Pain in the heart area does not always indicate a disease or myocardial infarction. This is often associated with diseases of the spine or chest organs. To properly provide first aid, it is important to know the signs of “true” heart pain.
Causes of pain in the heart area
Pain in the heart area Substernal pain can appear in people of absolutely any age under absolutely any circumstances. This condition does not always signal heart pathology. Conventionally, all pain that occurs in the chest can be divided into pain of cardiac origin and extracardiac.Non-cardiac causes include:
- Pathology of the digestive organs:
- some diseases of the esophagus;
- diseases of the stomach, pancreas and gall bladder.
- Respiratory diseases:
- pleurisy;
- pneumonia;
- pneumothorax;
- severe forms of bronchial asthma;
- tuberculosis.
- Vascular pathology:
- pulmonary embolism;
- dissecting aortic aneurysm.
- Diseases of the neuromuscular system:
- osteochondrosis of the cervical or thoracic spine;
- intercostal neuralgia;
- various myalgia.
- Viral diseases:
- shingles.
- Nervous system diseases:
- panic attacks and various dystonias.
Cardiac causes of pain:
- Myocardial infarction.
- Chronic ischemic heart disease.
Description of pain symptoms depending on the disease
Quite often, many people with chest pain do not pay attention to their nature and therefore mistakenly believe that the discomfort is associated specifically with heart disease. The characteristics of chest pain directly depend on the cause and degree of progression of the disease.For example, often the cause of burning sensations behind the sternum is a banal heartburn. The reason is that gastric juice enters the esophagus. These pains are often accompanied by belching and a sour taste in the mouth. With heartburn, the unpleasant sensations are clearly associated with food intake, i.e. occur after eating. Often occur when bending over or when the body is in a horizontal position. Taking antacids relieves the burning sensation in the chest. Absolutely similar discomfort is possible with a disease such as GERD (gastroesophageal reflux disease). One of its manifestations is heartburn.
Pain and heartburn can be caused by a disease such as esophageal spasm. When it occurs, swallowing is impaired due to the fact that the bolus of food does not move correctly towards the stomach. This is due to uncoordinated work of the esophageal muscles. Another pathology is achalasia. The disease is a malfunction of the valve between the esophagus and stomach. In this condition, food lingers in the lumen of the organ for some time, causing discomfort and pain in the chest.
Inflammatory diseases of the pancreas ( pancreatitis) and gallbladder ( cholecystitis) can cause pain in the lower chest. With a disease such as cholelithiasis ( cholelithiasis) there are also painful sensations that can easily be confused with heart pain.
Among pulmonary diseases, chest pain may appear when pleurisy(inflammation of the tissue lining the chest cavity) or pneumonia(pneumonia). A characteristic feature of these pathologies is the presence of a cough or increased pain when inhaling. These inflammatory diseases almost always lead to an increase in body temperature. Pleurisy can be a complication of pneumonia.
Such pain often appears with diseases of the pulmonary system, such as severe bronchial asthma or pneumothorax. The latter disease is the appearance of free air in the chest cavity, as a result of which the lung collapses.
There are several main vascular non-cardiac causes that cause chest pain and are associated with pathology of the peripulmonary vessels. These include pulmonary embolism or increased pressure in the vessels supplying blood to the lungs - pulmonary hypertension. In this case, the pain increases sharply when inhaling, and a cough may appear.
Another large vessel lesion that causes chest discomfort is dissecting aortic aneurysm. This condition is extremely dangerous for human life. A characteristic feature is a gradual change in the location of pain. At the beginning, unpleasant sensations appear in the heart area and gradually descend to the lower abdomen. Very often, a dissecting aneurysm is accompanied by a sharp decrease in pressure, tachycardia and loss of consciousness.
A very common cause of chest pain is osteochondrosis of the thoracic and cervical spine. The pain with this pathology is very similar to that with angina pectoris: it radiates (gives) to the shoulder blade or left arm. The only difference is the fact that the pain becomes more intense when moving, bending the body, turning the head or raising the arms.
At intercostal neuralgia And Tietze syndrome stabbing pains are localized in the area of the sternocostal joints or along the intercostal spaces. In this case, the pain sharply intensifies with a deep breath. As a result, the person cannot breathe deeply. This condition can be controlled by taking any painkillers and anti-inflammatory drugs.
Various inflammation of the chest and back muscles often lead to discomfort and unpleasant sensations in the heart area. The nature of the pain is approximately the same as with osteochondrosis and intercostal neuralgia.
A viral disease caused by the herpes virus, such as shingles is accompanied by damage to nerve endings and causes severe pain in the chest. It sometimes increases skin sensitivity. Rashes may appear at the affected area.
Panic attacks, nervous disorders and some dystonias are often the causes of pain in the heart area. The vast majority of such diseases affect young people with a labile nervous system or after suffering stress. The pain can be of absolutely any nature.
In addition to the diseases described above, the causes of pain can be “true” cardiac pathology. Most often, chest discomfort occurs when angina pectoris. The disease is often accompanied pressing pain in the heart, which gradually increase in intensity during exercise or stress. The reason is the narrowing of the lumen of the vessels supplying the heart muscle as a result of their sclerosis or spasm. Often, at rest, the pain stops on its own.
The most dangerous of the common diseases of the cardiovascular system is myocardial infarction. With this disease, there is a sudden cessation of nutrition to a certain area of the heart muscle due to blockage of the artery. The pain can radiate to the shoulder blade, neck, shoulder, or left arm. Associated symptoms are cold sweat, shortness of breath, and sometimes nausea.
Other cardiac pathology, accompanied by chest pain, may represent inflammatory changes ( myocarditis, endocarditis or pericarditis). This happens after bacterial or viral infections.
Differential diagnosis of chest pain
The first diagnostic measures that need to be performed when discomfort occurs in the chest area are to calm down and listen to the nature of the pain, its dependence on physical activity, body position, and possible emotional stress.
Self-diagnosis and self-medication in this case are fraught with dangerous consequences. Due to the fact that pain can signal a dangerous pathology, consultation with medical specialists is mandatory.
The next steps to determine the pathology are to consult doctors. A consultation with a therapist is required to prescribe a series of instrumental examinations or for referral to a more specialized specialist.
