Internal Medicine

Stinging in the chest

Definition- what is a stitch in the chest?

Stinging in the chest refers to pain in the chest area that feels "stinging". Affected patients are more likely to compare a sting in the chest to the sensation of a needle stick or a knife point. A stinging in the chest can always appear in the same place or in different places. It can only affect the left, only the right, or both halves of the chest. A stinging in the chest can occur occasionally or frequently and can be caused by both harmless and serious medical conditions.

These are the causes of a stitch in the chest

There are many different organs in the chest, all of which can cause the chest to sting.

Heart: The heart attack and angina pectoris (chest tightness) are triggered by constricted coronary arteries. Other heart diseases such as valve defects, cardiac arrhythmias or pericardial inflammation can trigger a stinging in the brood.
Vessels: The aorta, the main human artery, can tear if patients have an aneurysm (bulge) here. The aortic dissection, i.e. the splitting of the wall layers of the aorta is life-threatening.
High blood pressure: When there is a high blood pressure crisis, the blood flow to the heart deteriorates, which can cause a stinging sensation in the chest.
Lungs: When a blood vessel in the lungs becomes blocked, it is called a pulmonary embolism. If a lung collapses, doctors speak of a pneumothorax. Both diseases can cause a stinging sensation in the chest. More harmless diseases of the lungs with stinging in the chest are pleurisy and Bornholm disease (nerve irritation due to infection with the Coxsackie B virus).
Esophagus: The most common cause of stinging in the chest is probably heartburn. Other diseases are movement and swallowing disorders of the esophagus, tears in the mucous membrane or a tear in the esophagus due to excessive vomiting (Boerhaave syndrome).
Musculoskeletal system: The chest is surrounded by the spine and ribs. E.g. a broken rib or irritated intercostal nerve causes a stinging sensation in the chest.
Abdominal organs: It is possible that the stinging in the chest is caused by diseases of the abdominal organs, e.g. with inflammation of the pancreas or gall bladder and with Roemheld's syndrome (excessively bloated stomach causes symptoms similar to heart attacks).

From a heart attack

When it comes to sharp chest pain, most people probably think of a heart attack. In many cases, the pain during a heart attack is burning or pressing. Typical accompanying symptoms are the radiation of pain in the left arm and / or chin, as well as shortness of breath and fear of death. Nausea, vomiting, and pain in the upper abdomen are also possible. The heart attack occurs when a coronary artery is blocked, e.g. in the context of arteriosclerosis (hardening of the arteries).

Because of a pulmonary embolism

In most cases of pulmonary embolism, a venous blood clot is carried from the deep veins of the leg into a pulmonary artery via the bloodstream. This is where this embolus gets stuck and clogs the affected pulmonary artery. The blood backs up to the heart, the heart beats faster. Accelerated breathing and / or shortness of breath are possible because the pulmonary embolism means that less blood can be oxygenated in the lungs. Chest pain only occurs in about 70% of cases.

Through stress

A stinging in the chest does not have to have any physical cause, but can e.g. also be caused by stress. "Stress" here means excessive professional demands, grief, ongoing disputes in the partnership or in the family or the reaction to other stressful events and situations. The body reacts to such things with increased activity of the sympathetic nervous system, the part of the autonomic nervous system that is responsible for attention, flight and fight reactions. This speeds up the heart rate, and the additional feelings of fear and overwhelming can trigger a feeling of pressure or stinging in the chest. It is important not to simply dismiss a stinging in the chest with the words "I have too much stress", but rather to clarify possible physical causes. If no physical cause is found in these examinations, it is just as important to accept that the body reacts in this way to excessive demands and to seek help to reduce the stress or to improve its handling.

By smoking

When smoking, the toxic substance nicotine is inhaled and migrates directly into the blood via the alveoli. Nicotine activates the autonomic nervous system in different ways. For example, nicotine increases heart rate and constricts blood vessels, which increases blood pressure. In addition, nicotine activates pressure and pain receptors, which is why pain is more clearly perceived. The high blood pressure, the narrowing of the blood vessels in the heart and lungs, may show up as a stinging sensation in the chest. Some smokers report that this stinging is associated with smoking and lasts only a few minutes.

Through tension

Many people suffer from too little exercise and too long sitting. Especially with people who work a lot on the computer, long periods of sitting in the wrong position cause tension in the back and shoulder muscles as well as postural damage, e.g. on the spine. This tension can trigger sharp pain in the chest and often occurs at rest. That is why you should pay attention to a straight posture when sitting: Hanging shoulders and a rounded back are taboo.

