Left chest pain: causes, what to do, how to treat

Chest pain is a very common symptom that causes great concern. After all, we all know that this is how diseases of the cardiovascular system manifest themselves. But in reality, this symptom may indicate other disorders in the body, in particular pathologies of the gastrointestinal tract, respiratory system and even the spine. In any case, such a sign cannot be ignored, especially with acute pain, since extremely dangerous conditions, for example, pulmonary embolism and myocardial infarction, can manifest themselves in this way. With them, the patient’s life directly depends on the urgency of providing qualified medical care. Let's look at the main causes of chest pain and their distinctive signs.

Cardiovascular diseases

Cardiovascular diseases most often cause characteristic chest pain on the left. These may be conditions that threaten a person’s life or indicate the development of serious diseases.

Heart attack and ischemia

Chest pain on the left, radiating to the arm, is a typical sign of a heart attack, when the heart muscle becomes inflamed and atrophies. The precursor to this disease is coronary heart disease, which occurs as a result of impaired blood flow due to atherosclerosis.

Pericarditis

If the chest pain on the left side is sharply stabbing, this may be a sign of pericarditis. Pericarditis is an inflammation of the heart sac that is caused by infections and autoimmune processes. Pericarditis can easily be mistaken for a heart attack, but the pain associated with pericarditis is reduced when the person is standing.

Angina pectoris

Angina is an attack of pain in the chest on the left, as during a myocardial infarction. But it arises as a result of strong experiences, emotional upheavals and lasts no more than 5 minutes. Angina occurs due to insufficient blood supply to the heart. If chest pain on the left side lasts more than 5-7 minutes, it may be a sign of myocardial infarction.

Aortic aneurysm

Acute tearing pain in the chest on the left is one of the signs of an aortic aneurysm. An aortic aneurysm is a pathological enlargement of an artery that threatens human life. It is accompanied by difficulty breathing, numbness of the limbs, and difficulty speaking. Death is possible as a result of aortic rupture, so this pathological condition is especially dangerous.

Diseases that cause shoulder pain

Pain syndrome can appear against the background of various diseases and injuries over time leading to increased pain. If left untreated, they will all impair joint function.

Arthritis

Joint inflammatory processes can occur acutely and chronically. Acute arthritis causes severe pain, swelling, redness of tissues, limited mobility of the limb and disruption of the general condition of the patient. But they are easier to treat, so doctors try to prevent the acute course of inflammation from becoming chronic. With chronic inflammation, pain in the shoulder is often aching in nature, swelling is not expressed, but in the absence of medical care, slow destruction and pain in the shoulder joint occurs with the formation of ankylosis (immobility). Arthritis is dangerous because it causes numerous complications that are dangerous not only to the health, but also to the life of the patient. Depending on the type of arthritis, it is treated by a surgeon or rheumatologist.

Arthrosis

With arthrosis, degenerative-dystrophic processes occur in the shoulder joint with gradual thinning and destruction of cartilage tissue, which acts as a shock absorber during movement in the joint. The causes of shoulder pain are friction of the bone surfaces of the joint with their destruction, deformation and irritation of the nerve endings of the periosteum. Arthrosis can be the result of injuries, arthritis, or metabolic age-related changes. Arthrosis can and should be treated. It is quite possible to relieve patients from constant pain.

Humeroscapular periarthritis

This is a collective concept that includes all periarticular (periarticular) lesions of the shoulder joint area. The term "humeral periarthritis" was first used in the mid-19th century by the French surgeon Duplay and has been used for more than a hundred years to refer to all pain syndromes in this area.

It has now been established that the main cause of chronic pain in the shoulder region is a degenerative-inflammatory pathology of the deep muscles and tendons involved in the movement of the shoulder - tendinitis. The onset of the process is associated with repeated microtraumas, degenerative processes, and the deposition of calcium salts.

