Introduction
Chest pain is an increasingly common problem in today’s western society and has many causes. Since most people now perform sedentary activities, they tend to have a comfortable but not anatomically correct back and spine posture. As a result, spinal malpositions, spondylolisthesis or extremely hardened muscles in the neck and back area occur more and more frequently. All of these factors can lead to nerves emerging from the spinal cord being compressed or literally trapped. The consequences can be malaise, loss of strength, but often also chest pain, which can then often be assigned to a specific area, so-called dermatome-related pain.
Causes
As a rule, nerve-related chest pain is caused by a pinched or otherwise “irritated” nerve. Since nerves are used to control the muscles, but also to transmit sensations from the skin or extremities back to the brain, an irritated nerve can transmit false information. The compression of the nerve causes excitation, which is then transmitted from the nerve to the brain.
Thus, the brain is shown a pain in the thorax, which actually originates in the course of the nerve. Depending on the movement of the body or the spine, the compression on the nerves is increased or decreased. Very severe pain in the chest or pulling in the chest can be triggered by a so-called intercostal neuralgia.
This is an irritation of the nerve tracts which supplies the skin and the muscles between the ribs. The cause is unknown, it is suspected that it is caused by mechanical overstrain, such as stretching or pulled muscles. However, the symptoms usually appear a little later, so that the patient cannot make a connection to a pulling event.
Some of the affected persons report very strong pain, which they have never had before. The first suspicion often falls immediately on a heart attack. Burning, stabbing, jerky pains on the chest and on the side of the chest wall are described.
The most decisive difference to a heart attack is the movement-related pain. Pain can be relieved by changing the position of the patient. This is not possible in the case of a heart attack.
Nor do patients with intercostal neuralgia complain of shortness of breath and pressure on the chest. Otherwise, the clinical picture is very similar to that of a heart attack (outbreak of sweat, restlessness, anxiety). Furthermore, there is of course the possibility of a rib contusion or even rib fracture.
A so-called Tietze syndrome can also cause severe chest pain. This term refers to an inflammatory process in the cartilage between the ribs and the sternum. Here, too, the similarities of a heart attack are present, but here, too, pain can be provoked depending on movement.
A further distinguishing feature is the fact that in Tietze’s syndrome pain can also be exerted by applying pressure to the corresponding area of the sternum. The so-called pleurisy (inflammation of the pleura), which is usually caused by an infection, can also cause severe chest pain. Characteristic are stabbing, often very strong but breath-dependent pain, which can already rule out a heart attack. The duration of pleurisy can be very variable. As a differential diagnosis, however, pulmonary embolism, which also causes similar symptoms, should definitely be considered.
