumor that obstructs the airways, the flow of air is difficult when you breathe out and pain in the heart can occur.

In the case of respiratory infections or pneumonia, the pain when breathing increases when the air flows through the irritated airways.

In the case of a pulmonary embolism, i.e. an occlusion of the pulmonary vessels, the pain can also increase when breathing. The pain can feel similar to heart pain.

In the case of a so-called pneumothorax, air usually gets through a hole between the outer and inner sheets that surround the lungs. If a lot of air collects in this gap, this can also lead to pain and the affected lung cannot properly develop.

If you have heart pain when you exhale, you should pay particular attention to symptoms such as shortness of breath, coughing or sputum and consult a doctor.

Read more on the subject at: Painful breathing

Heart pain when coughing

Pain in the heart area that occurs when coughing can have different causes. Often it is a problem that does not come from the heart but from the muscles that are used to breathe.

The cough itself can be seen as a forceful, forced and rapid exhalation. This puts a lot of strain on the auxiliary breathing muscles.
If these are injured or irritated, chest pain occurs, which can feel like a sharp heartache.
For example, the diaphragm or the small muscles between the ribs can be affected.

If you have pneumonia or inflammation of the airways, you will experience chest pain, which is often worse when you cough.

However, the cough can also be an underlying heart condition.
In a healthy heart, the oxygen-rich blood flows from the pulmonary circulation through the left part of the heart into the large body circulation. A heart failure, which is accompanied by a restricted pumping capacity of the heart, can lead to a backlog of blood in the lungs. This increases blood pressure in the lungs and can lead to a cough.

Read more on the subject at: Pain when coughing

Concomitant symptoms

The accompanying symptoms of heart pain express themselves in different ways in each person and vary depending on the cause of the symptoms.

If the heart is insufficiently supplied with calcified coronary arteries or if there is a heart attack, the pain often radiates to the left arm, back, lower jaw or upper abdomen.
Many people feel fear and restlessness and they start to sweat. Women in particular also have nausea and vomiting as accompanying symptoms of heart pain.
Particularly in the case of elderly people and diabetics, attention should be paid to the accompanying symptoms, as they can sometimes not even perceive the heart pain itself due to the reduced sensitivity (see: Silent heart attack).

Further information on this topic can be found at: Symptoms of a heart attack

If cardiac arrhythmias are the cause of heart pain, palpitations and palpitations usually occur. Spells of dizziness and fainting can also occur.

With heart failure, the heart can no longer pump enough blood into the body's circulation. In addition to possible heart pain, this can lead to a drop in performance, fatigue and weakness.
Since the blood flow is disturbed by the heart's inadequate pumping power, the blood can back up into the pulmonary circulation. It can also build up in the legs because not enough blood can be transported back to the heart.
This can lead to shortness of breath, which occurs particularly during exercise. On the other hand, people with heart failure often have water retention in their legs.

Read more about this at: Symptoms of heart failure

Heart pain - when do I have to see a doctor?

Since it is often difficult to judge when it is necessary to see a doctor in the event of heart pain, special attention should be paid to the following points, as the pain in the heart region, as described above, can also have serious causes that must be clarified by the doctor or treated urgently have to.

If the pain in the chest area is persistent, increasing or recurring frequently and is associated with a strong feeling of tightness or radiation to other parts of the upper body, a doctor should be consulted.

This should also be clarified immediately if the heart pain intensifies during exertion or if there is a sharp drop in performance, weakness or even clouding of consciousness.
Furthermore, involuntarily rapid breathing of more than 20 breaths per minute at rest runs the risk of heart disease.