Also read our article: Chest pain from tension

When a headache occurs

Headache cannot be the cause of sharp pain in the chest. But if they occur as an accompanying symptom, i.e. at the same time as a stitch in the chest, this could be an indication of heart disease or high blood pressure. If headaches and stinging in the chest occur more frequently and / or for several minutes, the symptoms should be clarified by a doctor.

By occurring earache

Typically, earache and stinging in the chest do not go hand in hand. High blood pressure can cause a stinging sensation in the chest but is more likely to cause ringing in the ears, such as ringing in the ears. Tension in the spine can radiate into the area behind the ears and at the same time cause a stinging sensation in the chest. It is also conceivable that an infection of the upper respiratory tract can lead to both ear infections and pneumonia. This could cause earache and stinging in the chest at the same time. However, it is more likely that the earache had nothing to do with the stinging in the chest.

From pneumonia

Pneumonia may also cause sharp pain in the chest, typically on the side that is affected by the inflammation. The stinging occurs more often when inhaling and can radiate into the upper abdomen; in children, abdominal pain is possible anywhere. Other symptoms of pneumonia include a high fever, chills, cough, shortness of breath, and discolored cough discharge.

Also read our article: Symptoms of pneumonia

From heartburn

Heartburn causes acidic stomach contents to flow back into the esophagus. Here the acidic gastric juice then causes pain. Typically, affected patients describe a burning sensation behind the heart, but it is also possible that heartburn is felt as pressure or stinging in the chest. Heartburn is particularly common after large, fatty meals and when lying down.

A pinched nerve

In medicine, a “pinched nerve” is actually only an irritation of the affected nerve. This does not have to be pinched in the literal sense, a hardening or tension of the surrounding muscles is sufficient to "annoy" the nerve. Typically, a pinched nerve causes stinging pain in the chest that can be severe at times. In addition, restricted mobility and possibly other symptoms such as tingling may occur. Many patients think of these symptoms as a heart problem. However, this would be more noticeable through prolonged stinging and shortness of breath. However, if the symptoms persist, a medical examination is useful in order to rule out a serious illness.

You might also be interested in: Intercostal neuralgia

Stinging in the chest for localization

Localization on the left

Stinging in the chest on the left side can be caused by the heart, but it can also be caused by harmless things. If the cause is in the heart, the stinging occurs for several minutes and can radiate into the chin and left arm. In addition, affected patients experience chest tightness, shortness of breath and often fear of death. The pain caused by the stinging is very intense when you have a heart attack. Stinging in the chest on the left side can also be triggered, for example, by overloading during exercise (side stitch) or by nerve irritation near the spine or on the costal arch. Further possibilities are muscular tension and hardening, which are caused by incorrect posture, for example when working on the computer. Breath-dependent stabbing pain most likely suggests a problem with muscles, bones, or pleura (see also: Painful breathing). A stinging in the left side of the chest should be examined urgently by a doctor if there are accompanying symptoms suggestive of a heart attack.

You might also be interested in: Left chest pain

Localization on the right

The causes of chest pain localized to the right are very similar to those localized to the left. Of course, when stinging on the right side of the chest, the heart is less of the cause. Otherwise, however, many causes are possible: irritation of an intercostal nerve or tension in the back muscles on the right side, “pinched nerve” on the right side, pneumonia or pleurisy. Other possible causes are a collapsed lung (pneumothorax) on the right side, a pulmonary embolism, swallowing disorders, etc.

Do you suffer from right-sided chest pain? Find out the causes below Right Chest Pain - These Are the Causes! or stinging in the right chest

Breathing condition

When inhaling

As you breathe in, the chest rises and its girth increases as the ribs move forward to allow air to enter the lungs. Many different muscles are active when you breathe in: the diaphragm, the intercostal muscles, the chest muscles and some of the shoulder and back muscles. If these muscles are tense or if a nerve that supplies these muscles with information from the brain is irritated, then the chest stinging occurs when you inhale. Typically, a stinging in the chest when you inhale also occurs in pneumothorax (lung collapse), in which the lungs have collapsed due to a leak between the lung tissue and pleura. In pleurisy, too, the stinging is more likely to occur when you inhale, because when you inhale the pleura is stretched by the unfolding of the chest. In the case of functional heart problems caused by excessive stress and excessive demands, a stinging in the chest is also common when inhaling.