It may be necessary to consult doctors such as a pulmonologist, neurologist, surgeon, gastroenterologist, vascular and cardiac surgeon, psychiatrist, infectious disease specialist. For mild forms of nervous disorders, sometimes a consultation with a psychologist is sufficient.
Instrumental studies
Quite often, examination by medical specialists is not enough to determine the cause of chest pain. In order to clarify the diagnosis, it is often necessary to additionally resort to various instrumental diagnostic studies. Due to the fact that pain in the chest can be caused by pathology of various systems and organs of the body, most examinations are associated not only with studying the state of the heart. The main ones:
- Ultrasound of the abdominal organs;
- FEGDS (fibroesophagogastroduodenoscopy) – study of the condition of the esophagus, stomach and duodenum;
- fluorography or radiography of the chest organs;
- FVD (determination of external respiration function);
- Ultrasound of the heart, aorta and pulmonary vessels;
- radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the spine;
- electrocardiography (ECG), echocardiography (EchoCG), stress tests;
How to understand that your heart hurts
When pain occurs in the heart area, it is extremely important to determine the cause in order to provide proper first aid. The most dangerous pathology leading to discomfort in the chest area is associated with disruption of the cardiovascular system.
To determine real heart pain, it is enough to perform a few simple manipulations, which will most likely indicate whether the discomfort is associated with heart pathology.
The first thing to do is to understand whether there is a dependence of pain on the position of the body, whether it intensifies when bending the torso, raising the arms or taking a deep breath. If this is so, then most likely the cause is a disease of the musculoskeletal system (osteochondrosis, intercostal neuralgia, etc.).
Indirectly, even the nature of the pain can, with a considerable degree of probability, “tell” about the cause. With cardiac pathology, it is often pressing, often accompanied by difficulty breathing. Severe stress with existing chest discomfort may also indicate cardiac pathology. If the unpleasant sensations behind the sternum intensify in proportion to the physical activity performed and stop after performing it, then with almost one hundred percent certainty we can talk about angina pectoris (deficiency of enrichment of the heart muscle with blood during exercise).
What to do if your heart hurts: first aid
If the above-described clinical manifestations occur, it is important to stop all physical activity as soon as possible. It is necessary to take a lying or semi-sitting position. The next step is to calculate the HR (heart rate) from the pulse and approximately determine the BP (blood pressure). If your blood pressure is high, you can take Captopril (Capoten) or Clonidine (Clonidine) sublingually.
If it is impossible to “feel” the pulse on the wrist and you experience dizziness or nausea, you should suspect low blood pressure. In this case, it is extremely important, in addition to the lying position, to raise your legs above the level of your head. To do this, you can put any object under them.
For almost any condition, you can take soothing drops (Valerian, Corvalol, Motherwort, Hawthorn) or a Validol tablet. The most effective drug for heart pain is Nitroglycerin.
Rules for taking Nitroglycerin:
- The drug should be taken in a lying or semi-sitting position.
- It is taken only until the pain syndrome is relieved, i.e. if the pain has disappeared, there is no need for it.
- The maximum number of tablets used is 3 pcs.
- Possible simultaneous use with Validol.
- Apply only sublingually (under the tongue) with an interval of 5 minutes.
- If you are allergic to Nitroglycerin, it can be replaced with a drug from the group of calcium channel blockers (Nifedipine, Phenigidine). Contraindicated in cases of pronounced tachycardia.
- Nitroglycerin should not be used if you have low blood pressure.
If all the measures taken do not lead to the disappearance of pain, it is necessary to call an ambulance for an emergency ECG to exclude angina, ischemia or myocardial infarction. In addition to electrocardiography, it is important to take a blood test as soon as possible to determine the concentration of troponin in the blood - a protein, the amount of which increases sharply with the destruction of muscle tissue, in this case with a heart attack.
Treatment of all pain in the heart area depends entirely on the pathology that caused these sensations. The method and option of therapy is determined by a specialist in the field that causes discomfort in the chest.
Complications of diseases associated with chest pain
Pain in the heart area that occurs for any reason can lead to completely different consequences, including death. However, the most common of them are damage to specific organs.
Substernal pain arising due to pathology of the gastrointestinal tract can be complicated by diseases such as:
- perforated ulcer of the stomach or duodenum;
- gastrointestinal bleeding;
- formation of malignant tumors;
- B12 deficiency anemia.
Pathology of the lungs, accompanied by painful sensations in the heart area, has the following common complications:
- lung abscess;
- various infectious processes up to sepsis (blood poisoning).
Vascular diseases, in particular PE and dissecting aortic aneurysm, are fatal in most cases. Spinal diseases can be complicated by intervertebral hernias and, in the worst case, spinal canal stenosis and disability.
True heart pain most often ends in myocardial infarction, the development of heart failure, or death due to cardiac arrest. Intractable heart rhythm disturbances may occur, which will also ultimately lead to circulatory failure.
Forecast of true heart pain
The prognosis of chest pain of cardiac origin can be completely different. If the sensations discomfort appears due to stress, then in most cases the outcome of this condition is favorable. This is due to the fact that during nervous disorders there is an increased release of adrenaline into the blood, which constricts blood vessels and increases heart rate. As a result, the heart's need for oxygen increases. And due to narrowed vessels, a lack of blood circulation occurs. Collectively, this leads to heart pain.
If pain occurs during physical activity, then we are most likely talking about exertional angina. This disease has a less favorable prognosis because with increased myocardial oxygen demand, the heart vessels cannot provide full access to it. This may indicate a change in the vessels supplying the heart. With this pathology, the risk of developing myocardial infarction increases.
Symptoms occurring at rest, often indicate the development of a disease such as unstable angina. People call this a pre-infarction state. This condition is more likely to lead to a heart attack or even sudden cardiac death.
If pain in the heart area is severe and cannot be relieved by taking Nitroglycerin, then in this case the prognosis is the most unfavorable, because, most likely, myocardial infarction develops. The prognosis of this pathology is unpredictable. A person can live for many more years in satisfactory condition, with certain limitations, or die from cardiac arrest and circulatory failure. It all depends on the type of heart attack and the state of the body’s cardiovascular system.