If the heart rate is more than 100 or less than 40 beats per minute, if the blood pressure rises above 200 mmHg or falls below 100 mmHg, caution should also be exercised.
Also, heart pain, which is accompanied by symptoms such as blue lips, cold pale hands and feet, cold sweats, fever, nausea, and vomiting can indicate danger.
A doctor should be consulted as soon as possible, especially if several of these symptoms occur simultaneously and suddenly.

diagnosis

Various tests can be done to find out whether the diagnosis of heart pain is really a problem of the heart.
First of all, it is very important to talk to the attending physician, as he can learn more about the type, intensity and duration of the pain and can thus guide the examinations in the direction of the suspected diagnosis.
After that, an ultrasound of the heart (echocardiography), through which structural changes in the heart can be shown, an EKG to map the excitation conduction and a blood sample with determination of the laboratory values ​​of the heart, are particularly helpful.
In unclear cases, a CT or MRI of the heart can also be done.

EKG

The electrical excitation in the heart is, so to speak, the pacemaker for the beating of the heart. The excitations are perceived via a voltage measurement on the skin and shown in the EKG (electrocardiogram).
Depending on which cells are excited and thus activated, there are rashes in the ECG.
If cells or the conduction of the heart are damaged, there will be deviations from the normal ECG recording. The EKG can be used to draw conclusions about the underlying problem of the heart.

Long-term ECG

The long-term EKG works in principle like the normal EKG. The difference is that the measurements are usually carried out over 24 hours, but at fewer measuring points. Thus, the electrical excitations of the heart can be followed over a whole day.
In particular, cardiac arrhythmias, which may not occur permanently, can be easily identified. In addition, it becomes clear in which moments of everyday life functional disorders of the heart occur more frequently.

treatment

Treatment of all heart diseases usually begins with a reduction in the risk factors for cardiovascular disease. These are often weight loss, physical training, smoking cessation, lowering alcohol consumption and, in the case of diabetics, correct blood sugar control.

Read more about this at: Diet for heart disease and how can you prevent a heart attack?

In the case of an acute heart attack, nitrospray is usually given to dilate the blood vessels, painkillers, oxygen, aspirin and heparin are used to prevent blood cells from closing the blood vessels further. A cardiac catheter examination should be performed as soon as possible, in which the closed vessel is opened.

Read more on the subject at: Therapy of a heart attack

In the further course and also with coronary heart disease, i.e. a partial occlusion of the coronary arteries due to calcifications, drugs such as aspirin are prescribed to prevent future occlusion.

It is also helpful for most heart diseases to control blood pressure, which can be done with beta blockers or ACE inhibitors.
Furthermore, the blood lipids can be lowered, for which purpose statins are preferably used.

If heart failure or water retention occurs, dehydrating drugs, so-called diuretics, are useful.
If cardiac arrhythmias occur, antiarrhythmics such as beta blockers or amiodarone can be given.

Read more about this at: Heart failure therapy

Home remedies for heart pain

Some home remedies can help with heart pain. It is very important to follow a healthy lifestyle and diet, as large or bloating meals often make heart pain worse.

Smoking and high alcohol consumption should also be avoided.
If the complaints occur particularly during physical or emotional stress, rest or relaxation exercises often help.

It can also be helpful in reducing general stress levels and doing exercises like yoga or pilates.
If the pain occurs in a certain position, for example lying down, this should be changed slowly.

Homeopathy for heart pain

Homeopathy is particularly helpful for heart pain caused by stress, or for pain that is not caused by heart disease.

Naturopathy can provide soothing recipes that contain valerian, arnica, lemon balm, hawthorn blossoms or rosemary, for example. These ingredients can also be prepared in teas.

Osteopathy can relieve tension and relieve pain, especially in the case of pain with a muscular cause.

Read more on this topic at: Homeopathy for coronary artery disease and homeopathy for heart stumbling

Heart pain when lying down

When lying down, the blood distribution in the body changes compared to sitting or standing. Because especially the large veins in the body are very flexible and can store a lot of blood. When sitting or standing, the blood tends to collect in the large veins of the legs due to the force of gravity.

When lying down, however, the legs are usually at the same level as the rest of the body. This means that the blood that has collected in the legs flows back towards the heart more intensely. As a result, the heart now has more blood volume available to pump into the circulation.
In this case, healthy hearts can move more blood in less time. For a heart that has already been damaged, however, it is difficult to cope with the stress caused by the increased volume.