A degenerative-dystrophic process develops in the muscular-ligamentous system, which is periodically accompanied by inflammation of the tendons, accompanied by pain. The next stage is the growth of fibrous (connective) tissue and the development of ankylosis - joint stiffness. The tendons lose their elasticity, and the slightest injury causes them to rupture, which further aggravates the patient’s condition. There are a number of diseases that are included in the concept of “humeral periarthritis” and have their own characteristics:

1. Tendinitis
   is an inflammation of the 4 muscles that rotate the shoulder joint and maintain the stability of the joint. The muscles are located around the shoulder joint. Disorders in them often develop after lifting weights with arms outstretched - an action that is unusual for a given person. Tendonitis manifests itself as painful sensations in the outer part of the shoulder girdle, sometimes radiating to the elbow. Soreness sometimes arises again, which is associated with an exacerbation of the aseptic inflammatory process in the muscles. With any movement it increases. If timely therapy is not started, limb dysfunction will appear.
2. Biceps (biceps) tendinitis
   . Develops after a one-time sharp lifting of weights or systematic microtrauma in athletes, tennis players, and miners. It manifests itself as a painful wave in the upper part of the shoulder region, spreading along its front surface to the elbow. The painful waves become more intense when bending the elbow and lifting heavy objects. When pressed, the most sensitive point located in the intertubercular groove is revealed. Rotation and abduction of the arm are not impaired. If left untreated, the tendon may rupture and cause loss of significant function of the arm.
3. Calcific tendonitis
   . The disease is also associated with microtraumas, against the background of which calcium crystals are deposited in the muscles and tendons. Why this happens is not precisely established. Some experts associate the formation of crystals with hereditary characteristics. During the accumulation of crystals, pain in the shoulder along the affected tendon is periodically bothered. It intensifies during the destruction of crystals, accompanied by inflammation.
4. Rupture of ligaments and tendons.
   Rupture of healthy periarticular tissue is rare and is a consequence of acute trauma. Much more often, rupture occurs against the background of degenerative-inflammatory processes in the muscle tendons. Moreover, even a minor injury, for example, a sharp swing of the arm, can lead to complete or partial rupture of the tendon. At the time of injury, the patient feels severe pain and cracking (crunching). When the biceps tendon ruptures, the muscle moves toward the elbow joint. A rupture can be detected by performing magnetic resonance imaging (MRI). In case of a complete rupture, surgical treatment is provided.
5. Retractile or adhesive capsulitis
   . Also called frozen shoulder. The causes of the disease cannot always be identified. Various metabolic disorders contribute to its development - diabetes, atherosclerosis, thyroid diseases. The essence of the pathological process is that in the capsule and synovium there is a slow gradual proliferation of connective tissue, leading to a decrease in the functioning of the limb. There are no inflammatory and degenerative-dystrophic processes in the articular cavity. Symptoms: first, over the course of 3 to 4 months, there is an increase in pain, which intensifies when turning the arm inward. Then the pain in the shoulder decreases, but stiffness of movement appears. In the absence of adequate therapy, patients are bothered by constant painful attacks and impaired joint function.
6. Impingement syndrome
   . This syndrome is associated with pinching of the soft tissues of the shoulder joint under the coracoacromial ligament (arch). Develops against the background of injury and with constant prolonged raising of the arms above the head. Severe aching pain appears in the shoulder when raising the arm above the head. Over time, it is accompanied by dysfunction of the joint: rotation in any direction is limited. To eliminate symptoms, it is necessary to undergo a course of treatment and rehabilitation.

Osteochondrosis of the cervical spine

With cervical osteochondrosis, pain may radiate to the shoulder

Painful sensations in the shoulder girdle, radiating to the arm, can develop when the roots of the spinal nerves of the lower cervical vertebrae are pinched by altered intervertebral discs due to osteochondrosis. They can be both acute and aching in nature. Pain waves appear on the back and side of the neck and spread from behind down the shoulder blade, from the front along the collarbone, forearm to the hand. A neurologist will provide assistance for osteochondrosis of the cervical spine.

Respiratory diseases

The human chest contains not only the heart, but also the bronchi and lungs. Therefore, chest pain on the left may be a sign of diseases of the respiratory system, among which there are also serious pathological conditions.

Pleurisy

Acute pain in the chest on the left, intensifying with inspiration, is characteristic of pleurisy. The lining of the lungs - the pleura - becomes inflamed during infectious diseases and secretes a special secretion that irritates the nerve endings and causes pain. Pleurisy accompanies pneumonia and other infectious lung diseases.

Spontaneous pneumothorax

If the integrity of the pleura is compromised (usually due to injury), air enters the lining of the lungs during inhalation, which causes pain. Pain in the chest area on the left side is accompanied by difficulty breathing, weakness and dizziness. The cause of spontaneous pneumothorax may be damage to the pleura as a result of chronic diseases.

