Chest pain due to chest organs

It is obvious that organs located in the area of the chest or ribcage can also cause chest discomfort due to disease. For this reason, this assumption should first be made if a patient complains of chest pain or pulling in the chest. Diseases of the heart can trigger chest pain.

First of all, angina pectoris or coronary heart disease (CHD) should be mentioned here, which can cause such symptoms. With corresponding concomitant diseases, such as high blood pressure, increased cholesterol in the blood, lack of exercise and obesity, the vessels that supply the heart with oxygen-rich blood can become blocked. This is also known as atherosclerotic changes in the heart vessels.

If these vessels become narrow, not enough oxygen-rich blood can reach the heart muscle. In this case, the patient experiences chest pain, which he/she describes as pulling or cutting, possibly radiating into the left arm. If an area of the corresponding artery is still continuous, the patient will presumably not feel any discomfort at rest, but only during exertion.

This is known as stable angina pectoris, which must be examined. If the vessels close up almost completely, the patient will have complaints even at rest (unstable angina pectoris). This represents an absolute emergency, as a life-threatening infarction may result in the foreseeable future.

The symptoms of unstable angina pectoris are usually more severe and require immediate treatment (first with glycerine strokes under the tongue). Angina pectoris is diagnosed less by its painful character than by the time of occurrence. This is because chest pain of any kind, which occurs mainly during physical exertion, is a strong indicator of this clinical picture.

Also, often only a feeling of pressure on the chest of the patient with heart disease is described. Under strong to severe chest pain, a patient with an acute heart attack complains. In this condition, the above-mentioned vasoconstriction is completely closed.

Parts of the heart muscle can no longer be supplied with sufficient oxygen-rich blood and die. The pain is described as life-threatening. Patients usually state that they have never had such pain in their lives.

The pain is usually associated with restlessness, sweating, trembling and possibly shortness of breath. Patients reach for the chest area. The pain caused by a heart attack can also radiate into the left arm, lower jaw and upper abdomen.

Nausea, which is statistically more common in heart attacks in women than in men, is also sometimes described. Pain that pulls, bites, cuts, straddles the chest and extends to other regions is characteristic of an acute heart attack, which is a life-threatening situation and requires immediate emergency treatment. The pain is not dependent on positioning and breathing and is permanent.

Mild symptoms that do not correspond to the full picture of a heart attack do not rule out a heart attack, however, and must also be controlled. Severe chest pain, which is also described as cutting or biting and is dependent on breathing, could have been triggered by a pulmonary embolism. In this case, small particles of coagulated blood block a vascular path supplying the lungs.

Pulmonary embolism is a life-threatening infarction of the lung, which in many cases is fatal despite immediate treatment. Patients complain of breath-dependent, severe pain in the lung area and sometimes massive shortness of breath and coughing. Sometimes, however, the pulmonary embolism can only become noticeable by a pull in the left chest.

Often the symptoms occur for the first time after physical exertion or during going to the toilet (strong pressing). Blood particles may also be mixed with the cough, but this is not mandatory. As a rule, the pain caused by a pulmonary embolism does not have the distribution pattern of radiating into the jaw or left arm.

Here, too, the accompanying circumstances are often decisive in diagnosing pulmonary embolism. Patients who have spent a long time in hospital with little movement are always at high risk of developing pulmonary embolism. Severe to severe chest pain, which suddenly occurs, could also be caused by a so-called aortic dissection.

This is a tear in the main artery (aorta), which runs in an arc from the heart to the abdomen. If a layer of the artery tears and bleeding into the vessel occurs, this is called aortic dissection. This usually triggers this severe pain after physical activity, such as lifting heavy objects.

Often the pain radiates into the back, which must lead to the assumption of an aortic dissection. If there is a complete tear or rupture of the aorta, it is a life-threatening situation that must be treated immediately by surgery. Patients with high blood pressure and family history are particularly at risk for aortic dissection.

In most cases, however, this vascular disease is not diagnosed until the patients go to hospital with the symptoms. If one of the heart valves is narrowed (see aortic valve stenosis) or the mitral valve is thrown up (mitral valve prolapse), the patient may also experience angina pectinous complaints with a feeling of pressure on the thorax. In the case of aortic valve narrowing, the symptoms usually occur at rest and then become progressively worse.

In the case of a mitral valve prolapse, the complaints occur under stress. Chest pain can also be triggered by inflammation of the pericardium (pericarditis). The patient mainly feels stabbing pain.

This pain can be intensified when the patient is lying down or lying on his left side. If the patient sits up or turns to the right, the pain usually improves. To make a diagnosis, the accompanying symptoms of pericarditis must also be taken into account.

Most patients also complain of high fever. Stabbing chest pain can also be caused by a so-called pneumothorax. The lung is suspended by the pleura on the ribcage.

There is a gap between the lung and the pleura, which is held together by a fluid and negative pressure. In the event of a mechanical tear, fluid escapes from the gap, the negative pressure is lost and the lung purrs together on one side, which causes the stabbing chest pain in addition to sudden respiratory distress and a massive drop in performance. If the constricted lung displaces the chest organs in the opposite direction, a life-threatening situation arises which must be treated surgically as soon as possible (tension pneumothorax).

A pneumothorax can occur mainly after mechanical events (e.g. blunt injuries after a car accident or after a severe cough in young people). Unadjusted high blood pressure can also lead to chest pain. This is a so-called hypertensive crisis, which causes pain, especially behind the breastbone, occurs suddenly and can also cause a feeling of tightness.

Chest pain can also be caused by numerous diseases of the lungs, such as pneumonia, bronchitis and lung tumours. In contrast to tumorous diseases of the lung, chest pain in inflammatory diseases of the respiratory tract tends to fluctuate and is cough-dependent. Chest pain triggered by a tumour is usually caused by a suppressive or ingrowing process.

Diseases of the oesophagus can also trigger chest pain. A tear in the oesophagus (Mallory Weiss syndrome), which occurs mainly in alcoholic patients and patients who vomit frequently, can cause tearing, pulling and stabbing chest pain. A feeling of pressure or breath-dependent discomfort, or a pulling into the left arm is unlikely to occur.

A tear in the oesophagus is often associated with bloody vomiting, which is absent in other chest pain-causing diseases. A movement disorder of the oesophagus (achalasia) can also trigger cramp-like chest pain when eating. In this case, complaints have also been described as in the case of angina pectoris.