Pain behind the sternum


Pain behind the sternum (retrosternal pain) can have various causes. By definition, it is Chest painthat more or less just behind the sternum (sternum) lie and can have different characters. In principle, organs that are in close proximity are primarily considered. On the one hand, these are the esophagus with the one below stomach, the heart and the Lungs.
Not infrequently, however, can superficial happenings Cause pain in the chest area and possibly even behind the breastbone. For example, a Inflammation of the lung membrane (Pleura) be very painful, but the ribs and the nerves and muscles in between can also trigger similar complaints.

Also read our article Sternum pain

Causes and associated symptoms

One of the most common clinical pictures with burning pain behind the sternum is probably that Reflux disease (Reflux esophagitis). It occurs Stomach acid into the esophagus over and create one there inflammationwhich is usually felt by those affected as an acid belching or burning sensation behind the breastbone. These symptoms reinforced directly after eating or lying down.

Also one Inflammation of the stomach lining (gastritis) is relatively common. The cause of this can be very different, but what they all have in common is the symptoms. Mostly standing Pain in the upper abdomen in the foreground, but these can also have a different location and may also be around the navel or behind the breastbone.

To diseases of the heartwhich can cause pain behind the breastbone, counts above all Angina pectoris related to coronary heart disease. The already previously damaged vessels at heart have lost their elasticity and are narrowedwhich is why they are especially useful when exercising no longer convey enough blood can. Those affected then feel this phenomenon as paroxysmal chest tightness. Those affected sometimes describe this as stabbing pain, but often as discomfort behind the breastbone. The symptoms can range from pain to pressure on the chest to burning or heaviness. Often there is also an appearance in the arms, back or even in the jaw.

At the acute heart attack those affected also feel one sharp pain. This can be behind the breastbone, the left breast or in the upper abdomen. This is usually a very strong pain and often radiates into the left arm. Affected mostly have Fear of death, are cold sweaty, pale and they mostly feel Nausea and even vomiting. Also accompanying shortness of breath is typical for this clinical picture. It is important that the pain cannot be influenced by breathing or movement. If it is, it speaks against an acute heart attack.

Also Diseases of the lungs can be accompanied by pain behind the sternum. Examples of this are a acute pulmonary embolism or a Pneumothorax. However, both clinical pictures have one thing in common shortness of breathwhich is usually also in the foreground. Accompanying this, sufferers often have a cough and Chest pain, mostly breath-dependent are.
The pleurisy, so an inflammation of the lung pleura has very strong, strictly breath-dependent pain as the leading symptom. Whenever the lungs move in relation to the chest wall, chest pain occurs. Depending on the localization of the inflammatory focus, the pain can also be behind the breastbone. In addition, those affected usually have a fever and a general feeling of illness.

Drawing, persistent pain in the chest area with peaks of pain speak more for one Intercostal neuralgia, a disease that is localized in the intercostal spaces. Most of the time, the pain is more belt-shaped and increases with movement or tension.

Last but not least, pain behind the sternum can also go through degenerative changes in the thoracic spine caused. Changes to the intervertebral discs, the vertebral bodies themselves or the ligamentous apparatus can be in the foreground. For the sake of simplicity, this is summarized as the thoracic spine syndrome (BWS syndrome). Most of the time it is Limited mobility and leads to pain that can radiate in different directions in the chest area. Breathing can also usually make the pain worse.


Depending on the clinical suspicion, the diagnostic measures are often different. First of all, a detailed description of the pain quality, pain intensity and pain character is necessary for further assessment by the doctor. It is important to know when the pain is most likely to occur, where it is located, whether it is radiating, what makes it worse or better, and how severe it is. Depending on this and the general clinical condition of the patient, the most likely clinical pictures are then further clarified.

If the esophagus or the stomach is in the foreground, tests can be carried out on the one hand to determine whether the symptoms improve after administration of gastric acid blockers (so-called proton pump inhibitors, or PPIs for short).

Read more about this under Proton pump inhibitor effect

You can also do an endoscopic examination, a gastroscopy (Esophagogastroduodenoscopy, in short: ÖGD), so that the doctor can get a better picture of the condition of the mucous membranes and, if necessary, carry out an intervention.

If the heart is considered the most likely cause of the pain, an EKG is usually written, blood is drawn to check important cardiac enzymes, and an ultrasound of the heart muscle is done.

If the lungs are in the foreground, a chest x-ray is usually taken and, for more precise questions, even a computed tomography (CT). It is also important to check how the blood is loaded with the various gases and whether there are any signs of acute cardiac stress as part of what is happening in the lungs.

