Pain behind the sternum

Introduction

Pain behind the sternum (retrosternal pain) can have various causes. By definition, these are chest pains that lie more or less directly behind the breastbone (sternum) and can have different characteristics. In principle, organs that are located in close proximity to each other are most likely to be affected.

These are the esophagus with the stomach underneath, the heart and the lungs. However, it is not uncommon for superficial events to cause pain in the chest area and possibly even behind the sternum. For example, an inflammation of the lung pleura can be very painful, but the ribs and the nerves and muscles in between can also cause similar complaints under certain circumstances.

Causes and associated symptoms

One of the most common clinical pictures with burning pain behind the breastbone is probably reflux disease (reflux esophagitis). Here gastric acid enters the esophagus and causes an inflammation, which is usually felt by those affected as an acidic belching or burning behind the breastbone. This symptomatology is intensified directly after eating or even while lying down.

Inflammation of the stomach mucosa (gastritis) is also relatively common. The cause of this can be very different, but the symptoms are common to all. Mostly pain in the upper abdomen is in the foreground, but it can also have a different location and may also be located around the navel or behind the breastbone.

Heart diseases that can cause pain behind the breastbone include angina pectoris in connection with coronary heart disease. The already damaged vessels around the heart have lost their elasticity and are constricted, which is why they can no longer carry enough blood, especially during exertion. Those affected then experience this phenomenon as a seizure-like chest tightness.

Those affected sometimes describe this as a stabbing pain, but often as discomfort behind the breastbone. The symptoms can range from pain, pressure on the chest to burning or heaviness. Often there is also a radiance in the arms, back or even in the jaw.

In the case of an acute heart attack, those affected also feel a 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 persons are usually scared to death, cold sweaty, pale and they mostly feel nausea and even vomiting. Accompanying shortness of breath is also typical for this clinical picture. It is important that the pain cannot be influenced by breathing or movement.

If it is, this is more likely to speak against an acute heart attack. Diseases of the lungs can also be accompanied by pain behind the breastbone. Examples of this are acute pulmonary embolism or pneumothorax.

However, both clinical pictures have in common the shortness of breath, which is usually also the main symptom. This is often accompanied by coughing and chest pain, which is usually dependent on breathing. Pleuritis, i.e. inflammation of the lung membrane, is the leading symptom and causes very severe, strictly breath-dependent pain.

Whenever the lungs move in relation to the chest wall, chest pain occurs. Depending on the location of the inflammation, the pain can also be located behind the breastbone. In addition, patients usually have a fever and a general feeling of illness.

A long lasting pain in the chest area with pain peaks is more indicative of an intercostal neuralgia, a clinical picture that is located in the intercostal spaces. Mostly the pain is also rather belt-shaped and increases with movement or tension. Last but not least, pain behind the sternum can also be caused by degenerative changes in the thoracic spine.

These can be changes in the intervertebral discs, the vertebral bodies themselves or the ligamentous apparatus. To simplify matters, this is summarized as thoracic spine syndrome (BWS syndrome). In most cases, mobility is restricted and leads to pain that can radiate in different directions in the chest area. Breathing can also usually increase the pain.