Pressing pain behind the breastbone. Why does the chest hurt a lot when moving and at rest

- the most important symptom acute diseases organs of the chest and one of the most frequent reasons treatment of patients with a doctor; often in these cases, emergency assistance is required.

It should be emphasized that acute chest pain, appearing in the form of an attack, may be the earliest and, up to a certain point, the only manifestation of the disease requiring emergency care; such a complaint should always alert the doctor.

Such patients should be examined especially carefully, and in most cases, on the basis of anamnesis, examination data and ECG, the correct diagnosis can be made already at the prehospital stage.

Causes of sudden acute chest pain

The main causes of pain localized by patients in the chest are as follows.

Heart disease

• acute myocardial infarction,
• angina pectoris,
• pericarditis,
• myocardial dystrophy.

Vascular disease

• dissecting aortic aneurysm,
• pulmonary embolism (PE).

Respiratory diseases

• pneumonia,
• pleurisy,
• spontaneous pneumothorax.

Diseases of the digestive system

• esophagitis,
• hiatal hernia,
• stomach ulcer.

Diseases of the musculoskeletal system

• chest sciatica,
• chest trauma.

Other diseases

• Shingles.
• Neuroses.

Sudden and acute chest pain can be a symptom of the following conditions

Sudden, sharp chest pain with heart attack

The main task in carrying out a differential diagnosis in a patient with acute chest pain is to identify prognostically unfavorable forms of pathology in the first place.

Acute strong squeezing, squeezing, tearing, burning pain behind the sternum or to the left of it is the most important symptom of this formidable disease. The pain can appear during exertion or at rest in the form of an attack, or frequently repeated attacks.

The pain is localized behind the sternum, often capturing the entire chest, irradiation is characteristic to the left shoulder blade or to both shoulder blades, back, left arm or both arms, neck. Its duration is from several tens of minutes to several days.

It is very important that pain during a heart attack is the earliest and until a certain moment the only symptom of the disease, and only later do characteristic ECG changes appear (elevation or depression of the ST segment, inversion of the T wave and the appearance of a pathological Q wave).

It is often accompanied by the following symptoms:

• shortness of breath
• nausea
• vomiting
• weakness
• increased sweating,
• heartbeat
• fear of death.

The lack of effect with repeated administration of nitroglycerin is characteristic. To relieve pain or reduce its intensity, narcotic analgesics have to be re-administered.

Sudden, sharp chest pain with angina

Short-term acute compressive pain behind the sternum or to the left of it, appearing in the form of attacks, is the main symptom of angina pectoris. Pain with angina pectoris can radiate to the left arm, left shoulder blade, neck, epigastrium; unlike other diseases, irradiation into the teeth is possible and lower jaw.

Pain occurs at the height of physical exertion - when walking, especially when trying to go faster, climbing stairs or uphill, with heavy bags (exertional angina), sometimes as a reaction to a cold wind.

The progression of the disease, further deterioration of the coronary circulation lead to the appearance of angina attacks with less and less physical activity and then alone. With angina pectoris, the pain is less intense than with myocardial infarction, much less prolonged, usually lasts no more than 10-15 minutes (it cannot last for hours) and is usually relieved at rest when taking nitroglycerin.

Pain in the chest, appearing in the form of seizures, long time may be the only symptom of the disease. On the ECG, signs of a previous myocardial infarction can be recorded, at the time of a painful attack - signs of myocardial ischemia (depression or elevation of the ST segment or T wave inversion).

It should be noted that ECG changes without a corresponding history cannot be a criterion for angina pectoris (this diagnosis is made only with careful questioning of the patient).

On the other hand, a careful examination of the patient, including electrocardiographic examination, even during a painful attack may not reveal significant abnormalities, although the patient may need urgent help.

In cases where acute, sharp, constricting pain behind the sternum or in the region of the heart with irradiation in left shoulder, the lower jaw develops at rest (usually in sleep or in the morning), lasts 10-15 minutes, is accompanied by an ST segment elevation at the time of an attack and is quickly stopped by nitroglycerin or nifedipine (corinfar), you can think of variant angina (Prinzmetal's angina).

Chest pain, indistinguishable from angina pectoris in nature, occurs with stenosis of the aortic opening. The diagnosis can be made on the basis of a characteristic auscultatory picture, signs of severe left ventricular hypertrophy.