In the case of orthopedic causes, a specific physical examination is usually effective, and in the case of changes in the thoracic spine, an X-ray is usually effective.

Read more on the topic: Chest x-ray (chest x-ray)


Of course, there are also different therapeutic approaches for the many very different clinical pictures mentioned.

At Symptoms related to gastritis or reflux disease the therapy consists mainly of the Reduce acid production of the stomachin order to keep the additional irritation of the mucous membranes as low as possible.

For diseases that Heart concern becomes a Long term therapy aimed at, as the cardiovascular system is of crucial importance for the entire organism. In the Acute heart attack situation substances are used which, on the one hand, Place the vessels wide should that Reduce heart rate And take away the pain and fear In the long term, therapy to lower blood pressure and blood lipids is usually initiated; if necessary, blood thinning and relief for the pumping function of the heart are sought.

Is the lung affected, the cause is treated in each case. At a Pulmonary embolism for example, the Thrombus dissolved be at one Pneumothorax the Lungs unfolded again and at one pleurisy the Fights infection become.

Orthopedic diseases are mostly with Painkillers treated. If necessary, a relieving operation should also be performed in the case of chronic BWS syndrome.

All clinical pictures with pain behind the breastbone or other chest pain have this in common pain relieving therapy. As First aid usually always starts with one Administration of pain medication.

Pain behind the breastbone after eating

Pain when eating or shortly after eating, localized behind the breastbone or in the upper abdomen usually indicate gastritis. In some cases, those affected describe that the pain improves a little immediately after eating, but then returns to its original state after a relatively short time. To step accompanying to the pain Nausea, bloating, loss of appetite or vomiting, the diagnosis of gastritis is quite likely.

The typical burning behind the breastbone as part of a Reflux disease can also occur more intensely after eating. Lying down or bending forward can also worsen the symptoms.

Pain behind the breastbone when drinking

Difficulty swallowing, which occurs even when drinking liquids, usually indicate an already pronounced reflux disease of the esophagus. The mucous membrane is then so strongly irritated and inflamed that even contact with liquid can cause the typical burning sensation and lead to pain. If this is the case, a doctor should be consulted within the next few days if possible. After all, swallowing disorders can have a long-term negative effect on eating and drinking behavior and have further consequences. The permanent inflammation of the esophagus can also be the ground for further illnesses.

Read more about this under Reflux esophagitis

Radiation of pain in the back

Sometimes the pain behind the breastbone can be too radiate in the back. This is usually the case when that Heart or chest wall involved are. In both cases, radiation to the back is conceivable, but does not necessarily have to be the case. At the Heart attack for example, many different radiations of pain are possible. Also complaints, the primary one start from the stomach can be so pronounced that they radiate into the back. However, this is rarely the case.

Goes the Main cause from the spine out, back pain is in the nature of things. In this case, the pain behind the breastbone, if any, is to be understood as radiating pain.

Worsening pain from breathing

If the chest pain worsens when you breathe, this is a Sign which speaks against a cause in the heart. The sharp pain of a heart attack is usually permanent and completely independent of movement or breathing.

The pain occurs increased when inhaling on, the underlying condition may be the lung affect. At the Pneumothorax or pleurisy, for example, the pain is usually greatest when you breathe in. Exercise also often aggravates the symptoms.
Also one Intercostal neuralgia can cause increased discomfort when breathing.

Pain worsened by coughing

The same applies to the intensification of the pain behind the breastbone when coughing as to breathing in or moving. A Intercostal neuralgia for example, worsens when coughing, straining, or moving. Ultimately the pressure in the chest increases both when inhaling and when coughing, which is the crucial mechanism for the Reinforcement of the pain symptoms in these diseases.


The symptom is pain behind the breastbone or also retrosternal pain can a Signs of many diseases internal medicine or orthopedics.

Some of them are acutely life-threatening, which is why another Clarification should definitely take place. The urgency of the doctor's visit should, if possible, be based on the general condition and the general burden of disease.

For the assessment, the general symptom burden of the patient is decisive, but also the Differentiation between breathing and movement-dependent pain is of great importance. Cardiac pain, i.e. pain emanating from the heart, is usually constant and can hardly be influenced by external circumstances. These should then be clarified immediately in any case.

Gastritic complaints and orthopedic clinical pictures, on the other hand, are usually not as acute and can usually be managed well in the context of outpatient therapy.