Brief overview
- Causes: Heartburn (reflux disease), tension, muscle ache, vertebral blockage, rib contusion, rib fracture, shingles, angina pectoris, heart attack, pericarditis, high blood pressure, pneumonia, pulmonary embolism, lung cancer, esophageal rupture, psychological causes like anxiety or stress
- When to see a doctor? In case of newly occurring or changing pain, shortness of breath, feeling of pressure, anxiety, general feeling of illness, fever and drowsiness.
- Diagnostics: patient interview, physical examination, electrocardiogram, X-ray, ultrasound, gastroscopy, bronchoscopy, endoscopy
Chest pain: description
The ribs protect these delicate organs from external impact and their muscles allow the thorax to expand during inspiration. The muscular diaphragm delimits the chest cavity downward and is also considered an important respiratory muscle.
Sudden pain such as a pulling, burning or stinging sensation in this area often has a harmless cause, for example, muscle tension, or muscle strain.
It is not always easy, even for an experienced physician, to find the source of the discomfort, since everyone perceives and communicates pain differently. For example, a twinge in the left breast may be quickly dismissed as a rib blockage, while in reality a heart attack is behind the discomfort.
This article mainly deals with pain and its causes inside the chest. Pain in the area of the breast tissue occurs mainly in women (mastodynia), more rarely in men. Read more about breast pain here.
What are the causes of chest pain?
Depending on the underlying disease, the pain manifests itself in different parts of the thorax.
For the purpose of describing the causes, the thorax has been divided for simplicity into “behind the sternum”, the ribs, and on the left or right side of the chest. In this way, the causes in the different regions can be narrowed down somewhat. In addition, diseases are described which cannot be clearly assigned to any of the above-mentioned localizations.
It is therefore possible that certain causes can be assigned to several localizations. For example, many patients with myocardial infarction complain of pain behind the sternum, others mainly of discomfort in the left half of the chest. Therefore, please consider the localizations only as a rough guide.
Pain behind the sternum
Heart pain (angina pectoris): A temporary circulatory disorder of the heart muscle is called angina pectoris (“chest tightness”). The most common cause is narrowed coronary arteries, for example in coronary heart disease (CHD). These are no longer able to supply the heart with enough blood, especially during physical exertion.
Since they can hardly be distinguished from a heart attack and it is a possibly life-threatening emergency, it is absolutely advisable to call the emergency doctor! The immediate measure against the symptoms is the inhalation of nitroglycerin by means of a pump spray.
Typical symptoms are sudden, severe, often stabbing pain in the chest, usually behind the breastbone or in the left chest. This is accompanied by a feeling of tightness and shortness of breath. The pain often radiates to the left shoulder, upper abdomen, back, neck, and lower jaw. Sweating, nausea and fear of death accompany the often crushing pain.
The discomfort persists regardless of breathing or pressure on the chest.
In general, compared to angina pectoris, the symptoms of a heart attack last for at least twenty minutes. They do not subside even when medication to dilate the heart vessels (nitro spray) is administered. Call 911 immediately if you suspect a heart attack!
Other causes of retrosternal pain that require immediate medical or emergency medical attention are:
- Esophageal rupture: As a consequence of an existing reflux disease or a pre-damaged esophagus, a rupture of the organ occurs in rare cases when strong pressure is applied (for example, during vomiting). This triggers a violent stabbing in the chest, also bloody vomiting, shortness of breath, sometimes shock, later fever and sepsis.
- Diaphragmatic hernia: This refers to a gap in the diaphragm. When the stomach partially or completely slips up through this gap into the chest, it causes severe chest pain.
- Roemheld’s syndrome: This is when gas builds up in the abdomen, pushing the diaphragm upward, causing heart discomfort, often manifested by a twinge in the left chest and heart, heart palpitations, shortness of breath, and a feeling of pressure.
- High blood pressure (hypertension): Blood pressure peaks of up to 230 millimeters of mercury (mmHg) may cause symptoms similar to angina: Shortness of breath and pain in the sternum, sometimes heart pain.
The following causes of retrosternal pain are not immediately life-threatening, but may also require treatment by a physician or specialist:
- Mitral valve prolapse: In this heart valve defect, the heart valve between the left atrium and left ventricle (mitral valve) is bulging. This sometimes causes chest pain in those affected. Only rarely does a mitral valve prolapse result in noticeable health complaints, but a medical examination is nevertheless advisable.
Pain in the left chest
Sometimes pain is most likely to be felt on one side of the left side of the chest. In most cases, the causes are not life-threatening, for example, muscle strains, muscle pulls or pain caused by nerves.
However, injuries and lung diseases that may require medical attention also sometimes occur on the left side.
Other organs that may cause pain in the left chest or from which pain radiates to it are the stomach and spleen:
- Gastritis: In gastritis, there is pain in the upper abdomen, which in some cases radiates to the chest (usually the left).