Thus, only one conclusion is true: pain in the heart area can have absolutely any cause. Accordingly, the outcome is also very different. For very intense pain that cannot be relieved by Nitroglycerin, emergency consultation with medical specialists is required. The cause of any pain in this area should be diagnosed in time to prevent possible complications and improve the quality of life.
Pain in the chest area is accompanied not only by heart disease, but also by pathologies of other origins. These could be injuries, diseases of the spine, respiratory system, digestive or nervous system, and others. In any case, only a doctor can recognize this with the help of instrumental studies.
However, every person who encounters such a symptom is looking for an answer to the question: “How to understand that the heart hurts?” You need to know this so as not to miss the moment and seek help in time, for example, in case of myocardial infarction. It is important to understand how the heart hurts; the symptoms can be different. It is necessary to learn to distinguish cardiac pain from non-cardiac pain. To do this, you need to have an idea of the nature, intensity and duration of pain, as well as other manifestations of certain diseases characterized by unpleasant sensations in the chest area.
Early signs of a heart attack
As already mentioned, chest discomfort can have various causes. Heart disease is determined by certain characteristic signs. You should know that the “core” often does not experience any unpleasant sensations. At the same time, a person with other pathologies may complain that it is difficult for him to breathe or his heart hurts. However, these symptoms will have nothing to do with cardiac diseases.
The very first signals indicating that a major organ is not in order usually arrive several months or years before a heart attack. All people need to have an idea of how the heart hurts. Symptoms of the onset of the disease are usually the following:
1. Compressive, pressing pain behind the sternum, radiating to the back, arm, neck, jaw, especially to the left side. Accompanied by shortness of breath, sweating, nausea.
2. Pain occurs after exertion, physical or psychological, and goes away with rest and after taking nitroglycerin.
3. Shortness of breath occurs during exertion, even during everyday work that is not too hard, while eating, or while lying down. On the eve of an attack, a person may sleep sitting or suffer from insomnia.
4. Increased fatigue from normal work can haunt a person several months before the attack.
5. Men may suffer from erectile dysfunction for several years before being diagnosed with coronary artery disease.
6. Edema is one of the characteristic signs of cardiac dysfunction. At first they are insignificant, but gradually become more noticeable, especially visible in the rings on the fingers and on the shoes. If edema appears, it is necessary to undergo examination by a cardiologist or therapist.
7. Sleep apnea, or stopping breathing during sleep, and snoring can signal a predisposition to a heart attack.
How does your heart hurt? Symptoms of coronary diseases
Myocardial infarction
Signs of a heart attack may vary. The classic clinical picture of a heart attack usually unfolds as follows:
a feeling of heaviness, pressing or squeezing pain in the center of the chest, behind the sternum and in the arm;
irradiation of pain to the left arm, neck, lower teeth, throat, back;
dizziness, sweating, pale skin, nausea, sometimes vomiting;
a feeling of heaviness in the stomach, a burning sensation in the chest, reminiscent of heartburn;
fear of death, anxiety, severe weakness;
unstable and rapid pulse.
A heart attack can occur in another way. There may be no symptoms, which is the insidiousness of the disease. A person may complain of discomfort in the chest area, or may not experience any sensations - this is a silent heart attack. An extensive heart attack in its symptoms resembles acute heart failure: shortness of breath, suffocation, blue lips and fingertips, loss of consciousness.
A heart attack lasts about half an hour and cannot be stopped with nitroglycerin.
Coronary artery disease is manifested by attacks of angina pectoris. In this case, how does the heart hurt? Symptoms are usually the following:
interruptions in heart function;
irregular pulse;
dizziness;
sweating;
weakness.
rapid heartbeat;
With cardiac ischemia, patients complain of discomfort in the chest: pressure, heaviness, fullness, burning. The pain can radiate to the shoulders, shoulder blade, arms, neck, lower jaw, throat. It usually occurs during physical and emotional stress and goes away with rest.
With angina at rest, pain can occur at any time. Often in this case, the heart hurts at night. This form is unfavorable.
Inflammatory heart diseases
Pericarditis
Pain is the main symptom of pericarditis, or inflammation of the outer lining of the heart. It is felt in the middle of the chest, sometimes radiates to the back, neck, arm, and intensifies when swallowing, inhaling, coughing, and also in a lying position. There is some relief when sitting or bending forward. Patients' breathing is usually shallow. As a rule, this is a dull or aching pain in the heart area, but sometimes it can be sharp and cutting. With pericarditis, low-grade fever and rapid heartbeat are observed.
Myocarditis
With inflammation of the heart muscle, up to 90% of patients complain of pain. This is a stabbing, pressing or aching pain in the heart area, which does not depend on physical activity, but can intensify a day after exercise. It does not go away with nitroglycerin.
Heart valve diseases
With valve pathologies, the symptoms do not in any way reflect the severity of the disease. A person may not have any complaints, but still be seriously ill. Signs may be as follows:
difficulty breathing, shortness of breath during daily activities and during exertion, as well as when lying down;
discomfort (heaviness, pressure) in the chest during exercise, inhaling cold air;
dizziness, general weakness;
rhythm disturbances: irregular pulse, rapid heartbeat, interruptions in heart function.
With valve diseases, heart failure can develop with characteristic symptoms: swelling of the legs, bloating, weight gain.
Cardiomyopathy
Almost all patients with this diagnosis have pain. It is especially pronounced in hypertrophic cardiomyopathy. Pain changes as the disease progresses. At first it is long-lasting, has nothing to do with physical activity, does not stop with nitroglycerin, and is localized in different places. Subsequently, spontaneous pain or attacks are observed after exercise, which are relieved by nitroglycerin, although not always. The nature of the pain varies. It has a specific localization or occupies a large area, is present constantly or only during exercise, goes away from nitroglycerin, but may not go away.
Arrhythmia
There are many types of arrhythmias characterized by disturbances in heart rhythm. In some of them, pain in the heart is noted, which radiates to the left side of the body and to the arm.
Heart defects
Heart defects, congenital or acquired, may not manifest themselves for years, but may be accompanied by pain. As a rule, these are constant aching, stabbing or cutting pains, which are accompanied by swelling of the legs and increased blood pressure.
