Chest Pain

Causes

Causes of left sided chest pain - 

In the left half of the chest cavity there is a heart with great vessels, so the pain syndrome is often caused by cardiac pathology. Sensations range from mild discomfort that develops with physical activity to severe chest pain, forcing the patient to remain still. Most often, chest pain on the left is caused by:

•    Coronary syndrome : myocardial infarction , stable and unstable angina.
•    Inflammatory heart disease: infective endocarditis, rheumatism , myocarditis.
•    Violations of the conduction system of the heart: arrhythmias , extrasystole , paroxysmal tachycardia.
•    Increase in blood pressure.
•    Cardiac manifestations of collagenoses: systemic lupus erythematosus , dermatomyositis, vasculitis.
•    Dissecting aortic aneurysm .
•    Respiratory diseases: left-sided croupous or focal pneumonia , left-sided pleurisy, tuberculosis.
•    Diaphragmatic hernia .
•    Damage to the abdominal organs: splenomegaly, acute and chronic pancreatitis , trauma to the spleen.
•    Rare causes: tumors (lung, bronchi and pleura), peptic ulcer .
Causes of right sided chest pain-

The symptom is most often associated with damage to the respiratory system. The pain syndrome is constant, intense, sometimes patients have to take a forced position on their side. The chest begins to hurt more with deep breaths, sharp turns of the body, coughing fits. Common causes of right sided chest pain:

•    Infectious processes : right-sided bacterial or viral pneumonia, purulent bronchitis .
•    Pleurisy : dry, exudative .
•    Injuries : chest contusions, hemothorax and pneumothorax , lung contusion.
•    Pathologies of the biliary system : cholecystitis , biliary dyskinesia, cholelithiasis.
•    Liver damage : viral hepatitis, neoplasms, echinococcal cysts .

Causes of chest pain-

When the chest hurts in the middle, and discomfort radiates up the esophagus, this often indicates a pathology of the upper digestive system, but may be a sign of other diseases. Patients note an increase in symptoms with torso tilts, sudden movements. The main causes of chest pain:

•    Gastroesophageal reflux .
•    Damage to the thoracic esophagus: esophagitis , esophageal sphincter dyskinesia, esophagus spasm.
•    Pathology of the stomach: hyperacid gastritis , peptic ulcer.
•    Respiratory system dysfunctions: tracheitis, bronchitis, bronchial asthma .
•    Heart disease : Pericarditis endocarditis, myocarditis.
•    Volumetric formations of the mediastinum: pathology of the thymus (hyperplasia, cyst, thymoma ), lymphoproliferative syndromes ( hodgkin's lymphoma , non-Hodgkin's lymphomas), granulomatous processes ( sarcoidosis , tuberculosis, silicosis).
•    Complications of pharmacotherapy: long-term use of NSAIDs, corticosteroids, absorbable antacids.
•    Rare causes: Zollinger-Ellison syndrome, osteochondrosis , intercostal neuralgia.
Causes of breast pain-

There are two types of pain in the breast: cyclic, associated with the menstrual cycle, and non-cyclic, indicating the development of the disease. Pain syndrome during hormonal changes occurs symmetrically on both sides, and local pathological processes usually cause unilateral discomfort. There are such causes of pain in the mammary glands, such as:

•    External factors: improperly selected bra, tight clothing in the chest.
•    Physiological conditions: a few days before the onset of menstrual bleeding, during pregnancy and lactation.

•    Inflammation of the mammary gland: lactational mastitis , purulent mastitis, breast abscess.

•    Fibrocystic mastopathy: nodular and diffuse forms.
•    Nipple involvement: inflammation, eczema , Paget's cancer.
•    Benign tumors: fibrolipoma, intraductal papilloma, adenoma .
•    Malignant neoplasm: intraductal carcinoma, tubular carcinoma, papillary carcinoma.

•    Complications of pharmacotherapy: pain after taking oral contraceptives, antipsychotics and antidepressants.

Causes of pain in the ribs-

In such cases, chest pain occurs on one or both sides, pain is often sharp, shooting. Soreness is aggravated by the slightest movement, careless touch, wearing tight clothing. Some patients find it difficult to breathe. The following are the most prevalent causes of rib pain:

•    Intercostal neuralgia.
•    Herpes zoster.
•    Injuries: severe chest bruises, rib fractures.
•    Costal chondritis ( Tietze's syndrome).
•    Diseases of the vertebrae : osteochondrosis, intervertebral hernia , kyphoscoliosis.
•    Muscle damage : fibromyalgia , muscle strain, physical overexertion.
•    Osteosarcoma of the ribs .

