Heart pain occurs due to cardiac and extra-cardiac causes. The most common pathologies accompanied by pain syndrome: angina pectoris, arterial hypertension, arrhythmias. The symptom is characteristic of myocarditis and pericarditis, rheumatism, cardiomyopathy. Extra-cardiac factors — cardioneurosis, osteochondrosis, GERD, etc. For diagnosis, instrumental techniques (ECG, EchoCG, coronarography), laboratory tests (lipid profile, assessment of acute phase parameters, study of markers of myocardial necrosis) are carried out. To relieve pain in the heart, treatment of the underlying disease is necessary.
Causes of heart pain
Gastroesophageal reflux disease
Help before diagnosis
Prices for treatment
Causes of heart pain
Neurosis of the heart is the most common cause of heart pain. Symptoms are more common in emotionally labile people of young and middle age, adolescents, pregnant women. For cardioneurosis, pain sensations that are variable in strength and nature are typical. Patients complain of pressing, burning, stabbing pains. Discomfort mainly manifests itself during stress, excitement.
A specific sign of cardioneurosis is a constant fear of severe cardiac disease, myocardial infarction. The patient begins to listen to his feelings and interprets even minor pains in the heart as a sign of a deadly disease. In addition to the pain syndrome, there is increased sweating, a feeling of heat or chills, tremor of the fingers. After normalization of the psychoemotional state, the symptoms disappear without a trace.
The appearance of pain in the heart is characteristic of stage 2 of hypertension, when hypertrophy of the muscular layer of the heart develops. There are aching or pulling sensations provoked by excitement, physical exertion. The pain is prolonged, but not intense, so most patients do not attach much importance to discomfort. Against the background of pain, there are attacks of dizziness, “flickering of flies” before the eyes.
Cardiac arrhythmias are manifested by various types of pain in the precardial region — stabbing, aching, pulling. Usually, the symptom is accompanied by a feeling of interruptions or fading of the heart. Discomfort occurs for no apparent reason, at any time of the day. The pain syndrome has a low intensity, periodically bothers for several months.
Patients complain that the heartbeat increases sharply or slows down, the heart “skips a beat”. With arrhythmia, the appearance of pain is aggravated by a general deterioration in well-being. The patient feels a lack of air, sharp weakness, dizziness. With severe rhythm disturbance, pre-fainting states, fainting are possible. With the prolonged existence of arrhythmia, there is a decrease in performance, deterioration of memory and attention.
During an anginal attack, a person feels strong pressing or compressing pains in the heart. In response to a request to indicate the localization of pain, the patient presses his fist to the atrial region. The pain radiates to the left shoulder, arm, shoulder blade. Symptoms are provoked by physical exertion or psychoemotional stress. Soreness lasts no more than 10-15 minutes, disappears on its own or after taking nitroglycerin.
The clinical picture resembles a typical angina attack. Unlike the stable form of coronary heart disease, heart pain lasts for 20-30 minutes or more. Sometimes the pain syndrome is so strong that the patient loses consciousness. Specific irradiation in the neck, left arm. The pain is accompanied by pallor and cold sweat, frequent and weak pulse. A person feels an obsessive fear of death.
Acute stabbing pains in the heart bother with inflammatory diseases – myocarditis, pericarditis. The peculiarity of the clinical picture is constant pain of moderate intensity, which is combined with an increase in body temperature. In addition to soreness, there is palpitation, shortness of breath, weakness. Severe course is characterized by the appearance of edema on the extremities, perioral cyanosis.
With acute rheumatic fever, characteristic of children and adolescents, there is tingling in the heart area, acute pain. Basically, the symptom manifests itself 2-3 weeks after tonsillitis. Along with cardiac complaints, soreness is felt in large joints, subcutaneous nodules are formed. For chronic rheumatic heart disease, dull, aching pains caused by an acquired defect are typical.
Osteochondrosis is a common cause of chest pain, which patients mistake for a manifestation of cardiac pathology. The discomfort becomes more noticeable with a deep breath, bending the trunk to the side, feeling the ribs and intercostal spaces. Pain in vertebrogenic cardialgia is sharp, intense. To facilitate them, a person takes a stationary position, breathes shallowly to minimize chest movements.
