Chest pain

Definition: Chest pain

Chest pain is usually caused by the anatomical structures of the chest (thorax) .

The bony wall of the chest consists of the breastbone, ribs and spine. The so-called bony thorax is surrounded by muscles and is separated from the abdomen by the diaphragm.

The bony thorax contains the chest cavity with the vital organs heart and lungs , as well as important vessels such as the main artery (aorta) , which supplies the body with blood.

In addition, the trachea and esophagus run through the thorax and transport air to the lungs on the one hand and chyme to the stomach on the other.

Symptoms of chest pain

Chest pain (chest pain) may be
stabbing,

• burning,
• dull or
• as a feeling of pressure

appear. Severe pain that occurs particularly suddenly indicates an acute illness.

Causes of Chest Pain

Below are the most common causes of chest pain:

• Chest wall syndrome: Chest pain can occur in the context of musculoskeletal disorders . In this case, the pain is due to diseases of the muscles or bones. Local muscle tension and stabbing pain, which intensifies when palpating, speak for the presence of a chest wall syndrome.
• Tension in the muscles: Tension in the back and chest muscles can occur after sporting activities or as a result of an unfavorable posture . The pain usually occurs with movement.
• Vertebral blockages: In the case of vertebral blockages, movement of the spine is restricted in connection with severe pain in the chest. The pain worsens when laughing, coughing and breathing.
• Intercostal neuralgia: Intercostal neuralgia causes burning and stabbing chest pains originating in the intervertebral nerves. The nerve irritation can be caused, for example, by shingles or as part of a vertebral body inflammation.
• Chronic coronary heart disease (CHD): Heart pain (angina pectoris) is typical of coronary heart disease, which is particularly evident during physical exertion. The symptoms usually go away again as soon as a drug is inhaled. The circulatory disorder of the heart muscle is caused by atherosclerotic changes in the coronary arteries.
• Heart attack (acute coronary syndrome): An acute coronary syndrome describes reduced blood flow to the heart as a result of atherosclerotic narrowing of the coronary arteries. With a sudden onset, the pain associated with a heart attack usually occurs in the middle to left at the level of the heart under the breastbone. Patients describe the pain as dull and oppressive, sometimes the pain radiates to the left arm, back, upper stomach and jaw. The pain is not breath dependent. In addition, vegetative symptoms such as cold sweats, pallor, nausea , shortness of breath and sometimes fear of death may exist. How to recognize the signs of a heart attack.
• Psychogenic causes: Functional heart problems that cannot be assigned to any organic cause can occur in the course of mental illness. The symptoms can occur as part of a panic attack , an anxiety disorder , depression or a particularly stressful situation . The chest pain can cause great discomfort to those affected and its symptoms can be reminiscent of a heart attack. In addition to chest pain, you may experience increased heart rate, anxiety, and shortness of breath.
• Pulmonary embolism: Triggered by a blood clot that blocks the pulmonary arteries, pulmonary embolism is also a life-threatening disease. The main risk factor is being bedridden for several days or an operation within the last few days. The chest pain comes on very suddenly and may be accompanied by shortness of breath and coughing. Classically, the pain affects only one side and usually has a stabbing character.
• Aortic dissection: Sudden stabbing chest pain may indicate an aortic dissection. The disease causes a tear in the vessel wall of the main artery (aorta) with bleeding into the vessel wall. The tearing pain occurs acutely and can radiate to the neck , back and stomach. The pain is so severe that affected patients often describe it as the pain of annihilation. Shortness of breath and coughing can also occur.
• Pneumothorax: A pneumothorax describes an acute condition in which air enters the space between the lungs and pleura. Because the negative pressure that normally allows the lungs to expand is removed, the affected lung collapses. The stabbing chest pain tends to occur on one side and is often accompanied by acute shortness of breath and coughing.