Mitral valve prolapse
The pain usually occurs in the left side of the chest and is not associated with stress. It is pressing, pinching or aching in nature and does not go away with nitroglycerin. In addition, night and morning headaches, dizziness, lightheadedness, rapid heartbeat, and a feeling of lack of air are possible.
Aortic stenosis
With this pathology, there is a feeling of constriction in the chest, shortness of breath during exercise, muscle weakness, fatigue, and palpitations. With the development of coronary insufficiency, shortness of breath at night, dizziness, fainting with a sudden change in body position, attacks of cardiac asthma and angina pectoris occur.
Pulmonary embolism
This dangerous condition requires urgent help. Severe pain in the heart area, which intensifies with inspiration, is an early sign of pulmonary embolism. Unlike angina, the pain does not radiate to other places. The patient develops cyanotic skin, a sharp drop in blood pressure, and suffers from severe shortness of breath and palpitations. Nitroglycerin will not help in this case.
Aortic diseases
Excruciating, sudden, bursting chest pain - aortic dissection. Intense pain can lead to loss of consciousness. The patient requires urgent medical attention.
With a thoracic aortic aneurysm, mild, less often severe, throbbing or aching pain in the chest and back is noted. When an aneurysm ruptures, the patient experiences unbearable tearing pain, shock and death are possible if help is not provided in time.
Non-heart diseases
1. Intercostal neuralgia. It is often mistaken for heart pain, but in reality there are significant differences. With intercostal neuralgia, the pain is stabbing, sharp, intensifying with deep inhalation and exhalation, turning the body, sudden movements, coughing, laughing, sneezing. It may go away after a few minutes, but can last up to several hours or days. The person accurately indicates the location of the pain, its localization is pinpoint, on the left or right side of the chest between the ribs. With angina, it is burning, aching, but not sharp, does not depend on the position of the body, the exact location cannot be indicated, it is usually shown on the entire chest.
2. Thoracic and cervical osteochondrosis. It is easily confused with angina pectoris. It seems to a person that his heart hurts, his arm, usually the left, and the area between the shoulder blades go numb, the pain radiates to the back, upper abdomen, and intensifies with breathing and movement. It especially resembles a heart attack if it occurs at night, and the person experiences fear. The main difference from angina pectoris is that nitroglycerin does not help.
3. Diseases of the central nervous system. In this case, patients complain that their heart often hurts. As a rule, patients describe their condition differently. The pain can be constant and short-term, aching and sharp. With neuroses, various autonomic disorders are usually present: irritability, anxiety, insomnia or drowsiness, heat or chilliness in the extremities, dryness or increased moisture of the skin, muscle pain, stomach pain, headache. Usually people with neuroses very colorfully and in detail describe numerous symptoms that objectively do not correspond to the true state of the person. At the same time, “core people” are very stingy in describing their feelings. It can be difficult to distinguish cardioneurosis from cardiac ischemia, since there are no changes on the ECG.
4. Disturbances in the gastrointestinal tract. Pain caused by pathologies of the digestive system, longer lasting than heart pain, is accompanied by nausea, vomiting, heartburn, and depends on food intake. Acute pancreatitis is sometimes mistaken for a heart attack: severe pain with nausea and vomiting. Pain from spasms of the gallbladder and ducts can radiate to the left side of the chest, so it seems that the heart hurts. What to drink to find out for sure? If antispasmodics helped, then problems with the gastrointestinal tract.
5. Lung diseases. Pneumonia may cause heart-like pain. With pleurisy, acute pain occurs, it is limited, and intensifies when coughing and inhaling.
What to do?
This is the first question that comes to mind when someone feels chest pain. If there is a suspicion that your heart still hurts, that is, an attack of angina or a heart attack, you need to act as follows:
First of all, you need to calm down and sit down. Panic will only make the condition worse.
Try changing your body position. If it feels better, it may not be your heart that hurts. If the pain has not subsided, but continues to increase and is of a squeezing or pressing nature, it is possible that this is angina pectoris.
You need to open the window in the room to let fresh air in.
Nothing should restrict breathing, so the collar of clothing must be unbuttoned or undressed to the waist.
Place one nitroglycerin tablet under your tongue; if you have angina, the pain should subside fairly quickly. If it does not go away after 15 minutes, take another tablet and call an ambulance. If it is a heart attack, nitroglycerin will not help.
Conclusion
Even if the attack was stopped, the next day you need to go to the hospital for examination. And, of course, there is no need to self-medicate.
Update: October 2018
A healthy heart is a prerequisite for a long and fulfilling life. Pain in the heart area, at a minimum, requires careful attention to yourself. If they arise, then wariness and anxiety always appear. “Heart, heart, what happened that confused your life?” Do cardiac pains always indicate problems with the heart and how to distinguish them from other pains - in this article.
Heart area - where is it?
The projection of the heart onto the anterior chest occupies the area from the upper edge of the cartilages of the 3 ribs to the lower edge of the body of the sternum. The apex is projected into the 5th intercostal space 2 cm medially from the line crossing the middle of the clavicle. The right border goes from the cartilage of the 3rd rib to the 5th intercostal space on the right.
Typically, any discomfort in the left side of the chest is taken for heart pain, regardless of its nature and intensity. But the typical location of heart pain is the area behind the sternum and to the left of it to the middle of the armpit.
Features of the spread of heart pain are the appearance of referred pain (on the left in the shoulder blade and under it, in the arm). Sometimes the reflection is isolated, for example, 4-5 fingers of the left hand, the left jaw. Rarely does the pain radiate to the right arm or left shoulder.
Nature of pain in the heart area
The description of suffering by the patient himself is very important at the first stage of diagnosis. It is the detailed description of pain that allows the doctor to navigate in the direction of the search and reduce additional examination methods to the necessary minimum.
When questioning the patient, the following are taken into account:
- conditions for the occurrence of pain (during or after exercise, at rest, association with food, at night or during the day)
- the nature of the sensations (pricks, squeezes, aches, cuts, presses, constantly or periodically)
- duration of pain
- after which they stop.
