Chest pain

definition

Chest pain (called thoracic pain by the doctor) comes in a wide variety of forms and intensities and can accordingly have a wide variety of causes. The pain can e.g. B. be oppressive, throbbing or stabbing, movement-dependent or movement-independent and be accompanied by various other symptoms such as heartburn, vomiting, increased sweating or upper abdominal discomfort.

The pain can also radiate to various other parts of the body, in the case of a heart attack, for example, often to the left arm. Depending on the severity, type, location and accompanying symptoms, a lot can be assumed about the cause of the pain

For more information on chest pain, see our article Chest pain - what's behind it?

causes

Chest pain can have a variety of causes. The heart is rarely the trigger, but this dangerous possibility should not be ignored and chest pain should always be taken seriously. The diseases affecting the heart include myocardial infarction, inflammation of the heart muscles or sacs, heart valve defects and cardiac arrhythmias.
For injuries and tears in the main artery (aorta) a downright tearing pain is typical.You can find information about these clinical pictures in our area Diseases of the heart.

If the lung is affected, it can be, for example, a Pulmonary embolism (Obstruction of a pulmonary artery), one Pneumothorax (Air between the lungs and the chest, which leads to the collapse of the lungs) or pulmonary inflammation.
Also the Reflux oesophagitis, an inflammation of the esophagus caused by rising stomach acid, can cause chest pain, as well as tears in the esophagus or cramping of the annular muscles in the esophagus.

In addition, the muscles around the chest can cause chest pain, for example if they are excessively cramped or torn.
Pain from other parts of the body can also radiate into the chest, for example abdominal pain in one Biliary colic.

Last but not least, the pain does not always have to have a physical cause: Even great psychological stress or emotional strain can be reflected in chest pain without the body being missing anything.

You can read about the causes of pain under the chest in our article Chest pain - what's behind it?

Concomitant symptoms

The symptoms that accompany chest pain can provide information about their origin. If certain muscle parts are restricted in their mobility or if the pain worsens when moving, a tension or overload of the muscles is likely.Also read our article about Chest pain from tension.

Fever suggests an inflammatory disease that is mostly in the airways and is also noticeable as a cough. Depending on the type of cough and the coughed up mucus, the disease can be further differentiated. If the sputum is bloody, one can Pulmonary embolism (Blockage of a pulmonary vein). However, the pericardium, pleura and the Mediastinum (the space between the two lungs) inflame, which also manifests itself in a fever.

If the chest pain is accompanied by heartburn, it is likely to have reflux disease, in which stomach acid flows back into the esophagus and attacks it.
In the case of loss of appetite and indigestion, the stomach or liver can be affected, the pain of which can also radiate into the chest.

In our article, you can read about other causes of severe pain in the esophagus Burning pain in the esophagus - that's behind it!

If chest tightness is felt in addition to the pain, the cause may be coronary artery disease (narrowing of the arteries supplying the heart), which can develop into a heart attack. A heart attack also shows itself first as a feeling of tightness and severe pain, which often radiate into the left upper arm and the jaw, in addition to which there is usually cold sweat, shortness of breath and a severe burning sensation.

Pain between shoulder blades and chest

Pain in the upper back is often caused by tension and spasms in the muscles located there. They are usually breath-dependent, so they get stronger when you breathe deeper. This is because the respiratory muscles are often also affected, particularly often the Serratus posterior superior muscle. The cause of tension in this area can be a bad posture or an incorrectly accustomed breathing technique. If, for example, the shoulders are subconsciously pulled backwards while walking or sitting (for example to correct a supposed bad posture), the affected muscles can no longer relax and cramp over time. With so-called chest or high breathing, instead of the diaphragm, the chest and neck muscles are used to breathe, which can also tense them in the long term. It is therefore advisable to always breathe with the diaphragm (abdominal breathing).

Depending on the quality of the pain, its origin can be narrowed down: Muscle tension is usually expressed in punctiform, stabbing pain. If the connective tissue is affected, the pain is more likely to be perceived as diffuse and widespread.

A targeted relief of the painful muscles helps against pain of this kind, for example by changing the posture. If the symptoms persist for a long time, it is worth visiting a doctor or physiotherapist, who can give further tips and, if necessary, start physiotherapy.

Also read our article about Chest pain due to misalignment!

Pain between shoulder blades and armpit

In the case of pain between the shoulder blade and armpits, the cause is usually to be found in the muscles or connective tissue. For example, they can occur after excessive push-ups or lifting too heavy, often with a delay. Long-term, very one-sided stress on the muscles, for example from a desk job, can also lead to tension. Walking on crutches, which puts a lot of strain on the shoulder and chest muscles, can also be the cause. Mostly the Latissimus Dorsi muscle (the largest back muscle that pulls under the shoulder blade to the arm and borders the armpit from behind) and the smaller muscles underneath. The pain is often rather diffuse and difficult to localize, can occur independently of movement and breathing, and is sometimes very severe. They limit the mobility of the arm and can also occur when lying down, so that it is no longer possible to lie on the affected side. Especially when the position is changed while sleeping and the arm is moved, this pain also disturbs the night's rest. In addition, the tension can compress the intercostal muscles under the superficial muscles, which causes further pain and a feeling of tightness.

Do you work a lot while sitting? Stay fit and find out more about movement exercises in our article Exercise examples for loosening up and relaxing while sitting at the desk!

Pain between chest and rib

Pain between the ribs can have very different causes. The most common are bruises and sore muscles. Tension of the intercostal muscles or irritation of the nerves running between the ribs are also possible causes. The latter can be caused by comparatively small triggers, in women, for example, by a bra that is too tight. Less common causes of pain are so-called shingles (Herpes zoster) or a broken rib. Pain between the ribs is sometimes very strong and can also create an oppressive feeling of tightness in the chest, which is why many sufferers assume a much worse disease than they actually have.