• Lung cancer: A malignant tumor disease of the lungs can become noticeable through chest pain. Other symptoms such as coughing up blood, hoarseness , weight loss, night sweats and fever can indicate cancer.
• Obstructive airways diseases: Obstructive airways diseases such as asthma and COPD can also sometimes lead to chest pain.
• Cardiac tamponade (pericardial tamponade): Pericardial tamponade results in life-threatening compression of the heart in the pericardium. The pain begins abruptly and is usually below the breastbone. Additional symptoms may include hoarseness, difficulty swallowing, and vomiting .
• Inflammation of the heart sac (perimyocarditis): Inflammation of the heart muscle can lead to stabbing chest pains, which typically worsen when lying down, coughing and deep breathing. Heart muscle inflammation can occur as a result of an infection.
• Cardiac arrhythmias: Arrhythmias, such as absolute tachyarrhythmia, can manifest themselves as tachycardia, chest pain and an irregular heartbeat.
• Heart failure: In heart failure, the heart is no longer able to pump enough blood around the body. This results in edema, nocturnal urination and shortness of breath under stress, from which those affected suffer.
• Hypertension: Very high blood pressure can cause chest pain, dizziness, headaches , nausea, and nosebleeds.
• Heart valve diseases : If there is a narrowing of the aortic valve (aortic stenosis), chest pain, loss of consciousness and shortness of breath during exertion can sometimes occur.
• Infections of the respiratory tract: Inflammation of the lungs (pneumonia) or inflammation of the bronchi (bronchitis) can also manifest as chest pain. The pain worsens with deep breaths. Fever, shortness of breath and a dry to mucous cough are also often noticeable.
• Inflammation of the pleurisy (pleuritis): If the pulmonary lining becomes inflamed as a result of pneumonia, for example, chest pain and fever can occur as symptoms. The pain worsens when breathing and also when coughing.
• Mediastinitis: Inflammation of the mediastinum can occur as a result of an abscess in the throat area. The life-threatening disease typically manifests itself with severe chest pain, fever and clouding of consciousness.
• Esophagus tear (Boerhaave’s syndrome): A wall tear of the esophagus usually occurs after a strong gagging stimulus or as a result of a gastroscopy. Boerhaave syndrome presents with a stabbing, annihilating pain that can be felt under the breastbone.
• Gastroesophageal Reflux Disease: In reflux oesophagitis , or heartburn , gastric juice rises up into the esophagus, causing burning and pressure, accompanied by acid regurgitation and chest pain. The symptoms often occur after drinking alcohol or acidic foods and improve when taking acid-suppressing medication.
• Gastroduodenal ulcer disease: The tissue defect of the gastric mucosa occurs with stomach and chest pain in temporal connection with a meal. Ulcers often occur as a result of long-term use of painkillers when using NSAIDs (such as ibuprofen, diclofenac…).
• Inflammation of the pancreas (pancreatitis): A belt-shaped upper abdominal pain is the main symptom of pancreatitis.
• Gallbladder stones (cholecystolithiasis): Gallstones in the gallbladder can lead to severe periods of pain (biliary colic) accompanied by nausea and vomiting.
• Inflammation of the gallbladder (cholecystitis): Inflammation of the gallbladder is more likely to cause long-term severe upper abdominal and chest pain.
• Anemia: In the case of anemia , insufficient oxygen can be transported to the organs. The disease manifests itself with tiredness , exhaustion, shortness of breath, and more rarely chest pain.
• Diaphragmatic hernia: One speaks of a diaphragmatic hernia when parts of the gastrointestinal tract advance through a pathological opening in the diaphragm into the chest. For example, part of the stomach can slide out of the abdominal cavity into the chest cavity and lead to massive problems there.
• Shingles (herpes zoster): The varicella-zoster virus causes chickenpox at a young age, then remains in the body for life and appears as shingles in later years. The resurgence of the virus leads to nerve inflammation with the development of small blisters on reddened skin at the superficial nerve extensions. The liquid contents of the vesicle are highly contagious to non-immune people. Patients with shingles complain of severe pain and sensory disturbances, which usually go far beyond the visibly inflamed area of ​​the skin and are in the supply area of ​​the diseased nerves.