Even if there are no symptoms while sitting or standing, the heart can no longer work stably and vigorously enough to pump more blood while lying down. The heart has to work harder to transport the extra blood.
With every further work, however, the heart needs more oxygen to supply the muscle cells. If this supply can no longer be ensured, for example due to calcified coronary arteries, this manifests itself in heart pain.

Even if the heart muscle is already enlarged, for example to withstand increased blood pressure, the additional supply becomes difficult during exercise. For this reason, heart pain can occur when lying down, which is caused by an increased volume load.

Pain and shortness of breath

Breathlessness can lead to pain because the causes of breathlessness, such as pneumonia, can be very painful.
In addition, when there is shortness of breath, the auxiliary respiratory muscles are heavily stressed, which can lead to pain.

Read more on the subject at: Pain on inhalation

But the other way around, shortness of breath can also result from a heart disease. If the heart's pumping power is restricted, blood can back up into the lungs.
This causes fluid to leak out of the vessels and collect in the lungs. This makes it more difficult for the lungs to take up oxygen and may cause shortness of breath.

Further information on this topic can be found at: Difficulty breathing due to a weak heart

Heart pain after exercise

Heart pain that occurs after exercise can also be caused either in the heart itself or independently of the heart.
When doing sport, the body usually performs very well. This requires an increased supply of blood to the muscles. In order to guarantee this, the heart has to do more work than at rest, beating faster and more forcefully and thus consuming more oxygen itself.

If the heart does not keep up with the supply, the muscles use up their reserves and thus still generate their strength and take on what is known as an oxygen debt. This has to be replenished after exercise, which is why the heart has to continue working after exercise.
In contrast to the stress phase, the stress hormones and adrenaline, which may have masked the stress and pain during exercise, are now eliminated.

In addition, breathing is increased during exertion in order to absorb more oxygen.
As a result, the breathing muscles have to work harder during sport. As with all muscles, this can lead to sore muscles in the muscles between the ribs, which can be perceived as stabbing pain in the heart area.

Heart pain during pregnancy

During pregnancy, the child is supplied with the mother's blood via the umbilical cord. As a result, the mother's heart works for two people at the same time and pumps more blood volume per minute. In order to do this, the mother's heart has to muster more strength and thus works harder.
This increased performance can be particularly noticeable in stressful moments in the form of heart pain.

In addition, the growing child continues to press on the mother's abdominal organs, which in turn can transfer the pressure to the heart and thus lead to irritation of the heart, additional heartbeats and heart pain.

Read more on this topic at: Chest tightening during pregnancy and racing heart during pregnancy

Heart pain through the back

Back pain can also be accompanied by heart pain. A harmful posture or a wrong lying position while sleeping can cause tension that radiates into the area of ​​the heart.
In addition, diseases of the spine, the spinal cord or irritation of the nerve roots emerging from the spinal cord can cause pain that can be felt in the chest.
The nerves that are responsible for the sensations in the chest area can be irritated by such diseases, but the location of the origin of the pain is projected to the beginning of the nerve path.

Read more about this at: Thoracic spine pain

Heart pain from flatulence

When heart pain is caused by the pressure of the stomach or intestines on the heart while gas is flat, it is called Roemheld syndrome. The stomach and intestines lie directly below the heart and are separated from it by the diaphragm.
If they are bloated or enlarged, there is pressure on the heart.
This pressure can arise, for example, from heavy meals lying in the stomach. In addition, food intolerance or gastric mucosal inflammation can lead to flatulence.
Roemheld syndrome can be treated with drugs that reduce the build-up of gas in the intestines, thereby reducing gas. This reduces the pressure on the heart and thus the heart pain.