Causes of pain in the heart area
| Heart diseases: | Diseases of the stomach and esophagus: | Toxic effects: |
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| Heart overload: | Pulmonary pathologies: | Pathologies of large vessels: |
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| Mediastinal diseases: | Lesions of nerve trunks: | Bone lesions: |
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| Muscle damage: | Skin lesions: | Pathologies of the mammary glands: |
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Constricting pain
This is a typical cardiac pain, indicating oxygen deficiency of the heart muscle. It is characteristic of almost all forms of coronary heart disease. With angina pectoris, compressive pain in the chest in the region of the heart or behind the sternum gives typical reflections under the shoulder blade and left arm. It occurs during exercise and goes away on its own with rest or with the use of nitroglycerin, which dilates blood vessels and redistributes blood between the layers of the myocardium.
Patients with various types of rhythm disturbances are also concerned about this pain:
- it is most typical for atrial or ventricular fibrillation
- frequent extrasystoles
- paroxysmal tachycardia
- intracardiac blockades
- often the pain is accompanied by fear of death and necessarily irregular pulse
- The equivalent of pain in some cases is shortness of breath, indicating circulatory failure.
Atypical compressive pain under the left shoulder blade, in the region of the heart, can occur at rest, in the early morning hours against the background of spasm of the coronary arteries (Prinzmetal's angina).
Sharp pain
This type of pain always signals the need for emergency help, and therefore does not allow you to switch to anything else. The condition can also be described as acute pain, as it occurs suddenly.
Angina pectoris
A prolonged anginal attack with a typical location and reflection of severe compressive pain is the result of incipient thrombosis, embolism or severe stenosis of the coronary vessels. At this stage, nitroglycerin does not help much, but timely medication can prevent the death of the heart muscle. If after taking nitroglycernia twice with a five-minute break, the pain does not go away. It is necessary to call an ambulance.
Myocardial infarction
This is actually necrosis of the heart wall. Here, only treatment in a specialized hospital can save the patient’s life and preserve its further quality. When myocardial infarction occurs, the pain is very pronounced, prolonged, intractable with nitro drugs, accompanied by the fear of death and a feeling of lack of air. sweating, hand tremors. It can also be atypical, for example, radiating to the stomach or simulating intestinal colic, accompanied by nausea and vomiting, heart rhythm disturbances, convulsions, and involuntary urination. Some heart attacks occur with a mild pain syndrome, which does not lose its sharpness, but the pain is more tolerable. When pain is relieved only by neuroleptoanalgesia using powerful painkillers.
Diseases of the esophagus and stomach
The second option for dangerous sharp pain in the heart area is a catastrophe with the esophagus and the cardiac part of the stomach. Perforation of a cardiac ulcer will give a dagger-like pain, which will entail autonomic disorders in the form of lightheadedness. flashing spots before the eyes, dizziness or loss of consciousness.
For the esophagus, bleeding is more typical due to frequent vomiting (Mallory-Weiss syndrome) or from dilated esophageal veins with portal hypertension against the background of liver cirrhosis. The rate of loss of consciousness and the severity of circulatory disorders will depend on the volume of blood loss. In any case, perforation of the ulcer or bleeding is a reason for surgical assistance.
Pulmonary thromboembolism
This is a blood clot that has traveled from the pelvic system or into the arteries of the lung. The more branches of the pulmonary artery are thrombosed and the larger they are, the more pronounced and intense the pain. In addition, coughing with blood, shortness of breath, rapid heartbeat, and swelling of the neck veins are observed. With thrombosis of large trunks, collapse and loss of consciousness develop. It is also an emergency condition requiring emergency care and hospitalization.
Aortic aneurysm dissection
More often occurs in elderly men against the background of long-term unregulated arterial hypertension, atherosclerosis, or coarctation of the aorta. The provoking factor may be surgery on the heart or aorta. Most often, the ascending part of the vessel dissects. In this case, a longitudinal rupture of the inner membrane leads to the accumulation of blood between the layers of the aorta. Suddenly there is a sharp tearing pain behind the sternum or in the heart area, radiating under the shoulder blade. At the same time, the pressure initially increases. and then drops sharply. There is asymmetry of the pulse in the extremities, the skin turns blue. Sweating appears and fainting may develop. Neurological manifestations include disturbances in motor activity. A hematoma can lead to oxygen starvation of the heart, shortness of breath, and hoarseness. Patients often fall into a coma.
Fractured ribs
Sharp pain is also typical for. Subsequently, the nature of the pain changes to aching or gnawing.
Pressing pain
In cases where the heart is overloaded, pressure or dull pain may be felt on the heart.
- This type of pain can also occur in healthy people, for example, with excessive physical exertion or playing wind instruments, which increases pressure in the pulmonary circulation.
- With arterial hypertension, the heart has to pump blood against a pressure gradient, which impairs its blood supply and increases the load.
- Thyrotoxicosis leads to increased heart rate and overloads the heart with volume.
- Cardiac tamponade is a consequence of wounds and compression of the heart by blood. Also, the heart can compress the effusion during pericarditis of various origins (tuberculosis, tumor).
- With myocarditis of an infectious or allergic nature, mild pressing pain is accompanied by shortness of breath, rhythm disturbances, and heart failure.
- Myocardiopathy, myocardial dystrophy, cardiac tumors also give pressing sensations without a clear connection with the load, long-term or episodic.
- Pressing pain behind the sternum imitates foreign bodies of the esophagus or esophagitis.
- Intoxications of various natures (medicinal, narcotic, alcoholic), as well as poisoning with organophosphorus substances, ether, chloroform, and neurotoxic plant poisons, cause severe pressure on the heart, are combined with arrhythmias and heart failure, and are fraught.
- Purulent pathologies of soft tissues, mastopathy. will also give excess pressure in the projection of the heart.
- High levels also lead to a situation where pressing pain imitates cardiac pathologies.
In order not to fall into the situation of Tom Sawyer, who was not good at anatomy and hid the gifted flower closer to either the heart or the stomach, you can use a comparative table to distinguish stomach pain from heart pain.
Stitching pain
If the heart stabs sporadically, the pain is not accompanied by blood flow disorders (no fainting, dizziness, memory or speech disorders), and is usually not dangerous.
- Most often, stabbing pain in the heart is caused by neurocirculatory dystonia, in which the vessels do not have time to adequately narrow or expand when the load changes.
- Rarely, stabbing pains are accompanied by infrequent extrasystole).