Emphysema

With emphysema, the lungs lose their ability to get rid of excess air, which occurs due to loss of elasticity in the walls of the bronchi. Chest pain on the left or above the chest can occur due to this serious disease, which causes complications such as pneumothorax and respiratory failure. This dangerous condition requires immediate treatment.

Pulmonary embolism

The lungs are supplied with oxygen through the blood vessels, and a blood clot entering the pulmonary artery is called an embolism. This disease manifests itself as aching pain in the chest on the left and problems with breathing. Pulmonary embolism is characterized by increased pain with deep inspiration. It is not associated with cardiovascular diseases, but poses a potential threat to human life.

Gastrointestinal pathologies

Diseases of the gastrointestinal tract, or more precisely the esophagus, can also provoke the appearance of chest pain. In such cases, they often radiate to the back, to the right and left of the sternum, and in most cases they are associated with food intake and are associated with swallowing disorders.

Swallowing problems are called dysphagia.

Most often, patients with complaints of chest pain are diagnosed with:

• esophageal diverticulum;
• gastroesophageal reflux disease (GERD);
• hiatal hernia;
• spasm of the esophagus (esophagospasm).

Esophageal diverticulum

A diverticulum of the esophagus is a protrusion of its wall with the formation of a kind of “pocket” in which food accumulates. Clinical manifestations of the disease usually occur when the size of the diverticulum is more than 2 cm. In such cases, periodic pain in the sternum and back is observed, as well as regurgitation of chewed food. Sometimes the body temperature also rises to subfebrile levels.

GERD

GERD is a chronic disease accompanied by the reflux of stomach contents into the esophagus, and in some cases, the contents of the duodenum. This causes irritation of the mucous membrane and its inflammation.

With GERD, chest pain is localized in the center and left, which often causes concern in patients. In some cases, they spread to other parts of the sternum. The intensity of pain can vary from mild discomfort to quite severe pain. Their appearance is associated with food, but sometimes they also occur after smoking, and some patients complain of chest pain when they lie down, including at night.

Also with GERD the following may be observed:

• heartburn that occurs when the body bends forward or in a lying position;
• belching of air or food;
• feeling of heaviness, bloating;
• fast saturation;
• dysphagia or pain when swallowing.

A characteristic feature of GERD is the onset of all symptoms directly during or immediately after eating. Also a pathognomonic manifestation is improvement in well-being after taking antacids and changing body position to vertical and walking.

Hiatal hernia

A hiatal hernia means a displacement into the chest cavity of those anatomical structures that should normally be located underneath it, in particular the abdominal segment of the esophagus, the cardia of the stomach, or even intestinal loops. With age, the risk of developing pathology progressively increases; as a result, it is found in 69% of people over 70 years of age.

A diaphragmatic hernia is not always accompanied by chest pain. In fact, very often it is asymptomatic and is discovered by chance during an examination regarding complaints of other disorders of the gastrointestinal tract. But in about 50% of cases, a hiatal hernia leads to pain in the central abdomen just below the ribs, spreading along the esophagus or radiating to the area between the shoulder blades and the back. Less often, they are encircling in nature or localized only behind the sternum, thereby resembling the clinical picture of pancreatitis or angina pectoris, myocardial infarction.

Another symptom of the disease may be heart rhythm disturbances. This leads to fairly frequent diagnostic errors, and therefore the prescription of treatment that does not lead to improvement. To avoid this, it is important to trace the conditions for the onset of pain. The presence of a diaphragmatic hernia is indicated by:

• the appearance of pain after eating, during physical activity, coughing and lying down;
• reduction or complete disappearance of discomfort after belching, taking a deep breath, changing body position, or after the patient drinks a glass of water;
• increased pain when bending forward;
• the occurrence of swallowing disorders, especially when consuming liquid and puree foods, very cold or, conversely, very hot drinks, as well as when rushing while eating.

A hernia is dangerous due to strangulation. In this case, severe cramping pain occurs in the chest, radiating to the back. This is accompanied by nausea, vomiting, often with blood, as well as increased heart rate, decreased blood pressure and shortness of breath.

Also, the disease is often complicated by the development of GERD. Therefore, the characteristic signs of reflux are subsequently added to the existing symptoms.

