Psychosomatic pain

Chest pain is associated with psychological stress. In stressful situations, the air is often held in a reflective manner or at least breathing is reduced. Frequent exertion can also lead to increased tension in the thorax area, which can trigger the pain.

Heart phobias also play a major role in chest pain. Many people suffer from great fear of having heart diseases that are not present. The medical profession refers to this as heart phobia.

Ankylosing spondylitis

Bekhterev’s disease is a chronic inflammatory disease with pain and stiffening of spinal joints. During the course of the disease, typical changes in the spine occur, whereby the backward curvature of the thoracic spine is intensified, which can lead to pain in the area of the ribcage.

Tietze Syndrome

Tietze syndrome is a rare disease with unknown cause. The pain is rather punctual at the cartilaginous transition between the sternum and the first to fourth ribs or the tip of the sternum. There are no signs of inflammation and the disease heals within months. A Tietze syndrome only needs to be treated if there is a corresponding level of suffering. In most cases, anti-inflammatory drugs from the NSAID group are sufficient.

Diagnostics

Since chest pain can have many different causes, a careful anamnesis is very important. It is important to note that further examinations may be necessary depending on the suspected diagnosis:

The exact localization
Radiation / Propagation
The quality of the pain and
To know the strength of the pain. – EKG
Echo
X-ray of the thorax (chest X-ray)
Possibly CT or MRI of the lungs.

Therapy

The therapy of chest pain depends on the cause. The best prognosis is for pain caused by the skeleton or muscles. These are typically the least dangerous chest pains and can usually be completely cured by conservative therapy such as physiotherapy. Sufficient pain medication is important to avoid the wrong posture, as healing can sometimes take months.

Localization – Center

Chest pain can have many different causes, and it can be helpful to try to identify the location of the main pain. For example, if severe pain tends to be centred behind the breastbone, the first thing that is often suspected is a heart attack. In this case, the pain is independent of position or breathing and can radiate to other parts of the upper body, such as the left arm, lower back or upper abdomen.

Pain in the middle of the chest can also be an indication of reflux disease. In this disease, the acid gastric juice flows back into the esophagus, causing irritation of the mucous membrane. Especially if the symptoms occur after drinking alcohol and nicotine or increase when lying down, the suspicion is obvious.

A severe cough can also cause pain in the middle of the chest. If the pain occurs rather at night or on an empty stomach or directly after eating, it may be a stomach ulcer. If vomiting occurs at the same time as chest pain, several clinical pictures are possible, which require treatment at different rates.

A more harmless disease is the so-called Mallory-Weiß-Syndrome. The mucous membrane of the oesophagus is torn on the surface, for example after violent vomiting, due to a reflux disease or permanently increased alcohol consumption. If this is suspected, a gastroscopy should be performed to rule out possible bleeding in the oesophagus or stomach.

A far more serious problem with similar symptoms is the tearing of the oesophagus. Often the person affected has vomited very severely beforehand, resulting in a massive increase in pressure within the oesophagus, which the latter cannot withstand. This leads to severe pain and shortness of breath.

A further life-threatening clinical picture also makes itself felt through sudden, severe pain in the middle of the chest: aortic dissection. Blood passes through a tear between the layers of the aortic wall, which can cause the wall to bulge, form thrombi or tear the aorta. In both of the latter two situations there is an acute risk of shock and the need for hospitalization.