Sudden, sharp chest pain with pericarditis

The pain occurs acutely, often against the background of a hypertensive crisis or during stress (physical or emotional), localized behind the sternum with irradiation along the spine, sometimes spreading along the aorta to the lower abdomen and legs.

It has a tearing, bursting, often wavy character, lasts from several minutes to several days. Pain can be accompanied by asymmetry of the pulse in the carotid and radial arteries, rapid fluctuations blood pressure(BP) from a sharp rise to a sudden drop up to the development of a collapse. There is often a significant difference in blood pressure on the left and right hands, corresponding to the asymmetry of the pulse.

Due to the deposition of blood under the intima of the aorta, signs of anemia are growing. Differential diagnosis with acute heart attack myocardium is especially difficult in cases when ECG changes appear - nonspecific or in the form of depression, sometimes ST segment elevation (although without the cyclicity of ECG changes characteristic of myocardial infarction during dynamic observation).

Repeated administration of narcotic analgesics, including intravenous administration, often does not relieve pain.

Sudden, acute chest pain with pulmonary embolism

In this case, there is an acute, intense pain in the center of the sternum, right or left half of the chest (depending on the localization of the pathological process), which lasts from 15 minutes to several hours. The pain may be accompanied by severe shortness of breath, a drop in blood pressure, in every tenth patient - fainting (syncope).

On the ECG, signs of an overload of the right heart can be recorded - a high pointed P wave in leads II, III, and VF, deviation of the electrical axis of the heart to the right, McGin-White sign (deep S wave in standard lead I, deep Q wave in lead III ), incomplete blockade of the right bundle branch block. The pain is relieved by narcotic analgesics.

In lung disease, chest pain is usually associated with breathing. Localization of pain in pleuropneumonia, pulmonary infarction depends, as a rule, on the location of the inflammatory focus in the lungs.

Respiratory movements, especially a deep breath and coughing, lead to increased pain, which in these diseases is caused by irritation of the pleura. In this regard, when breathing, patients usually spare the affected side; breathing becomes shallow, the affected side lags behind.

It should be emphasized that with pleuropneumonia and pleurisy in the first hours and days of the disease, pain is often the main subjective symptom, against which other manifestations of the disease are less significant for the patient.

Percussion and auscultation of the lungs are essential for making a correct diagnosis. objective signs pulmonary pathology. Pain associated with pleural irritation is well controlled by non-narcotic analgesics.

Sudden, acute chest pain with spontaneous pneumothorax

When spontaneous pneumothorax pain is usually prolonged, most pronounced at the time of development of pneumothorax, increases with breathing, later on, shortness of breath comes to the fore.

Pain is accompanied by the following symptoms:

• pallor of the skin,
• weakness
• cold sweat
• cyanosis
• tachycardia,
• decrease in blood pressure.

Lagging of half of the chest during breathing and tympanitis detected during percussion on the side of the lesion are characteristic, breathing over these sections is sharply weakened or not heard.

On the ECG, you can see a slight increase in the amplitude of the R wave in chest leads or a sharp change in the electrical axis of the heart.

The appearance in a patient with pneumonia of the sharpest pain in the chest, combined with severe shortness of breath, intoxication, sometimes collapse, is characteristic of a breakthrough of a lung abscess into pleural cavity and the development of pyopneumothorax. In such patients, pneumonia from the very beginning may have the character of abscess, or the abscess develops later.

Sudden acute chest pain with diseases of the esophagus

For acute pain in the chest due to diseases of the esophagus (ulcerative esophagitis, damage to the mucous membrane foreign body,), localization along the esophagus, a connection with the act of swallowing, the appearance or a sharp increase in pain when food passes through the esophagus, a good effect of antispasmodics and local anesthetics are characteristic.

The antispasmodic effect of nitroglycerin determines its effectiveness in pain syndrome due to esophageal spasm, which can complicate differential diagnosis with an attack of angina pectoris.

Prolonged pain in the lower third of the sternum at the xiphoid process, often combined with pain in the epigastric region and usually arising immediately after eating, may be caused by a hernia of the esophageal opening of the diaphragm with the outflow of the cardiac stomach into the chest cavity.

In addition, these cases are characterized by the appearance of pain in the sitting or lying position of the patient and its decrease or complete disappearance in the upright position. Usually, when questioned, signs (heartburn, increased salivation) and good exercise tolerance are revealed.