Strong pain
- Pain can be unbearable during a heart attack, pulmonary embolism, or dissection of an aortic aneurysm. It's often a 10 out of 10. Patients are excited and rushing about. Experience an intense fear of dying.
- 10-9 points on the intensity scale gives mediastinitis - inflammation of the mediastinum. When a purulent process develops due to complications of surgical treatment, injuries to the esophagus, or disintegration of tumors, the pain forces patients to take a forced position with their chin pressed to their chest. It intensifies when swallowing and throwing back the head. There is also fever, sweating, agitation or confusion, and swelling of the upper body.
- Angina pectoris gives pain from 6 to 8 points.
- Myocarditis and pericarditis from 5 to 2.
Aching pain in the heart area
The more intense the rhythm of modern life becomes, the greater the number of patients complaining of pain in the heart in the cardioneurosis program. In such patients there are absolutely no organic changes in the organ or the vessels that feed it, or they are insignificant.
- there is only a high degree of neuroticism
- depression
- anxiety disorder
- Cardioneurosis often develops as part of somatized depression.
Dissatisfaction with oneself and the world around us, which does not come out in behavioral characteristics, breaks out in the form of pain in the heart. At the same time, patients are haunted by many unpleasant sensations: pressure on the heart, freezing when breathing, aching pain and anxiety for their health.
Often, fixation on a non-existent cardiac pathology forces a person to undergo multiple examinations, change specialists and clinics, significantly complicating his life. At the same time, an experienced psychotherapist or group correction could solve the problem in a short time.
Pain in the heart: what to do
If you suspect problems with your heart, it is better to reassess the risks and immediately consult a physician or cardiologist. After questioning and examination, the doctor will prescribe:
- urine and blood tests
- fluorography of the chest organs
- if necessary, bicycle ergometry, treadmill and echocardioscopy.
This tactic will allow you to react in time to real heart disease or quickly verify its absence and preserve excess nerve cells. In addition, cardiac pathologies often mask other serious and not so serious diseases, which it is also advisable to diagnose and treat in a timely manner.
Pain near the heart is considered the most popular symptom and in prevalence can only be compared with headaches. But not all pain that is described as cardiac, in fact, is so.
For example, the sternum has a mass of nerve fibers and certain large plexuses, during irritation of which pains similar to heart pain occur. Direct pain near the heart is sometimes the main complaint in the process of various ailments.
Pain near the heart is a symptom of failures of the central nervous system, respiratory and digestive systems. Pain is often perceived as a heart pathology. At a young age, pain in the heart area is a symptom of various health difficulties: osteochondrosis, neuralgia, pleurisy.
Dull pain in the heart
It is not clear in all cases that this is a symptom of pathological processes in the heart. Only professional diagnostics determines that dull pain will not be a consequence of diseases of the spine, pleura, or lungs.
The causes of dull pain are:
- mitral valve disease;
- myocarditis;
- cardiopsychoneurosis.
The pathology of pain is associated with the heart, this is evidenced by its constant manifestation and duration. Often before this, the patient is engaged in active physical activity, experiences stress, suffers from hypothermia, or has consumed an excessive amount of food.
Acute pain in the heart
Acute pain, which is particularly sharp, often occurs during pericarditis, angina, and is a harbinger of a heart attack. Additional symptoms include general lethargy and malaise. Symptoms in women are supplemented by severe nausea, and pain is reflected in the upper abdomen.
Sharp pain is quite difficult to distinguish from symptoms of pleurisy. At the same time, during an attack of pain, a cough appears. It can also be provoked by pulmonary embolism, dissection of an aortic aneurysm.
Burning pain in the heart area
A burning sensation can be a sign of neurosis, disruptions in the gastrointestinal tract, pathological processes of the esophagus and heart attack. To make an accurate determination, it is necessary to focus on general symptoms.
Pain when inhaling in the region of the heart
- Many people often stop suddenly due to sharp pain in the chest when trying to take a deep breath. This also happens at a young age. People often feel as if something in their chest might rupture.
- Herpetic or intercostal neuralgia often manifests itself in the same way., thoracalgia, precordial syndrome, which do not affect the functioning of the heart.
- When during a deep breath shortness of breath begins and further deep breathing is impossible, general symptoms of heart disease appear, then, most likely, urgent help from a specialist is needed.
Pain in the heart radiates to the arm
Sometimes this is how ischemia manifests itself. The pain varies in nature: squeezing, stabbing. In certain situations, patients may notice a sensation under the armpit. The heart rate may increase, blood pressure may increase, rhythm disturbances, etc.
Pain when moving
Pathological processes in the heart very often appear during physical activity, for example, while climbing stairs or while walking quickly on level ground. This is how ischemia manifests itself predominantly.
Together with the unpleasant sensation, shortness of breath and disruptions in the functioning of the heart occur (a feeling that the heart may stop).
What to do if you have heart pain, first aid
People are often frightened by sudden pain in the heart area.
Necessary actions in this case:
- Stop panicking, stay calm, take a sitting or lying position.
- Loosen clothes to allow free breathing and allow access to oxygen.
- 1 tablet of nitroglycerin sublingually for 15 minutes will relieve pain.
- If nitroglycerin does not help, you need to call an ambulance - most likely, a myocardial infarction is occurring.
- If the pain started for the first time, you should not self-diagnose. The difficulty may not lie in cardiac pathology. If in doubt, you need to take Corvalol, Validol, take a comfortable position, lying or sitting, and try to keep movements to a minimum.
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The examination process includes many stages and consists of the following procedures:
- Consultation with a doctor. A cardiologist who specializes in heart disease can give advice about discomfort in the heart area. The specialist asks the patient, performs an examination and listens to the heart rhythm for the presence of a murmur. The initial examination also includes percussion (the heart is tapped).
This method helps determine the size and boundaries of the heart. If the specialist has suspicions, he sends the patient for further diagnostics. - ECG. An electrocardiogram is performed in local hospitals; a similar diagnostic method has been used for a long time. A functional examination will show the heart rate during a period of rest. Typically the process takes up to 15 minutes.
The study may reveal:- Regularity of rhythm.
- The work of the heart muscle.
- Heart rate.