Treatment

Help before diagnosis

In case of minor discomfort, it is enough to remain calm for several days, avoid physical exertion and overwork. For pain in the mammary glands before menstruation, patients are advised to wear soft, comfortable bras and take NSAIDs. With an intense pain syndrome or the addition of other pathological symptoms, it is necessary to consult a doctor who will find out why the chest hurts. If the pain is accompanied by loss of consciousness, cyanosis of the skin and cold sweat, the person needs emergency medical care.

Conservative therapy

Medical tactics depend on the cause of the development of thoracalgia, in the case of diseases of the internal organs, etiotropic treatment is carried out, with unbearable pain, it is supplemented with analgesics. The chest hurts less after the use of warm compresses, electrophoresis with anti-inflammatory and analgesic drugs. To eliminate the cause that caused the pain syndrome, medicines of the following groups are used:

•    Non-steroidal anti-inflammatory drugs. NSAIDs are the drugs of choice for rheumatic processes, they can stop the symptoms and maintain a stable remission. In bronchitis and pneumonia, they reduce the production of inflammatory mediators and relieve pain.

•    Antianginal drugs. If it hurts in the pericardial region of the chest, the drugs improve the blood supply to the myocardium, increase the delivery of oxygen to the cell. Means also normalize heart rhythm, reduce the risk of heart attack. Apply calcium channel blockers, beta-blockers.

•    Antibiotics. Etiotropic drugs are indicated for pneumonia, purulent bronchitis and pleurisy.  Antibiotics reduce the activity of the inflammatory process, due to which the pain in the chest subsides.

•    Antacids. Means lower the acidity of gastric juice, therefore, are effective in gastroduodenal reflux and hyperacid conditions. When taking antacids, the irritating effect of hydrochloric acid on the mucosa of the esophagus decreases, and pain is eliminated.

•    Hormonal preparations. Estrogen drugs are used to treat severe pain in both breasts during the premenstrual period. Hormones of the adrenal cortex are recommended in case of severe rheumatic diseases, in which the chest and heart hurt.
•    Cytostatics. The drugs are used for various oncological pathologies. Their action is aimed at destroying cancer cells and slowing down the growth of tumor tissue. Combinations of 2-3 drugs are most effective, the duration of administration depends on the stage and degree of response to chemotherapy.

Tests Required for Diagnosis

To verify the diagnosis, the musculoskeletal system and internal organs are examined. The main methods are instrumental methods of visualization of anatomical structures, to clarify the cause of thoracalgia, laboratory diagnostics are performed. The most informative methods:

•    Electrocardiography. To exclude or confirm the cardiac etiology of pain in the left side of the chest, an ECG is recorded in standard leads. Expansion and deformation of the complexes, elevation of the ST interval indicate myocardial ischemia. For the diagnosis of arrhythmias, Holter monitoring is carried out.

•    Ultrasound Research. Echocardiography ( EchoCG ) is necessary if the chest hurts on the left side. Evaluate the contractile function of the heart muscle, ejection fraction, signs of destructive lesions of the valvular apparatus. Abdominal ultrasound is used to detect diseases of the spleen, pancreas, or gallbladder that cause thoracalgia.

•    Radiography. On chest radiographs, one can detect focal processes in the lung tissue, volumetric formations of the lungs and mediastinum, which are usually the etiological factor of chest pain. Women are scheduled for mammograms. Plain radiography of the gastrointestinal tract is recommended for the detection of diaphragmatic hernia, ulcerative defects.

•    Endoscopic methods. To diagnose damage to the esophagus that provokes pain in the chest, EGDS is performed. During the study, the state of the mucous membrane, the contractility of the cardiac sphincter are studied. In case of severe damage to the respiratory system, bronchoscopy is indicated to examine the mucosa 

In general and biochemical blood tests, signs of inflammatory processes, pathologies of the liver and biliary system are detected. Bacteriological culture of sputum and bronchial washings is necessary to determine the type of pathogen. In women, the concentration of sex hormones is determined. If unbearable pain in the chest is felt and cancer is suspected, a biopsy of a suspicious formation is performed for cytological analysis.
 

Useful info

Surgery

Pain in the chest area associated with complicated fractures of the ribs or spine requires surgical intervention - open reposition of fragments with fixation by bone osteosynthesis. With purulent mastitis, opening and drainage are shown, washing the wound with antiseptics. Oncological causes of pain syndrome serve as the basis for radical operations. To prevent recurrences, the affected organ, adjacent tissue and regional lymph nodes are removed.