Antispasmodic and antacids are effective (for example, maalox, rennie, etc.); nitroglycerin in this situation can also relieve pain. Often, pain caused by diseases of the esophagus or, in terms of localization, and sometimes in nature, resembles pain in angina pectoris.

Difficulty in differential diagnosis is aggravated by the effectiveness of nitrates and possible electrocardiographic changes (negative T waves in the chest leads, which, however, often disappear when recording an ECG in a standing position).

It should also be borne in mind that with these diseases, true attacks of reflex angina pectoris are often observed.

Sudden, sharp chest pain with radiculitis

Acute, prolonged chest pain associated with trunk movement (bending and twisting) is the main chest symptom.

Pain in sciatica, in addition, is characterized by the absence of paroxysms, increased by hand movements, tilting the head to the side, deep inhalation and localization along the nerve plexuses and intercostal nerves; in the same place, as well as on palpation of the cervicothoracic spine, severe pain is usually determined.

When determining local pain, it is necessary to clarify with the patient whether this is the pain that forced him to seek medical help, or it is another, independent pain.

Taking nitroglycerin, validol almost never reduces the intensity of pain, which often subsides after the use of analgin and mustard plasters.

Sudden, sharp chest pain from chest trauma

With a chest injury, diagnostic difficulties may arise in cases where the pain does not appear immediately, but after a few days. However, indications of a history of trauma, a clear localization of pain under the ribs, its intensification during palpation of the ribs, movement, coughing, deep inspiration, that is, in those situations where some displacement of the ribs occurs, facilitate recognition of the origin of pain.

Sometimes there is a discrepancy between the intensity of pain and the nature (strength) of the injury. In such cases, it should be borne in mind that with the lightest injury, latent pathology bone tissue ribs, for example, with their metastatic lesion, myeloma.

X-ray of the ribs, spine, flat bones of the skull, pelvis helps to recognize the nature of bone pathology.

Sudden, sharp chest pain with shingles

Acute pain along the intercostal nerves is characteristic of. Often the pain is so strong that it deprives the patient of sleep, is not relieved by repeated administration of analgin, and is somewhat reduced only after the injection of narcotic analgesics. Pain occurs earlier than the typical skin rash of shingles, making diagnosis difficult.

When a person has pain in the chest area, the first thing they do is simply to eliminate the unpleasant sensation to make it easier. But it is not always possible to do this, since it is important to get rid of the cause of the development of pain syndrome.

Therefore, it would be more correct to consult a doctor for an examination and identify the culprit of the symptom. What can cause a person to be bothered by chest pain in the middle? What to do in such a situation?

Pain in the middle of the chest

Possible reasons

Pain in the middle of the breastbone can bother a person for various reasons. It can be directly related to pathologies. of cardio-vascular system, but sometimes diseases of other organs located in the chest are the culprits.

Coronary artery disease

This is a common disease that often causes the patient to become disabled or die. This pathology leads to oxygen deficiency in muscle tissue hearts due to constriction coronary arteries.

Modern medicine doesn't know drugs or operational techniques that could completely get rid of this ailment. The methods used only help to keep the disease under control, slowing down its progression. Pathology can occur in both acute and chronic form, which determines the severity of clinical manifestations.

IHD is accompanied by the following symptoms:

• olives behind the chest of a dull, pressing or burning character, which are given to the hand, scapula, cervical region;
• retrosternal pulsation;
• high pressure;
• headache;
• swelling;
• pallor of the skin.

If a person has such unpleasant symptoms, you need to immediately stop moving, it is best to lie down, calm down, and stabilize breathing. If the room is too cold, you will need to take cover, because the cold can intensify the attack.

As a rule, chest pain disappears without the use of special means. But if the symptom persists, then you can take a nitroglycerin tablet. It is placed under the tongue and kept there until it dissolves. After a few minutes, the discomfort should go away. If this does not happen, be sure to call a doctor. Pain in the sternum in men in the center of the cell is a dangerous phenomenon that can be a sign of myocardial infarction. It is the stronger sex that is more susceptible to this disease.

Pain that worsens while lying down and with a deep breath can be a sign of pericarditis (inflammation of the bursa).