- ECG helps detect coronary heart disease, rhythm disturbances and tachycardia.
- Holter monitoring. When the electrocardiogram is unable to show interruptions, but the patient still complains of pain near the heart, a similar research method is prescribed.
Monitoring is carried out over three days. A special portable device is used, its electrodes are applied and secured to the patient's chest.The patient may not be present in the hospital for the entire test, but the purpose of the test is to test heart function under a variety of conditions. This method makes it possible to prevent a heart attack.
- -test. A method that is generally similar to a conventional electrocardiogram, but the patient is examined while running, on the track. This method determines the degree of tolerance of physical activity by the heart and determines possible pathological processes of the cardiovascular system. The study will detect interruptions in rhythm and ischemia.
This method is used to obtain the results of coronary bypass surgery after a heart attack and angioplasty. - Ultrasound examination of the heart. Allows you to assess the condition of the heart and determine the degree of its ability to pump blood.
Diagnostics contributes accurate determination of the thickness of the heart walls, the size and condition of the valves, and chamber cavities. Internal formations are identified and information is obtained about the amount of blood flow in the large vessels of the heart.
Treatment
- Pain near the heart in women, radiating to the left arm are a rather serious symptom that requires timely surgery. Therapy for the patient depends on the initial diagnosis and the specific disease. When the diagnosis is made, an experienced specialist will tell you why the patient’s left arm is numb and prescribe appropriate therapy.
- In some cases, to completely forget about pain near the heart you need to take a course of conventional medications to strengthen and improve the function of the main muscle. In other situations, surgical intervention is required, after which the sensations in the left arm and heart will disappear.
- It must be said that when pain lasts more than 5 minutes, this may indicate symptoms of angina pectoris, therefore, it is necessary to consult a doctor. When sharp pain lasts more than half an hour, there is a possibility of myocardial infarction.
Heart pain can manifest itself in various ailments, not necessarily related to cardiology. Diseases of the gastrointestinal tract, respiratory system, skeleton, as well as various neurological disorders have similar symptoms.
What to do if your heart hurts? When such sensations occur, it is necessary to be able to accurately determine their nature, because in most cases the patient may require urgent qualified assistance. It is very important to know the manifestations of a heart attack, the consequences of which can be very dire.
Why does my heart hurt? Unpleasant sensations in the chest can occur in a person, regardless of his physical condition and age. Their possible causes are:
- heart pathologies;
- previous injuries;
- skeletal diseases;
- dysfunction of the respiratory system;
- pathologies arising in the gastrointestinal tract;
- nervous overstrain.
Considering the reasons described above, if discomfort occurs in the chest, the patient should figure out what exactly is hurting him. It is necessary to know what symptoms of pain in the heart indicate the development of diseases of this organ.
Development mechanism
The heart is a hollow organ that pumps blood throughout the body by contracting muscle tissue. It operates continuously throughout a person’s life, and a case of cardiac arrest is fatal.
Normal myocardial function is ensured by an adequate supply of nutrients and oxygen to the organ. If the level of blood flow in the heart muscle decreases, this triggers the breakdown of glucose without the participation of oxygen, provoking the release of lactic acid.
The organ contains many nerve endings that are irritated by high concentrations of lactic acid.
The most common cause of pain is insufficient nutrition of the heart.
Often, against the background of nerve irritation, the process of inflammation begins, localized anywhere in the organ. Depending on the cause and type of lesion, pain can be of a different nature.
How to recognize a heart attack
Heart disease can be identified by a number of characteristic signs. It should be noted that often with diseases of this organ the patient does not experience any pain or discomfort. In other cases, patients complain of heaviness in the chest, heart pain and difficulty breathing, but as a result, these symptoms are in no way related to diseases of a cardiac nature.
One of the worst causes of pain in the chest area is a heart attack. This is not a medical diagnosis, but one of the courses of cardiac diseases. If it occurs, it is necessary to take urgent measures aimed at saving the patient’s life. Therefore, it is very important to promptly recognize the following symptoms:
- Pains of a pressing and squeezing nature, localized behind the sternum and radiating to the left arm, neck, back, jaw. In this case, shortness of breath, attacks of nausea, and increased sweating may occur.
- Even with minor exertion, the patient begins to choke. We are talking not only about physical, but also about psychological factors. Usually, to relieve pain, it is enough to take Nitroglycerin.
- Shortness of breath when lying down and while eating. Before an attack, the patient suffers from insomnia or, on the contrary, he may fall asleep while sitting.
- Increased fatigue can overcome the patient a couple of months before the attack.
- Cardiac dysfunction is manifested by swelling. At first they are insignificant and are noticeable only by marks from shoes and rings on the fingers. If the patient experiences serious swelling, then this is a reason to consult a doctor.
- Erectile dysfunction in men occurs several years before ischemia is detected.
- Stopping breathing during sleep is a sure sign of a heart attack.
A heart attack can last up to half an hour. Taking Nitroglycerin is not able to improve the patient's condition.
Myocardial infarction
This disease often leads to death. It affects the heart muscle, negatively affecting the functioning of the organ. Most often accompanied by the following symptoms:
- heaviness, pain of a squeezing or pressing nature, localized in the center of the chest and spreading to the left arm;
- increased heart rate, irregular heart rhythm;
- dizziness, nausea, sometimes accompanied by vomiting;
- general weakness and anxiety;
- pale skin, increased sweating.
Another course of a heart attack is possible, in which there are no symptoms. In this case, we are talking about a silent heart attack. Signs of an extensive heart attack resemble acute heart failure, when the patient experiences suffocation, shortness of breath, blue discoloration of the fingertips and lips, accompanied by loss of consciousness. If you suspect this disease, you absolutely cannot wait.
Cardiac ischemia
For the most part, this disease manifests itself with signs of angina pectoris. Patients most often complain of heaviness and pressing sensations in the chest. Severe pain can radiate to the shoulder blade, neck, arm, lower jaw and throat. Most often this occurs due to physical exertion and stress.
Experts identify the following symptoms of the disease:
- cardiopalmus;
- nausea;
- weakness;
- irregular pulse;
- sweating
In advanced cases of the disease, attacks can appear at any time. If your heart hurts at night, then this is an unfavorable symptom.