Read our article about what you can do about sore muscles Sore muscles - what works best?

Pain between chest and stomach

A distinction must be made here between superficial and deep-lying pain. The superficial pain often has its origin in the Rectus abdominis muscle, the large abdominal muscle. If this is tense, it pulls on the edges of the lowest ribs and exerts painful tension on the chest. The pain that occurs is often breath-dependent, as the abdominal muscles are arched forwards when breathing in the abdomen. Exercising too much abdominal muscles can also cause this type of pain. If the pain is deeper, the diaphragm may be affected, which is the main breathing muscle below the lungs on the lower edge of the chest. The cause can be B. Overwork from constant coughing or excessive physical exertion.

You can find more information about diseases of the diaphragm in our articlel Diseases of the diaphragm!

Pain between chest and shoulder

If there is pain between the chest and shoulder, the joints, nerves or muscles are usually affected. A common cause is previous overload, for example through exercise or heavy lifting. In most cases this pain will go away within a few days. If a nerve is pinched, the pain may last longer and a doctor's visit may be necessary.

Also read our article about Chest pain from nerves!

Caution is advised in the event of severe pain between the chest and left shoulder: If this radiates into the left upper arm and is also associated with a tightness in the chest, this can indicate an impending heart attack. In this case, it is necessary to go to a hospital as soon as possible.

You can read about other causes of shoulder pain in our article Shoulder pain read up.

Pain between chest and stomach

Because the stomach is partly under the ribs, stomach discomfort can also be felt partly as pain in the lower left chest. Stomach problems can have very different causes, most of which are harmless and will disappear again after a short time. For example, excessive or very high-fat food intake can irritate the stomach and cause cramp-like pain. Excessive alcohol consumption and smoking can also lead to stomach upsets. In rare cases, however, stomach pain can also indicate serious illnesses, for example an irritable stomach, stomach ulcer or a part of the stomach sliding up into the chest.

Find out what you can do against stomach pain in our article Stomach Pain - What Can You Do About It?

There are also many organs in the abdomen. Some of these can also cause chest pain. You can find out which organs these could be and what you can do about them in our article Chest pain from abdominal organs read up.

Painful breathing

If the chest hurts when you breathe, in most cases the trigger is in the lungs. Here the most common diseases are the bronchitis (Inflammation of the airways) and pneumonia (inflammation of the lungs). Also one pleurisy (Pleurisy) or broken ribs are possible, as well Pneumothorax (Air in the chest that constricts the lungs). Other diseases like a tumor or the tuberculosis are also possible, but very rare. In addition, allergic reactions must be taken into account, but allergic asthma is always associated with shortness of breath.

You can find out how to recognize pneumonia in our articlel How do I recognize pneumonia?

Pain when coughing

For respiratory infections (Pharyngitis, bronchitis, pneumonitis) a painful cough is a common complaint. The inflammation irritates the mucous membrane and makes it sensitive to stress. If you cough vigorously to get rid of the phlegm filled with bacteria, this can lead to pain. In the case of persistent infections, the respiratory muscles can also get "sore muscles" from coughing and then pain with further stress. Other illnesses such as pleurisy (pleurisy) or a lung tumor are possible, but much less common.

How to fight coughs with home remedies, read in our article Home remedies for coughs!

Pain in the heart

If the chest hurts in the heart area, the heart is rarely the trigger. Much more common are referred muscle pain, irritation of the esophagus from reflux disease, spinal problems or psychological stress. Nevertheless, heart pain should always be taken seriously, as it can hide dangerous heart disease in rare cases. These include CHD (coronary artery disease), cardiac arrhythmias, pericardial inflammation and, of course, myocardial infarction. Therefore, if you have chest pain, it is always a good idea to see a doctor to rule out heart disease, especially if the pain persists or gets worse.

For information on how to protect yourself from a heart attack, see our article Prevent heart attack.

diagnosis

For a diagnosis, the doctor first asks for details about the pain: Possible clues for the cause can be:

• Quality (piercing, throbbing, dull, burning, punctiform, diffuse, etc.),
• Localization,
• Strength
• Duration of pain

In an anamnesis interview, the doctor also asks about accompanying complaints, previous illnesses, dietary habits and any family illnesses.
Diagnostic tools such as x-rays or echocardiography can also be used to detect or rule out lung or heart diseases.

In our article you can find out how such an anamnesis interview could work anamnese read up.

therapy

Basically, it is important to treat the cause of chest pain, that is, not to remove the pain itself, but to remove the trigger.
The reflux disease of the esophagus can be combated by giving drugs that inhibit the excessive production of gastric acid; other drugs bind gastric acid that has already been formed. A change in eating habits (especially low-fat foods) also often helps.

Do you often suffer from gastrointestinal problems? In our article you can find out how to eat optimally if you have digestive problems Diet for digestive disorders read up.

Problems with the muscles usually go away on their own, warmth and rest help.Physiotherapy can help in severe cases.

While lighter inflammations such as bronchitis often heal on their own, pneumonia usually has to be treated with antibiotics to kill the pathogen.

Painkillers are usually necessary for broken ribs, as these cannot be splinted or cast. The Angina pectoris (Tightness in the chest) becomes Nitroglycerin treated in the form of spray or bite capsules, which dilate the arteries and relieve the tightness within minutes.
In the event of an acute myocardial infarction, it is important to reopen the misplaced heart arteries as soon as possible, with the help of medication or in an operation with balloon dilation.

Duration

As a rule, chest pain has mundane causes and disappears after a short time. However, if they persist over a longer period of time, a doctor should be consulted in order to detect or rule out possible serious illnesses. A visit to the doctor is also recommended if pain recurs in the same area.