Ischemia

Aortic aneurysm

Aortic aneurysm is a serious condition that is life threatening. Its essence lies in the expansion of certain areas of the aorta, while its walls become thin. As a result, strong pressure is exerted on them, the tissues are damaged, which provokes rupture and bleeding. In this case, it is important to provide timely medical assistance otherwise the patient will die.

Aneurysm almost always proceeds without symptoms, so the patient may not be aware of the pathology for years. But when she goes into severe degree, the main blood vessel is greatly enlarged, presses on nearby organs, so the patient is tormented by pain behind the chest.

The disease causes the following symptoms in a person:

• pain behind the sternum of a sharp, throbbing character;
• pain in the back, passing along the spine;
• choking, cough;
• pale skin color;
• low blood pressure;
• heart rhythm disturbances;
• darkening in the eyes;
• general deterioration.

What to do with middle chest pain? If a person has an attack, then you need to call ambulance... Before her arrival, take a recumbent position in such a way that top part the body was somewhat elevated. Do not drink any medicines, as they can lead to bleeding. The patient must be hospitalized and prescribed surgery.

Aortic aneurysm

Vegeto-vascular dystonia

Vegetative disorders are observed in patients due to psychoemotional overstrain, disruption in activity nervous system, genetic predisposition. As a rule, the pathology is mild, so hospitalization is not required. But sometimes the VSD becomes severe, as a result of which the working capacity suffers greatly. Then a person can already be admitted to a hospital.

The symptoms of the disease are as follows:

• sudden chest pain that is pressing or constricting;
• frequent heartbeat;
• lack of air;
• panic attacks;
• pressure drops;
• low body temperature;
• nausea, vomiting;
• stool problems;
• dizziness;
• sleep disorders;
• depression.

In addition to pain in the heart on the left side, patients note a constant sensation of coldness in lower limbs and on the fingers, excessive sweating, pain in the abdomen. But when a person is examined, no deviations in the indicators are detected.

The attack of pain behind the chest can last two to three minutes, but sometimes it lasts for several days. In this case, the pain either weakens or intensifies. Most often, symptoms appear after extreme excitement or physical exertion.

Read also: Why it occurs, what do these symptoms mean?

Osteochondrosis of the thoracic region

This pathology can affect the intervertebral discs in the thoracic spine. The development of the disease provokes the destruction of the tissues of the discs, because of which they can no longer perform a shock-absorbing function, and a change in the structure of the bones - their rapprochement with each other.

As a result, the nerve endings are compressed, which leads to pain. She can give in different areas spine, increase with physical activity, sudden movements, lifting heavy loads and even when a person just sneezes or coughs.

Pain in the chest when inhaling - characteristic symptom musculoskeletal problems. In this case, the sensations do not go away for several days, in contrast to pain in the heart. They give in to analgesics, but nitroglycerin, validol does not help.

Osteochondrosis

Gastritis

This disease develops in the stomach, located in the chest, and therefore pain is felt in the same area. Gastritis is inflammatory process in the digestive organ, which leads to the development of unpleasant symptoms after eating, including “heart” pain behind the sternum on the left.

There is a pathology of the stomach due to the use of junk food, alcohol, uncontrolled intake of certain medications and other reasons.

Gastritis is accompanied by the following manifestations:

• heartburn;
• belching with a sour substance;
• feeling of burning pain behind the chest;
• violation of swallowing function.

If the pathology is not treated, then you can earn dangerous complications: ulcer, aspiration pneumonia, cancer.

Gastritis

Other causes of pain

Also, chest pain sometimes occurs as a result of a spinal injury as a result of an accident, a fight, or a fall. In this case, the danger lies in the fact that a person may not immediately understand that he has a serious injury.

Another culprit behind the pain behind the sternum can be damage to the diaphragm. This organ separates the chest cavity from the abdominal cavity. With severe ruptures, internal bleeding can begin, which poses a serious danger to human life. In this case, urgent help is needed.

Chest pain with a deep breath often worries people who play sports and regularly increase their level of physical activity. Pain usually occurs two to three hours after an intense workout. In this case, you do not need to call a doctor, the pain will go away on its own. But nevertheless, it is worth consulting with a cardiologist, perhaps the cause of severe pain is some pathology.

Pain can occur after exercise

Thus, chest pain can occur due to a variety of causes associated with the heart and other organs in the chest. To identify the culprit, you should consult a doctor. It is possible to get rid of the pain behind the chest caused by pathology only when the ailment is eliminated.