Inflammatory heart diseases
One of the causes of a number of heart diseases is various inflammations. The differences between the ailments of this group are determined by the location of the pathological focus. Depending on its location and size, the manifestations of the disease may differ.
This disease is characterized by inflammation of the outer lining of the heart. In this case, pain occurs in the middle of the chest, which radiates to the neck, arm and back, intensifying when coughing, inhaling or swallowing. Most patients report severe pain when lying down. There is some relief when bending forward or sitting.
Most often, the pain in the heart is dull and paroxysmal, but occasionally it can become cutting. This occurs against the background of an increased heart rate.
Myocarditis
This disease is characterized by inflammation of the heart muscle, namely the myocardium. Most patients with this disease complain of pressing, aching or stabbing pain. They occur in the heart area, regardless of physical activity. They can be observed even at rest. At the same time, the drug “Nitroglycerin” does not relieve pain.
Cardiomyopathy
Almost all patients who have been diagnosed with this condition experience pain. Most often they occur in the hypertrophic form of the disease. With the development of pathology, pain sensations may change:
- At the first stage, they are long-lasting and not associated with physical activity. Localization can be almost everywhere in the upper body.
- In an advanced state, the disease manifests itself as spontaneous paroxysmal pain that occurs as a result of physical exertion. Nitroglycerin can help, although not in all cases.
Valve diseases
The symptoms of these ailments directly depend on their severity. A seriously ill person may not have any complaints. Therefore, the disease is recognized by the following signs:
- shortness of breath, as well as breathing problems that occur during exercise and in a lying position;
- discomfort in the form of squeezing and heaviness in the chest, which occurs when inhaling cold air and exertion;
- weakness, dizziness;
- arrhythmia, increased heart rate and disruptions.
Valve diseases can lead to the development of heart failure. Its symptoms are swelling of the legs, obesity, and bloating.
Other cardiac diseases
There are a number of other heart diseases that manifest themselves as follows: 
- Arrhythmia. Pain in the heart, which in advanced cases affects the arm.
- Heart defects. Regardless of the nature of the disease (congenital or acquired defect), it may not have any manifestations for many years. As symptoms, experts note pain of various natures (aching, cutting and even stabbing). In this case, swelling of the limbs and surges in blood pressure are possible.
- Aortic stenosis. At first, the patient experiences shortness of breath due to physical exertion, fatigue and general weakness. There may be irregularities in the heart rhythm and a feeling of heaviness in the chest. When the disease is complicated by coronary insufficiency, dizziness and fainting, angina pectoris and cardiac asthma are observed.
- Mitral valve prolapse. Severe pain occurs in the area of the heart, which does not depend in any way on the person’s physical activity. Most often they appear at night and in the morning, when the patient faints, becomes dizzy, the pulse exceeds the norm, and the patient himself complains of lack of air.
- Aortic diseases. Pain in the chest occurs suddenly and is described by patients as excruciating and bursting. Sometimes they reach such strength that they can lead to loss of consciousness. Therefore, the patient needs urgent hospitalization. An aortic aneurysm is accompanied by unexpressed throbbing pain that can spread to the back. If an aneurysm ruptures, the pain becomes unbearable and death is possible.
- Pulmonary embolism. The pain intensifies when inhaling. The difference between the disease and the manifestations of angina pectoris is that the pain does not spread to other places. There is a sharp drop in pressure, cyanosis of the skin, severe shortness of breath and rapid heartbeat.
Chest pain of non-cardiac origin
Very often, patients complain of severe pain in the heart, but diagnostics show that they are caused by a disease that is in no way related to cardiology. Due to the similarity of manifestations, the patient may simply confuse the symptoms, because pain in the chest area does not always indicate cardiac problems.
Intercostal neuralgia
Signs of this disease are often mistaken for heart pain. Patients with neuralgia experience symptoms similar to angina pectoris, but there are significant differences:
- The pain with neuralgia is sharp, shooting in nature.
- When moving, turning, taking sharp breaths, laughing and coughing, an increase in pain is observed.
- It is possible to have both a quick cessation of pain and a significant attack (hours or even days), when with every movement the patient’s condition may worsen.
- The localization of pain occurs between the ribs pointwise (left or right), and can radiate to the lower back, heart, back, spine.
Pain in the heart area can manifest itself in both thoracic and cervical osteochondrosis. The symptoms of this disease are in many ways similar to angina pectoris. Most often, patients complain of the following pain sensations:
- severe heart pain;
- irradiation to the left arm and the area between the shoulder blades;
- pain in the back and upper abdomen, which intensifies with inhalation and sudden movements.
When pain appears at night, it resembles heart pain, accompanied by causeless fear. The drug "Nitroglycerin" is not able to reduce discomfort.
CNS diseases
When such disorders occur, most patients complain of heart pain. Most often, they describe their condition in different ways:
- most complaints are associated with acute pain of a short-term or constant nature;
- Some patients experience aching pain and burning sensations.
This is accompanied by a number of vegetative disorders. Appears:
- general irritability;
- loss of sleep or constant drowsiness;
- anxiety;
- fever, feeling of chilliness in the extremities;
- dry or, on the contrary, too moist skin;
- discomfort in the stomach area, muscle pain and headaches.
Most often, people suffering from neuroses are able to describe false symptoms in all colors. At the same time, heart patients, as a rule, talk about their feelings extremely sparingly. Due to the absence of changes on the ECG, cardioneurosis is very often confused with coronary artery disease.
Problems associated with the gastrointestinal tract
If pain is caused by pathologies of the digestive system, then it is characterized by a longer duration than cardiac pain. In this case, heartburn, nausea and even vomiting are observed. Typically these symptoms occur after eating.
Often, with acute pancreatitis, the patient is diagnosed with a heart attack. Against the background of this disease, severe pain appears in the heart area with nausea and vomiting. Gallbladder spasms can also cause pain in the left side of the chest. Most patients mistakenly attribute this to heart disease, when they need completely different treatment.
The way your heart hurts may indicate the development of a certain disease, not necessarily of a cardiac nature. The features of the manifestation of most ailments that cause discomfort in the chest area were described above. This knowledge will help the patient recognize the first signs of the disease and understand that he needs urgent treatment.
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