Esophagospasm

The spasm occurs at the junction of the esophagus and the stomach. This is accompanied by symptoms very similar to those of angina pectoris. The pain can be quite severe. They are localized in the heart area, but can radiate to the neck, lower jaw and shoulders, but unlike angina, they appear during meals and can persist not only for several minutes, but also for hours. This is accompanied by dysphagia and a feeling of difficulty passing food, which can quickly subside after drinking warm drinks, in particular tea or water.

Esophagospasm has a reflex origin and usually accompanies other diseases of the gastrointestinal tract, including GERD, peptic ulcer of the stomach and duodenum, hiatal hernia, cholecystitis, etc.

But esophagospasm can be relieved by taking nitroglycerin, since the esophagus is also formed by smooth muscle fibers.

Spinal problems

The spine is connected to many organs, so spinal pain often radiates to the sternum. Often, a pressing dull pain on the left side of the chest may indicate problems in the thoracic spine.

Osteochondrosis

Pain in the chest and back on the left with osteochondrosis usually appears at a serious stage of the disease, when complications arise in the form of a vertebral hernia. In the thoracic region, osteochondrosis is most complex, since it is often accompanied by difficulty breathing and limited freedom of movement.

Injuries

With injuries to the sternum, aching or sharp pain in the left chest may appear, sometimes this is a sign of a rib fracture on the left side of the chest. The nature of the pain depends on the severity of the injury. In some cases, with spinal injuries, pain radiates to the left side of the chest.

Tactics for determining the cause of chest pain

When discomfort or chest pain occurs, patients often initially turn to a therapist, which is very rational. At the appointment, the doctor initially finds out the nature of the complaints. Much attention is paid to:

• localization of pain (left, right, center or girdling, deep or superficial);
• intensity (the severity of painful sensations is not always equivalent to the existing threat);
• character (squeezing, pressing, dull, aching, stabbing, shooting, etc.);
• conditions of occurrence (during physical activity, eating, transition from heat to cold, at rest, when taking a horizontal position, etc.);
• conditions of termination (after rest, when walking, after eating, drinking, drinking nitroglycerin, when lying on the sick or healthy side, after belching, vomiting);
• duration;
• accompanying symptoms;
• irradiation (in the left arm, neck, jaw, between the shoulder blades, in the stomach, etc.);
• the duration of the pain.

The doctor must find out whether there have been recent injuries to the chest or spine. Mention of such episodes makes it possible to simplify diagnosis and quickly determine the cause of chest pain.

Physical examination

The second stage of diagnosis is a physical examination. It involves sequential execution:

• examination of the skin and mucous membranes for rashes, color changes, and signs of cyanosis;
• assessment of pulse in the radial and femoral arteries;
• blood pressure measurements;
• palpation of the chest, muscles, spinous processes of the vertebrae, identifying symptoms of radicular syndrome;
• percussion (tapping) of the chest;
• auscultation of the heart and lungs (heart sounds are assessed, murmurs, wheezing in the lungs, the sound of pleural friction are detected);
• palpation of the abdomen;
• examination of the lower extremities for signs of varicose veins, thrombophlebitis.

The suspected cause of pain can be detected at any stage of the examination. As a result, the patient receives an appointment for laboratory and instrumental diagnostics.

Diagnostics

Such a complex symptom as aching or acute pain in the left chest requires careful diagnosis. The therapist decides where exactly to look for its cause.

by collecting detailed information about the circumstances under which the pain occurs and the patient's health status.
If necessary, the patient can be sent to a specialist neurologist
.
Diagnosis often begins with the exclusion of diseases of the cardiovascular system - an ECG
and a visit to
a cardiologist
; if necessary, the patient is prescribed
an echocardiogram
. In other cases, to diagnose diseases that cause chest pain on the left, blood tests, endoscopic, ultrasound and x-ray examinations can be prescribed.

What tests may be needed for chest pain?

If you complain of chest pain, the following may be prescribed to diagnose the disease:

• chest x-ray;
• computed tomography (MSCT chest);
• ECG;
• Holter monitoring (24-hour ECG monitoring);

stress tests (treadmill test);

• general blood test (allows you to determine the presence of inflammation);
• gastroscopy (if diseases of the esophagus or stomach are suspected).