Read more on the subject at: Chest pain from abdominal organs

Menopausal heart pain

During the menopause there are various changes in the body that come about as a result of the natural decline in the female sex hormones estrogen and progesterone.
Since these hormones also have an impact on mental mood, menopause is often associated with increased sensitivity, mood swings, stress and restlessness. These feelings can lead to palpitations, extra heartbeats, or heart pain.

Another change that the drop in hormones brings with it is the loss of the protection of the vessels, because estrogen ensures, among other things, that the vessels become widened. For this reason, diseases of the cardiovascular system with heart pain occur more frequently after the menopause.

Read more on the subject at: Palpitations during menopause

Heart pain after alcohol

Heart pain after drinking alcohol can be associated with increased stress, which the body is exposed to when reducing alcohol, and heart palpitations.
Long-term alcohol consumption in particular is very damaging to the cardiovascular system, can increase blood pressure and cause serious illnesses such as heart attacks.

However, heart pain after drinking alcohol may not have anything to do with alcohol consumption itself.
In the night after drinking alcohol, many people often simply fall into bed and do not pay attention to their lying position. The next morning this can lead to tension in the chest area, which feels like heart pain.

Further information on this topic can be found at: Palpitations after alcohol - is that dangerous?

Psychogenic heartache

Heart pain is a very common complaint in all age groups.
If no organic disease can be found as the cause, it usually has its origin in psychological or emotional complaints.
It is always important to see people as a holistic person and not to forget the physical as well as the psychological and social side. There can always be organic and psychological causes that aggravate each other.

Just as unpleasant situations “hit the stomach” for some people or others cramp up due to stress and thus get back pain, emotional problems can also manifest themselves in the form of heart pain.

Cardiac arrhythmias or palpitations caused by fear or restlessness are particularly common. Since these complaints can lead to fear and restlessness, especially in stressful situations, a vicious circle with persistent symptoms can arise here.
In the case of people with heart pain, the psychological situation should always be taken into account and, if necessary, included in the treatment.

Read more about this at: Heart rhythm disorder due to stress

Heartache from lovesickness

The terms lovesickness and heartbreak are often used very similarly, because lovesickness often gives rise to a feeling of severe heartbreak. The heartache itself can be the cause of the pain.
These are very uncomfortable and may even seem hopeless, but as soon as the lovesickness ends, the pain will also pass.

In rare cases, however, acute emotional and psychological complaints can also cause heart disease. This is called Broken Heart Syndrome.
This leads to a reversible reduction in the function of the heart. In most cases, the lower parts of the heart muscle no longer beat as strongly, which reduces the heart's pumping capacity.
As with other heart diseases, there is heart pain and blood backlog in the lungs, which is noticeable by breathlessness and coughing. It can also lead to dizziness and feelings of weakness.
The prognosis for this disease is very good and the acute illness is often over within a week. Afterwards, the heart usually regenerates itself and regains a normal pumping function. If this is not the case, therapy to safeguard the heart function, for example with beta blockers, can be started.

You might also be interested in:

• What happens when you are lovesick?
  and
• Broken Heart Syndrome

Duration of heart pain

The duration of heart pain can vary widely. However, it often gives an indication of the severity of the heart disease in connection with the severity of the symptoms.
If the symptoms only occur for a short time or under stress, one speaks of stable angina pectoris. If the symptoms persist, one speaks of unstable angina pectoris. This represents an acute and threatening under-supply of the heart and should be treated immediately.

Read more on the subject at: Angina pectoris

forecast

The prognosis of heart pain depends on the cause, accompanying illnesses and the intensity and duration of the symptoms.
A healthy lifestyle and physical training can greatly improve the prognosis.

In the case of stable angina pectoris, i.e. complaints that occur due to calcified vessels and usually disappear at rest, the mortality rate per year is 5%. If you have a heart attack, the prognosis is worse and depends heavily on the time until a cardiac catheterization can be performed. The damage that has already occurred to the heart also plays a role in the prognosis.
In the further course, a good drug setting and a reduction in risk factors favor the prognosis.
Psychogenic heart pain is completely curable with good therapy.