General information
Chest pain (chest pain) is a common symptom that can have numerous causes. These range from harmless muscle diseases, through diseases of the gastrointestinal tract and life-threatening heart attacks. Due to the diversity of the diseases, the diagnosis and correct therapy is often difficult. This could also be interesting for you: pain when breathing, stabbing in the chest when breathing
Causes and symptoms
Numerous diseases can be the reason for the leading symptom “chest pain” or pulling in the chest. The different diseases often have a special pain character, which makes the diagnosis somewhat easier. Symptoms of a heart attackHeart and vessel diseases: Some heart and vascular diseases can cause chest pain.
These usually belong to the life-threatening diseases and must always be taken seriously. Angina pectoris or heart attack is often described as a feeling of tightness or pressure behind the breastbone. The pain often radiates into the neck, lower jaw and left arm.
Pain triggers are usually physical or mental stress, which leads to an increase in heart rate. Due to the fast heartbeat, the heart muscle is no longer supplied with sufficient blood because the coronary arteries are narrowed by arteriosclerosis. In the event of a real heart attack, the heart muscle no longer recovers on its own, but must be treated by a heart catheter and intervention.
One speaks of stable angina pectoris when the pain subsides after a short time and rest with the help of medication. Acute, breath-dependent pain can also occur in the event of a pulmonary embolism. This is particularly the case when a larger vessel in the lung is suddenly blocked by a blood clot.
Coughing and shortness of breath also occur. Typically, a pulmonary embolism is caused by a severe cough or pressing on the toilet. Inflammation of the pleura can also cause massive chest pain.
Another vascular disease that causes chest pain is aortic dissection. This is a sudden rupture of the aorta. This tear can cause a real hole in the aorta, or it can occur only in the first layer of the wall layers of the aorta.
In this case, the blood does not flow into the free chest cavity, but forms a bulge in the aorta. However, this bulge can tear at any time and lead to massive blood loss. Such a tear is accompanied by severe chest pain that radiates into the back, abdomen and legs.
If the vessel wall tears completely, the patient bleeds to death within a very short time. Only a quick operation and closure of the vessel can possibly be life-saving. Pericardium and pleura: Inflammation of the pleura (pleuritis) can result from a lung infection.
The germs spread beyond the lungs to the pleura. Inflammation of the pleura is very unpleasant and leads to breath-dependent, stabbing pain and coughing. The pain increases with deep breathing or coughing.
As a result, the patient is usually very short of breath and no longer fully ventilates his lungs. This leads to a delayed healing of the lung. The duration of such pleurisy depends strongly on the severity of the disease.
Therefore, the therapy consists of antibiotic therapy of the inflammation and sufficient pain therapy to prevent breathing. A pneumothorax is a tear in the pleura which leads to a collapse of the lung. Due to the tear, the pressure in the chest changes and the lung on the affected side collapses.
There are two types of peumothorax. In a tension pneumothorax, a wall layer of the pleura lies over the tear. This leads to a constant inflow of air into the chest, but the air can no longer leave the chest.
Acute severe pain and shortness of breath occur. If the pneumothorax is not relieved early, the heart and adjacent vessels are displaced by the air. The patient becomes unconscious and may die.
A pneumothorax that still allows air to escape to the outside also causes severe pain and shortness of breath. However, the vessels are not displaced and the other lung can initially compensate sufficiently for the gas exchange. The cause of a pneumothorax is often an accident.
Pericarditis also leads to stabbing pain in the chest.Due to the position of the heart in the body, the pain increases when lying down and when lying on the left side. In a sitting and right-side position, the pain decreases in intensity. In most cases, viruses are the cause of pericarditis, usually following an infection.
In the case of a crisis-like rise in blood pressure (hypertensive crisis), severe chest pain and pressure behind the sternum can suddenly occur. However, the symptoms of the above-mentioned clinical pictures do not always have to be accompanied by severe pain, but can also become noticeable, especially in older people, by a feeling of pressure, a pulling in the left breast or a stabbing in the chest area. Therefore, the therapy consists of antibiotic therapy of the inflammation and sufficient pain therapy to prevent breathing.