On exhaling

If the stinging occurs in the chest, especially when exhaling, this can be triggered by the muscles involved in breathing (see above).Even irritated or “pinched” nerves can trigger a stinging sensation when you exhale, because they are additionally irritated by the movement of the chest. Tension in the back muscles or vertebral body blockages can also be responsible for a sharp pain when exhaling, as they are moved and displaced against each other by exhaling. If the stinging in the chest when exhaling is combined with attacks of breathlessness, tightness in the chest and a whistling sound, an asthma attack could be responsible for the stinging when exhaling.

The diagnosis of stinging in the chest

The symptom "stinging in the chest" can be caused by many different diseases. To make a good diagnosis, the treating physician must first ask questions about the exact nature of the pain, its severity, and how long it has progressed. A physical exam follows to see if the pain is e.g. is triggered depending on the movement. Possible further examinations are, depending on the doctor's suspicion, an EKG, a laboratory examination, an ultrasound examination or imaging using CT or MRI. Not all of these examinations are always useful, so different methods can be selected depending on the type of pain described.

Concomitant symptoms

Depending on the accompanying symptoms with the stinging in the chest, other diseases can be the cause of the symptoms. Here are a few examples.

Heart stumbling, cardiac arrhythmias: Indication of a heart disease
Fever: Occurs with pericardial inflammation, pleurisy, pneumonia or simple colds along with a stinging in the chest.
Shortness of breath: In the event of a heart attack, asthma, pulmonary embolism, pneumonia or pneumothorax
Circulatory problems, dizziness: With high blood pressure, with a pulmonary embolism, with myocardial infarction, with aortic dissection (splitting of the wall layers of the main artery, with pneumothorax (lung collapse)
Back pain: With tension, hardening of the muscles, with "pinched" nerves.
Heartburn, difficulty swallowing: For diseases of the esophagus
Feeling of fullness: In diseases of the stomach, e.g. a hernia (part of the stomach is in the chest)

Read more on the subject at: Heart attack

Pulmonary embolism

Aortic dissection

Back pain

Back pain is a common symptom of sharp pain in the chest. Many people suffer from too little exercise and an incorrect sitting posture, e.g. During their professional work in the office, with tension in the back muscles or so-called vertebral body blockages. As a result of this tension, nerves are stimulated either at their exit points from the spine or during their course to the muscles they supply. These nerve irritations then become noticeable as a short stinging in the chest, usually at rest or during other movements.

You can find out what you can do against back pain in our article: Back pain- what can you do?

dizziness

Stinging in the chest, which occurs at the same time as feeling dizzy, can be explained by psychological causes or diseases that affect the cardiovascular system. The psychological causes include a panic attack, stress and excessive demands. If these anxiety states occur more often, one speaks of a panic disorder. High blood pressure can cause stinging in the chest and dizziness, as can a (small) pulmonary embolism. Another possible cause is e.g. a heart attack, which in most cases would cause other symptoms.

Shortness of breath / shortness of breath

Stinging in the chest, which occurs with shortness of breath or difficulty breathing, may indicate lung disease. Possible causes are: pneumothorax (lung collapse), pulmonary embolism, pneumonia, or asthma. The heart can also be responsible for a stinging sensation in the chest combined with shortness of breath. Angina pectoris (heart attack), heart attack or aortic dissection are conceivable here. Psychological causes, e.g. Stress or a panic attack can cause stinging in the chest and shortness of breath at the same time.

Treatment / therapy

Treatment and therapy for stinging in the chest depend on the cause:

Heart: A heart attack is treated by reopening the closed vessel by inserting a stent (stent) or by trying to dissolve the clot with medication. Patients then have to take medication for life to reduce the likelihood of having another heart attack. Pericarditis is treated with antibiotics, anti-inflammatory drugs, or cortisone, depending on the cause.
Vessels: An aortic dissection must be operated on as an emergency.
High blood pressure: When a high blood pressure crisis occurs, drugs are given to lower blood pressure.
Lungs: Pulmonary embolism is treated by removing the clot, either with surgery or with medication. Pneumothorax is treated by inserting a chest tube (a tube between the lung tissue and the chest wall to let the air out).
Esophagus: Heartburn can be relieved by giving drugs that reduce acid production. Tears in the mucous membrane of the esophagus are treated endoscopically (principle of gastroscopy).