1. CHEST (PAIN)- (Liz Burbo)

Physical blocking

The chest is the part of the body between the shoulders and abdomen that contains the heart and lungs. The description below applies only to chest PAIN.

Emotional blockage

In metaphysics, the chest represents the family. Chest pain may indicate that a person has experienced pain due to an unsatisfied desire to snuggle against the chest of a father or mother; it can also mean that the person is not allowing someone to snuggle against his chest. It is possible that he swells, bulges out the chest, trying to appear necessary and important in the family. In addition, any chest pain indicates that a person feels guilty - in front of himself or in front of someone else. He may blame himself or someone else for not caring enough for someone else in his family.

Mental blocking

Your body tells you that you must love yourself and give yourself the right to be yourself, that is, to accept all your shortcomings and weaknesses. Do not make your happiness dependent on others: do not assume that you can love yourself only if others love you.

Chest pain appears in diseases of the lungs, heart, pathology of the osteoarticular system. Thoracalgia after abdominal pain is the 2nd most frequent reason for seeking medical attention for pain. Clinical experiments have shown that the incidence of thoracalgia is about 25% per 100 people interviewed.

The following types of chest pain are distinguished:

• vertebrogenic;
• non-vertebral.

Vertebral thoracalgia is caused by problems with the spine. It appears with the following diseases:

• osteochondrosis of the 2-4th degree;
• scoliosis (lateral curvature of the spine);
• intervertebral hernia;
• calcification of the ligaments;
• instability of the vertebrae;
• degenerative-dystrophic lesion of the intervertebral joints.

The severity of pain in these diseases is different. So, with an intervertebral hernia, pain occurs due to stenosis spinal cord or pinching of the nerve roots.

With osteochondrosis, the height of the intervertebral discs decreases. The condition contributes to the entrapment of nerve fibers leaving the spinal cord through the spinal clefts. Depending on the degree of nerve entrapment, a bursting or It's a dull pain in the chest.

With instability of the vertebrae, acute pain can be localized not only in the area of ​​damage. It extends to the surrounding areas and is encircling. It occurs even with the slightest movement of the body, body turns. Only timely treatment of pathology can eliminate.

A pulling pain in the chest appears with scoliosis. The disease forms a persistent infringement of the nerve roots, which cannot be cured with drugs.

A sharp pain in the lower back of the lumbago type can be observed with an intervertebral hernia. Severe compression of the nerve root in pathology can be combined with narrowing of the spinal cord. In such a situation, painful sensations are not eliminated by anti-inflammatory and analgesic drugs. Treatment of "lumbago" is carried out with novocaine blockades.

Deciding why it hurts rib cage when moving, doctors first of all exclude non-vertebral causes of the disease. Among them are often found:

• heart disease;
• intercostal neuralgia;
• traumatic injuries of the ribs;
• diseases of the gastrointestinal tract;
• myofascial syndromes.

Girdle chest pain appears with diseases of the pancreas and stomach. These organs are located in the left hypochondrium. With their inflammatory or tumor lesions, painful sensations arise after eating. They increase with movement and decrease at rest.

Acute chest pain in the middle appears when ischemic disease heart and myocardial infarction. Both diseases are dangerous. Without adequate treatment, pathological conditions lead to the death of a person.

True, one should distinguish pain syndrome in the chest in the middle with intercostal neuralgia or thoracalgia of vertebrogenic etiology. Often the pain behind the sternum is caused by the pinching of the nerve roots. In such a situation, the pain is aching, cutting, stabbing, but not sharp.

When moving, the intercostal muscles are actively working, participating in the act of breathing. If there is pain in the chest to the right and left, myositis (inflammatory changes in the muscles) can be assumed. It appears after severe hypothermia and is aggravated by breathing.

It can talk about both spinal diseases and heart diseases.

Strong shingles occurs in the following diseases:

• stomach ulcer;
• pancreatitis;
• pancreatic tumor;
• strong enlargement of the spleen.

When peptic ulcer the stomach has a defect in the mucous membrane. Usually, a person has pain with an ulcer in the area of ​​its localization. In the presence of several ulcers on the greater and lesser curvature of the organ, severe girdle pain may appear in the area of ​​localization of the wound defect. Nevertheless, a similar symptom is more typical for cancerous lesions, when the tumor passes through the entire stomach cavity.