Chest pain: what happens at the doctor’s?

In order to make the correct diagnosis, the doctor treating you will ask you a few precise questions about your symptoms during the brief anamnesis interview . The anamnesis interview will include the following questions:

• How long has the pain been there? → In the context of an acute, life-threatening illness, the pain usually occurs very suddenly.
• Is the pain worse with exertion? → This could indicate the presence of coronary heart disease, in which increasing calcification of the coronary arteries leads to the symptoms. Because of a possible heart attack risk, there is an urgency for a medical assessment.
• Is the pain related to breathing? → Respiratory pain that worsens with deep breathing or coughing is often due to a cause affecting the lungs, such as pneumonia or pneumothorax.
• Is the chest pain associated with eating? → This could be an indication of a disease of the esophagus or stomach.

This should be followed by a physical examination , during which the doctor listens to the heart and lungs. In addition, he will examine your vital signs, which include blood pressure, pulse and body temperature.

A blood test can also provide information about the cause, since certain enzymes in the blood are increased during a heart attack, for example.

In addition, the doctor treating you will carry out an electrocardiogram (ECG) , in which the heart activity is recorded electrically.

A chest X-ray can be used to detect, for example, inflammation of the lungs, pathological accumulations of fluid, changes in the contours of chest organs (heart, aorta, lymph nodes, lungs, etc.).

An echocardiography describes an ultrasound examination of the heart. This can be used for further examination of diseases of the heart structure, the heart valves and its mobility. Here, for example, the first indications of the very dangerous aortic dissection could be found. The ultrasound probe is first guided along the left thorax in the vicinity of the left breast. In special cases, a so-called endosonography with a probe guide as in an esophagus endoscopy can be useful. (This is usually done under local anesthetic and sedative medication).

If another cause is suspected, further imaging examinations such as a lung reflection (bronchoscopy) , a gastroscopy (gastroscopy) or a computed tomography (CT) may be necessary.

How is chest pain treated?

Treatment for chest pain depends entirely on the underlying cause.

In principle, the risk potential and the acuteness are decisive for the required measure.

In the event of a heart attack , immediate medication and prompt heart catheter treatment, which may save the situation, is necessary.

A blood coagulation disease with subsequent pulmonary embolism usually requires emergency drug therapy, very rarely surgical intervention.

If heartburn (reflux oesophagitis) is present, in addition to acid-inhibiting medication such as proton pump inhibitors, a change in lifestyle can help.

In the case of spinal column-related chest pain, depending on the cause and symptoms, drug-based pain therapy and physiotherapeutic treatment can improve the condition. If necessary, a specialist diagnosis will be initiated by the assessing doctor.

Shingles requires early virus-killing drug therapy to avoid dangerous complications and alleviate suffering. There is a therapy standard here that is generally very effective, but requires a few doctor contacts over the course of the disease.

Chest pain: what you can do yourself

As is well known, one’s own influence lies in one’s own lifestyle and often in the required medication, which is usually only of short-term help.

The appropriate lifestyle changes that will help in the long term can be discussed with the doctor. This is about scientifically proven connections between unfavorable traditions and everyday conditions such as eating habits, nicotine and alcohol consumption , misuse of medicines, drug abuse, frequent PC workstations with a lack of physical activity , work-related physical compulsions, e.g. in the trades, etc.. With courage and inventiveness, Incorporate many beneficial elements into everyday life that alleviate suffering. This includes sports activities, relaxation measures, the choice of suitable foods and meal sizes and the weaning of bad habits and dependencies.

In the doctor’s consultation, one’s own risk history, lifestyle and professional risk environment can be explored and specific measures can be recommended.

Sufferings such as heartburn can be alleviated directly with home remedies

• Avoid later meals before bedtime,
• drinking a lot and
• distributing the amount of food over many small meals a day.

Wearing tight clothing that puts pressure on the stomach and avoiding heavy loads also reduces the risk of acidic stomach contents surging up the esophagus and causing heartburn. Buffering (high-protein) foods such as quark dishes can also help in the short term.

If the cause of the symptoms is muscle tension , a warm bath, a hot-water bottle or a massage can relieve the chest pain.

When using painkillers at home as needed, a doctor’s consultation should have checked the suitability of the medication beforehand. For example, ibuprofen, diclofenac, aspirin are not suitable for treating stomach or esophagus problems. In addition, there are a variety of reasons why a doctor must check whether on-demand therapy with painkillers makes sense.

Chest pain: when is it an emergency?

If you experience chest pain with any of the following symptoms , dial 911 . At the rescue center, the applicable criteria are used to weigh up whether immediate rescue service instruction, possibly with an emergency doctor, is necessary – or whether a family doctor, possibly presentation to the medical on-call service (family doctor representative), can take place:

• if you have a chronic disease such as coronary heart disease, aneurysm, a coagulation disorder, etc. with new or worsened symptoms
• Acute pain in your chest occurs for the first time .
• The pain changes in strength or location.
• The pain radiates to the shoulder, back, arm, or jaw .
• In addition to the chest pain, you notice fever , dizziness or a general feeling of illness
• In addition to the chest pain, shortness of breath, pallor, cold sweats or fear of death occur.
• You have severe chest discomfort and a pronounced feeling of illness

How can Med-Healths help with chest pain?

If your chest pain has already been clarified by a doctor and a serious illness has been ruled out as the cause, you can use the Med-Healths App to get in touch with our doctors.

In a personal video call, she or he will talk to you about possible triggers for your symptoms and answer your questions about chest pain. There is also the option of prescribing medication via the app, issuing an online sick note for the employer and, if necessary, referring you to a suitable specialist practice.