Also read our article: Chest drain

Implantation of a stent after a heart attack

The duration / prognosis of a stitch in the chest

The prognosis for stinging in the chest varies depending on the underlying condition. Stinging in the chest due to a heart attack occurs for several minutes and causes severe pain, the prognosis after a heart attack always includes the risk of having another heart attack. If the stinging in the chest is triggered by an incorrect posture, it usually only occurs briefly, but several times a day. The prognosis is good if the tension is countered with exercise and the right posture.

Course of the disease when stabbing in the chest

The course of stinging in the chest varies depending on the cause. In diseases that can be traced back to the heart, lungs and esophagus, the course of the disease is often chronic. Even if the stinging in the chest stops (e.g. after a heart attack), the patient will still have heart disease for a lifetime and will require drug therapy. More acute illnesses that cause a stinging sensation in the chest have a shorter disease course. Pneumothorax is usually healed after a few days, pneumonia after about two weeks.

How contagious is that?

Stinging in the chest is not contagious because the diseases that cause a stinging in the chest are not transmitted by contagious pathogens. Stinging in the chest is usually caused by problems that affect the heart, cardiovascular system, lungs or esophagus and are not contagious. Pneumonia or infection with the Coxsackie B virus (can cause Bornholm disease, see above) are contagious. Since these diseases can (but do not have to) trigger stinging in the chest, a stinging in the chest is maximally indirectly contagious.

Stinging in the nipple

In nursing mothers, injury to the nipple from sucking the baby is the most likely cause of the nipple stinging. Not only does this stinging need to occur during breastfeeding if it is caused by an injured nipple, but it can also occur during a pause in breastfeeding. Another possibility is nipple inflammation, which can also occur in non-breastfeeding women. Some women are very sensitive to the cold and sometimes have a stinging nipple stinging when they are cold. Unfortunately, a stinging nipple can also indicate breast cancer. If the stinging continues there for a long time, blood or wound secretion flows from the nipple or if a hardening can be felt in the breast: You should definitely see a gynecologist!

Read more at: Pain in the nipple

Stinging in the chest while breastfeeding

There are several causes of breast stinging while breastfeeding. A strained posture, e.g. If the baby is bent too much forwards or if the baby is held tight, the back muscles may become tense. On the one hand this leads to back pain, on the other hand it can irritate the nerves that supply the muscles of the chest and chest. This irritation may manifest as a stinging sensation. Another possibility is incorrect system technology and / or incorrect suckling behavior of the baby. If necessary, you should seek help from a midwife or lactation consultant (or an experienced mother) and have the application checked. A thrush infection (infection with the yeast Candida) of the mammary glands is also conceivable, which causes the sharp pain. The mother and child must then both be treated with antifungal agents. A thrush infection can occur on one or both sides. Inflammation of the mammary glands or the milk ducts is also possible in breastfeeding mothers, which can cause an unpleasant stinging. Perhaps the nipples have also been injured from breastfeeding and strong sucking on the child. If there are long-term problems with breastfeeding or chest pain, a visit to a gynecologist is advisable to find the cause and treat it.

Read more at: Painful breastfeeding

Problems during breastfeeding in the mother

Stinging in the chest during pregnancy

Many women complain of breast tenderness during pregnancy, especially at the beginning. The simple explanation is the hormonal remodeling processes in the body by the hormone prolactin, which cause the mammary glands and milk ducts to grow. Pulmonary embolism is a more serious condition that causes stinging in the chest during pregnancy. During pregnancy, the risk of developing blood clots is increased, so pulmonary embolisms are also more common than in non-pregnant women. Typically, the stinging in the chest is then dependent on breathing, and there may also be shortness of breath.

You can find more on the subject at: Breast pain in pregnancy

Pulling in the chest during pregnancy

Stinging in the chest when coughing

If the chest stinging when you cough, it may be caused by a cold or the flu. Especially when there are other symptoms such as fever, runny nose and malaise. Otherwise, a stinging stinging in the chest when coughing also occurs with pneumonia, esophagitis or pneumothorax (collapsed lung).

Also read our article: Therapy for a cold

Stinging in the chest while drinking

Sharp chest pains can occur if the drink is either too hot or too cold, if you drink too quickly, or if you choke while drinking and some of the liquid mistakenly gets into your windpipe. If the chest stinging occurs more frequently when drinking, this may be an indication of a disease of the esophagus, e.g. a swallowing disorder, inflammation of the esophagus, a hernia at the junction of the stomach, or a tumor that narrows the esophagus and causes pain.