Inflammatory and tumor processes in the pancreas provoke a bursting sharp pain. It indicates the destruction of the organ or the germination of a pathological formation into the surrounding tissues.

When deciding why the chest hurts, a group of reflected pain should be separately identified. They are distant from the primary source, so the treatment of this type of pathology is rarely effective. It is not always possible to establish the primary area of ​​pain syndrome. However, neuropathologists can suggest a diagnosis because spinal nerves have points of exit to the surface of the body (dermatomes).

The reasons for the reflected painful sensations have not been established by scientists. There is an assumption that they are associated with the interaction between the axons of nerve fibers. But in practice, it has been established that with ischemic heart disease, pain syndrome is not always localized in chest wall... They can be reflected into the abdomen and left arm.

Acute pain can be observed when nerve fibers are stretched or the root is compressed in the thickness of the inflamed muscle. In such a situation, the condition is alleviated by the use of muscle relaxants and anti-inflammatory drugs.

Aching and bursting pain

Bursting and aching pain in the chest cavity occurs with diseases of the heart and lungs. Among the causes of death, chest pain is among the leaders.

When sneezing, coughing and physical exertion with coronary heart disease and myocardial infarction, aching pain is transient.

Cardialgia is not always due to ischemic myocardial damage. It can be the result of the existence of the following pathological conditions in the chest cavity:

• pericarditis - inflammation of the pericardium;
• pleurisy - inflammation of the pleura of the lungs;
• malformations and enlargement of the heart;
• diseases of the coronary arteries and heart;
• neurological and mental diseases.

Separately, the neurological causes of cardialgia should be highlighted. Clinical researches proved that distant dull, stabbing, aching pain behind the breastbone is very often observed in people who are often nervous.

Acute angina is so severe that the person cannot walk. Any attempt to make a movement causes pain in him. Only drugs of the nitroglycerin group can eliminate an attack of angina pectoris.

Patients with angina pectoris clearly know that when pain appears in the sternum, a tablet of the drug should be placed under the tongue. Medicine dilates blood vessels and improves blood supply to the heart.

Differential symptoms, allowing to separate the painful sensations of the heart and other etiology:

• heart damage worsens with exercise;
• vertebral diseases are not eliminated by taking nitroglycerin;
• intestinal pathology worsens immediately or some time after eating.

The nature of the sensations may indicate the severity of the disease. If its external symptoms are not pronounced, and only inside the chest is felt Blunt pain probably, this indicates the onset of ischemic changes in the myocardium or the development of osteochondrosis of the spine of the 2-3rd degree.

In order to exclude pathological changes, it is necessary to perform a number of clinical and laboratory tests:

• electrocardiography;
• general analysis of blood and urine;
• blood chemistry;
• Ultrasound of the heart and blood vessels;
• chest x-ray.

If necessary, doctors prescribe some additional tests that can more accurately diagnose the causes of pain in the chest.

Treatment

Treatment of painful sensations inside the chest cavity is based on determining the cause of the pathology. Etiological treatment will not only eliminate the symptoms of the disease, but also prevent the progression of the disease.

However, it is not always possible to eliminate the cause of the disease. For example, degenerative-dystrophic diseases of the spine occur due to impaired microcirculation and delivery of nutrients to the spinal column. In such a situation, only the symptoms of the disease can be eliminated.

Wandering pain in heart disease baffles specialists. It can migrate for a short period of time. In such a situation, it is very difficult to make a diagnosis in a timely manner, and, as you know, heart disease does not tolerate delay.

Girdle irradiation in inflammation of the pancreas requires the appointment of drugs for the digestion of food and diet number 9.

Thus, bursting, aching, acute and chronic chest pain can occur with a variety of conditions. In most cases, with early detection of the disease, serious consequences can be prevented.

If it hurts somewhere, it means that the body is not all right. Many people quite rightly think so. Pain cannot be tolerated, nor can it be ignored. Especially when the pain is concentrated in the middle of the sternum.

Causes of pain

The sternum is an oblong bone located directly in the middle of a person's chest. The ribs are attached to the sternum and together they form the ribcage. This bone structure protects the heart, large blood vessels, lungs, esophagus from mechanical damage from the outside.