Gastroesophageal reflux disease
With GERD, severe burning pains in the chest area, which resemble angina pectoris, are bothering. Symptoms are associated with eating, often they appear in the morning after waking up. The intensity of burning behind the sternum increases when bending forward, in a supine position. GERD is characterized by a combination of pain with heartburn, acid belching, and discomfort in the epigastric region.
Heart defects: stenosis or mitral valve insufficiency, arterial valve defects.
Cardiomyopathy: dilated, restrictive, hypertrophic.
Acute vascular pathologies: delaminating aortic aneurysm, PE.
Diseases of the respiratory system: left-sided pneumonia, pleurisy, spontaneous pneumothorax.
Gastrointestinal diseases: cholecystitis, pancreatitis.
Damage to the musculoskeletal system: fractures and cracks of the ribs, Titze syndrome, fibromyalgia.
The primary appointment of a cardiologist begins with the collection of anamnesis, external examination and physical examination of the cardiovascular system. During auscultation of the heart, deafness of tones, functional or organic noises are listened to. Blood pressure is measured on the hands and feet, if necessary, SMAD is prescribed. To establish the etiology of heart pain, a number of laboratory and instrumental techniques are carried out:
ECG. The cardiogram often shows signs of left ventricular hypertrophy, rhythm and conduction disturbances, and symptoms of cardiac muscle ischemia. Elevation of the ST segment in combination with inversion of the T wave is pathognomonic for MI. Functional stress tests with physical activity are performed to clarify the diagnosis.
EchoCG. According to ultrasound data, the anatomical structure of the heart, the functioning of the valves, and the thickness of the myocardium are evaluated. Echocardiography is used to measure the ejection fraction of the left ventricle. Dopplerography is performed to study blood flow in the coronary arteries and main vessels.
Radiological methods. Overview radiography of the OGC is recommended for visualizing the size and contours of the heart, calculating the cardiothoracic index. A CT scan of the heart is required for a detailed examination of the coronary arteries, pulmonary vessels and cardiac cavities.
Coronarography. The invasive technique is indicated for the probable development of myocardial infarction, coronary artery stenosis. A contrast agent is injected into the vascular bed, which allows you to visualize the inner surface of the arteries of the heart, identify blood clots and atherosclerotic plaques.
Laboratory methods. An increase in the biochemical analysis of blood cholesterol and LDL indicates atherosclerosis. To confirm them with an anginal attack, the level of myoglobin, troponin, and cardiac enzymes is determined. To exclude rheumatism, acute phase indicators are measured, antistreptolysin-O.
Given the high prevalence of extra-cardiac causes of heart pain, consultations with other specialists are usually necessary. With possible GERD, EFGDS, pH-metry are prescribed. To assess the condition of the ribs, thoracic spine, radiography is performed in two projections, CT, MRI. If cardioneurosis is suspected, tests are performed to assess the functional state of the autonomic nervous system.
Help before diagnosis
Most cases of heart pain occur with emotional and physical overstrain, so a person needs to sit down or lie down, try to calm down. It is necessary to unbutton the collar, take off tight clothes, provide fresh air. In case of interruptions in the work of the heart, it is advisable to take a deep breath and strain, press your fingers on the closed eyeballs. To relieve anginal pain, nitrovasodilators are used.
After verification of the main diagnosis, complex etiopathogenetic treatment is carried out. If digestive problems are detected, the patient is referred to a gastroenterologist. The therapy of osteochondrosis is carried out by a neurologist, a vertebrologist. In case of heart pain associated with cardiovascular pathology, prescribed:
Antihypertensive agents. The drugs reduce pre- and post-loading on the heart, so that the myocardium begins to contract normally. This helps to eliminate painful sensations, and also dramatically reduces the likelihood of hypertensive crises, heart attacks and strokes in hypertensive patients.
Antiarrhythmic drugs. Medications stabilize the heart rate and rhythm, coordinate the contractility of the atria and ventricles. After the heart rhythm is restored, pain and discomfort disappear, and overall well-being improves.
Antianginal drugs. Medications are recommended for coronary heart disease. They improve blood supply and trophism of the heart muscle, reduce preload. At the same time, reversible damage to myocardial fibers is restored, typical pain attacks are reduced.
Thrombolytics. The drugs are administered in the first hours after the diagnosis of myocardial infarction. They destroy blood clots in the coronary artery, restore normal blood flow. With their early application, it is possible to delimit the necrosis zone as much as possible.