Right chest pain
Chest pain, which can also be located on the right side, is often caused by muscle tension, nerve irritation, injury or lung disease. However, they do not occur only on the right side, but may also occur on the left or both sides.
In some cases, the pain worsens with breathing or movement.
Other organs responsible for right chest pain in rare cases include:
- Gallbladder: Problems of the gallbladder (for example inflammation, infection or gallstones) also lead in some cases to pain in the upper abdomen, which may move to the right side of the chest or to the shoulder (for example in biliary colic).
Pain in the region of the ribs
For the following causes, chest pain is most likely to originate in the rib area. Again, the pain occurs on one or both sides, depending on where the cause is located:
- Vertebral Blockages: These restrictions on movement of the spine often occur suddenly and irritate nerves and muscles between the ribs. Especially in the area of the thoracic spine, such blockages lead to complaints similar to angina pectoris.
- Tietze syndrome: This very rare disorder causes swelling of the rib cartilage in the sternum area. Affected patients report rib as well as sternal pain.
Other localizations
Sometimes pain is felt in other areas or in areas that are difficult to localize. In some cases, it is not possible to assign the pain to one side, because it may occur on the left or right side or on both sides depending on the situation:
- Pneumonia: Typical signs of pneumonia are coughing, stinging in the chest and chest pain, strained breathing, high fever and sputum. The symptoms are expressed on one or both sides.
- Lung cancer: Malignant tumor diseases of the lung are often accompanied by steadily increasing chest pain, cough, shortness of breath, hoarseness as well as bloody sputum.
- Tension and soreness: Tension of muscles, soreness and pain in the upper back often radiate into the chest. They cause motion-dependent, usually mild, sometimes pulling pain in the chest. These complaints are possible in all areas of the chest and are the most common cause of chest pain.
- Shingles (herpes zoster): The varicella viruses (in children the trigger of chickenpox, in adults the disease manifests itself in the form of shingles) spread in the supply area of a nerve branch. One half of the chest is often affected. A belt-shaped skin rash and electrifying, burning pain in the chest are the result.
- Pneumothorax: If the pleura is ruptured, air enters the gap between the lung and the pleura, causing the lung to collapse. Sudden shortness of breath, stabbing pain in the chest (left or right), coughing and a feeling of suffocation are common consequences. A pneumothorax usually results from external injury. Call the emergency physician immediately!
Chest pain: treatment
Chest pain is often triggered by serious, sometimes sudden and possibly life-threatening conditions. Basically, treatment depends on the underlying disease.
Treatment by the physician
In life-threatening conditions, the physician immediately initiates various treatment measures:
- Vertebral blockages can be released with the aid of certain hand movements.
- Under certain circumstances, infusions, oxygen administration or other measures are necessary to stabilize the patient.
- In some cases, early surgery is indicated, for example in the case of a heart attack or ruptured lung.
In less acute cases, the physician treats according to the respective cause:
- Various antiviral drugs and painkillers are used for herpes zoster (shingles).
- Uncomplicated rib fractures or bruises can be treated well with painkillers.
What you can do yourself
For less serious causes of pain, you have the following options for treating your symptoms yourself with simple remedies or for supporting the appropriate treatment:
- Heartburn: Avoid heavy meals (especially before bedtime) and avoid acid-forming substances such as nicotine and alcohol, as well as spicy foods.
- Shingles: Drug treatment can be supported with bed rest. This makes chest pain more bearable in many cases.
Chest pain: When to see a doctor?
Ideally, you should also have a general feeling of illness, fever or even dizziness in connection with chest pain clarified by a doctor.
You must act immediately if you notice any signs of an acute heart attack: severe, often radiating pain in the left chest, shortness of breath, dizziness, weakness, blue lips. Call the emergency doctor immediately!
Chest pain: examinations and diagnosis
During the initial consultation with the patient, the physician obtains important information about the patient’s medical history (anamnesis). Among other things, he asks for a precise description of the quality of the pain, its duration and its occurrence. Possible questions include:
- Can the chest pain be localized precisely or does it seem to be of undetermined origin?
- Does the chest pain occur repeatedly at a certain time or with a certain posture, activity or movement?
- Does the chest pain get worse as it progresses?
- Does the chest pain get worse when you breathe?
Examinations
- Electrocardiography (ECG): Measuring the electrical activity of the heart is essential to detect heart disease. Typical changes in the heart curve indicate, for example, a heart attack or angina pectoris.
- X-ray of the chest (X-ray thorax): With the help of an X-ray, it is possible for the doctor to detect many changes in the lungs and skeleton.
- Gastroscopy: A gastroscopy reveals abnormal changes in the esophagus and stomach, if necessary.
- Pulmonary endoscopy (bronchoscopy): A bronchoscopy is used to visualize lung disease.
- Mediastinoscopy: Rarely, an endoscope is used to examine the mediastinal cavity.