Pain in the sternum in the middle can be caused by the following pathological conditions:

1. Diseases of the heart and aorta;
2. Diseases of the esophagus;
3. Diseases of the stomach;
4. Diseases of the diaphragm;
5. Diseases of the mediastinum;
6. Diseases of the skeletal system;
7. Neuropsychiatric diseases.

Heart disease

If there is pain in the sternum in the middle, first of all, you need to exclude probable heart problems, as the most dangerous cause. Indeed, in most cases, chest pain is caused precisely by heart disease, and more specifically ischemic heart disease. develops with insufficient supply of oxygen to the heart muscle. In conditions of a lack of oxygen, the myocardium suffers greatly and signals this in the form of acute pain. Both, and are clinical forms of ischemic heart disease. However, the nature of pain in these diseases is different.

For angina pectoris, pressing pains behind the sternum are typical. The patients themselves describe this pain as if someone had put a brick on the chest. The pain often radiates to the left arm and neck. Painful attacks last up to twenty minutes, the pain overtakes and then releases the person.

Note! A characteristic sign of angina pectoris is the elimination of pain after the use of nitroglycerin.

With a pronounced lack of oxygen, the death of the heart muscle occurs, this is how myocardial infarction develops. This disease is accompanied by pressing, burning pain behind the sternum, but the pain is much more intense than with angina pectoris. The pain can also radiate to the left arm, neck, under the lower jaw, to the entire chest and even to the abdomen. Pain is often accompanied by a feeling of pronounced fear of death, cold sweat on the face. The pain is unbearable, after 15-20 minutes it does not go away, and also does not stop with nitroglycerin.

Sternum pain can also occur with inflammatory heart disease - and pericarditis... This pathology often occurs after the postponed infectious disease. In general, the following symptoms are characteristic of inflammatory heart diseases:

• Pain on the left in the chest, as well as in the sternum;
• Fever
• Weakness, malaise.

Diseases of the aorta

The occurrence of pain in the sternum can also be caused by a disease of the aorta, in particular, its aneurysm. This is a local enlargement of a portion of the aorta. on the early stages is asymptomatic, however, as the disease progresses, characteristic symptoms appear.

Signs of a thoracic aortic aneurysm are:

• Long-term pain in the sternum, heart area (painful attacks can last for several days);
• The pain does not radiate;
• It is not eliminated after the use of nitroglycerin.

The danger of the disease is that at any time aneurysm stratification can occur, which leads to fatal bleeding. Thoracic aortic aneurysm rupture is indicated by symptoms such as the appearance of sharp pain behind the sternum, often radiating to the back, as well as a drop in blood pressure.

Diseases of the esophagus

The esophagus is located along the sternum. Therefore, it is not surprising that diseases of this organ often manifest as chest pain. One of the most common diseases of the esophagus is achalasia of the cardia.... This is insufficient relaxation of the lower esophageal sphincter (cardia), due to which the patency of the esophagus is impaired. Thus, during swallowing, the food lump gets stuck at the level of the spasmodic lower esophageal opening and cannot get further into the stomach.

The symptoms of achalasia are:

The appearance of pain in the middle of the sternum may also be associated with (synonym for GERD). The disease is characterized by the development of inflammation of the esophageal mucosa due to the reflux of gastric contents. Retrosternal pain in GERD can radiate to the interscapular region, neck, lower jaw, and left side of the chest. It should be noted that esophageal pain is often mistakenly perceived as an attack of angina pectoris due to a similar clinical picture. However, chest pain in GERD has its own characteristics:

1. Sternum pain occurs after eating;
2. Strengthens after tilting the body forward, as well as in a horizontal position of the body;
3. Decreases after using antacids.

Important! Symptoms such as sour belching and regurgitation of food also testify in favor of GERD.

Diaphragm diseases

The diaphragm is a muscle-tendon plate that separates the chest cavity from the abdominal cavity. The diaphragm has a natural opening - the esophagus, through which the esophagus exits the chest cavity into the abdominal cavity. The development of a hernia of the esophageal opening of the diaphragm is said when organs through the indicated opening abdominal cavity protrude into the chest cavity.

A diaphragmatic hernia occurs with pain in the middle and lower sternum region, spreading to the epigastric region. The pain can radiate to the back, interscapular region and even in the hypochondrium, which mimics the girdle pain in. Features of chest pain in diaphragmatic hernia:

• Pain often occurs after eating, aggravated by coughing, after lifting weights;
• Strengthens after tilting the body forward
• Decreases after belching, deep inhalation, or if the person takes an upright position;
• The pain can be described as moderate, dull;
• Pain is associated with symptoms of GERD.