A pneumothorax is a tear in the pleura which leads to a collapse of the lung. Due to the tear, the pressure in the chest changes and the lung on the affected side collapses. There are two types of peumothorax.
In a tension pneumothorax, a wall layer of the pleura lies over the tear. This leads to a constant inflow of air into the chest, but the air can no longer leave the chest. Acute severe pain and shortness of breath occur.
If the pneumothorax is not relieved early, the heart and adjacent vessels are displaced by the air. The patient becomes unconscious and may die. A pneumothorax that still allows air to escape to the outside also causes severe pain and shortness of breath.
However, the vessels are not displaced and the other lung can initially compensate sufficiently for the gas exchange. The cause of a pneumothorax is often an accident. Pericarditis also leads to stabbing pain in the chest.
Due to the position of the heart in the body, the pain increases when lying down and when lying on the left side. In a sitting and right-side position, the pain decreases in intensity. In most cases, viruses are the cause of pericarditis, usually following an infection.
In the case of a crisis-like rise in blood pressure (hypertensive crisis), severe chest pain and pressure behind the sternum can suddenly occur. However, the symptoms of the above-mentioned clinical pictures do not always have to be accompanied by severe pain, but can also become noticeable, especially in older people, by a feeling of pressure, a pulling in the left breast or a stabbing in the chest area. Gastrointestinal tract: An inflammation of the esophagus due to the backflow of acid gastric juice (reflux) is a very common disease.
The pain occurs in the neck and in the area of the breastbone. Sometimes the symptoms are difficult to separate from heart disease. When lying down and after eating, the pain is often strongest and can be accompanied by heartburn.
Since chronic esophagitis can cause changes in the epithelium and the development of esophageal cancer, diagnostics and therapy are essential. If the esophagus is damaged in advance, high pressure, for example when vomiting, can cause the esophagus to tear. This disease is very rare and is accompanied by sudden onset of severe chest pain.
Muscles, nerves and bones: The most common cause of chest pain is muscle tension and changes in the spine. The pain is motion-dependent. In addition, the numerous small nerves under the ribs can become inflamed (intercostal neuralgia) and cause pain individually.
In contrast to muscle pain, nerve pain is not dull, but rather electrifying and burning. This pain typically also occurs with shingles. This is an infection of certain nerve tracts by the herpes zoster.
If a nerve supply area in the chest area is affected, belt-shaped, burning pain occurs there. The disease can lead to secondary damage and paralysis. For this reason, a quick therapy with antivirals is necessary.
A rare disease is the Tietze syndrome. This is a disease of the rib cartilage at the base of the sternum. It is accompanied by pain and swelling in the area of the front thorax.
The pain is motion-dependent and can be triggered by pressure, which distinguishes it from angina pectoris. The exact cause is still unclear, but the disease is attributed to inflammation.Bekhterev’s disease is a progressive stiffening of the spine, which leads to deep-seated pain. It occurs mainly at night and is particularly pronounced in the thoracic and lumbar spine.
The disease is progressive and cannot be cured. For this reason regular physiotherapy is necessary. Psychology: Chest pain can also be triggered psychologically.
This is especially true in stressful situations. Usually the pain is preceded by acute shortness of breath and a significantly increased heart rate (tachycardia). By resting and calming down, the pain and other symptoms usually subside quickly.
For an exact diagnosis of chest pain, numerous examinations must often be carried out. Often an exact anamnesis with as detailed a description of the pain character as possible is groundbreaking for further examinations. If a cardiac or vascular disease is suspected, a cardiac catheterization must be performed for clarification.
An aneurysm can be visualized by means of computer tomography. Echocardiography can also provide indications of heart disease. Causes in the gastrointestinal tract can be identified by gastroscopy.
An irritated esophagus is noticeable in the endoscope. Muscular or neurological causes can be identified by a physical examination. Bony changes can be visualized by means of an X-ray. A laboratory chemical examination is usually necessary. It can provide indications of inflammation, a heart attack or an infection.