Diseases of the stomach

Known to present with epigastric pain, often extending to lower part sternum. Depending on the location of the ulcer, pain can also radiate to the left half of the chest, right hypochondrium, back. The onset of pain is directly related to food intake. Often, uncomfortable sensations appear after half an hour or an hour after eating.

Ulcerative pain relieves after the use of drugs that reduce gastric secretion... In addition, at the height of a painful attack, a person may experience acidic contents, which brings relief. Belching also testifies in favor of peptic ulcer disease. It is also worth noting that in rare cases, pain in the sternum is also acute, although localization of pain in the upper abdomen is more typical for this ailment.

Respiratory diseases

Diseases of the lungs, pleura occur with pain in the chest from the side of the lesion. But only tracheobronchitis can manifest itself with pain directly in the sternum in the middle. Usually this disease develops within the framework. Therefore, at the beginning of the disease, a person is worried about weakness, fever, sore throat. Discomfort quickly descends, spreading to the trachea and bronchi.

Pain with tracheobronchitis is localized behind the sternum in its upper and middle third and intensifies in time... At the onset of the disease, the cough is dry, unproductive. When a person coughs, he feels an unpleasant soreness in the chest. After a few days, the cough becomes moist, the sputum comes off more easily. The pain behind the breastbone gradually decreases, the general well-being improves.

Diseases of the mediastinum

The mediastinum is the anatomical space located in the chest cavity. In front, the space is limited by the sternum, behind by the spine, and the lungs are located on the sides of the mediastinum. In the mediastinum are such organs as:

• Thymus;
• Trachea;
• The upper part of the esophagus;
• A heart;
• Main bronchi;
• Large vessels and nerves.

Inflammation of the mediastinal tissue is called mediastinitis. The disease develops when an infection enters the mediastinum from neighboring inflamed organs (trachea, lungs, esophagus, heart, etc.), or when mediastinal organs are injured. Acute mediastinitis develops suddenly and its first sign is the appearance of intense pain behind the breastbone. The painful sensations are especially intensified when swallowing and throwing the head back. There are also signs such as:

• Fever;
• Chills;
• Profuse sweat;
• Cough;
• Suffocation;
• Heart rhythm disorder;
• Puffiness of the face and upper body;
• Blueness of the skin.

Note! Mediastinitis is an extremely serious condition that requires urgent medical attention.

Diseases of the skeletal system

It is logical to assume that pain in the sternum can be triggered directly by diseases of this bone. But it is worth noting that diseases of the sternum are very rare. Therefore, when chest pain occurs, first of all, it is still necessary to think about the possible pathology of the heart or esophagus.

In trauma practice, doctors, although rarely, are still faced with. People get this injury as a result of an accident when they hit the steering wheel with their chest, less often - with a direct blow to the sternum or strong compression of the chest. With a fracture, the victim feels severe pain in the sternum, aggravated by breathing. At the site of the fracture, edema and subcutaneous hemorrhage are determined. When the fragments of the sternum are displaced, damage to neighboring organs, in particular the lungs, is possible, with the development of pneumo- or hemothorax.

The sternum, like any other human bone, can be affected by a malignant process.... Sternum cancer is a rare disease, and yet it is worth mentioning. Cancer can occur in the sternum primarily or secondarily - after the penetration of metastases into the bone. On the initial stages the disease does not manifest itself in any way and the patient does not even suspect about his diagnosis. As the disease progresses, weakness, malaise, anorexia, and low-grade fever develop. Also at this stage, a person begins to be bothered by pain in the sternum.

Neuropsychiatric diseases

Sometimes a person goes to the doctor with disturbing pain in the sternum, but after conducting research, it is found that the person is absolutely healthy. In this case, the pain is psychogenic in nature, this condition is also called cardioneurosis. The patient himself describes his painful sensations, like a lump or a stone behind the sternum. There may also be a complaint about a rapid heartbeat, irregularities in the rhythm, "as if the heart wants to jump out." As a rule, all these phenomena occur after emotional experiences. A person is very worried about chest pain, suspects that he has dangerous disease... In general, anxiety, anxiety, multiple fears are characteristic of a person with cardioneurosis,