Chest pain. Causes of pain in the chest area: which doctor to consult

Chest pain

(chest pain) is a common symptom. In many cases, chest pain can be caused by heart disease, and this makes it especially serious. However, the list of causes of chest pain is much wider. This area contains the heart, lungs, esophagus, large vessels, bones and muscles - and any of these organs can be a source of pain. Chest pain can also be caused by the diaphragm and abdominal organs, primarily the stomach. Finally, pain can be caused by problems in other organs, and its localization in the chest is explained by the complex arrangement of nerves and muscles.

Possible nature of chest pain - what you should pay attention to

Chest pain can be aching, stabbing, shooting, squeezing, burning. In some cases it can be acute, intense, even intolerable.

It is important where exactly the pain is localized. Usually the pain can be quite clearly localized as follows:

in one half of the chest - right or left. Sometimes the localization of pain can be more specific, for example, in the ribs;
behind the sternum. Pain behind the sternum, especially when it hurts both behind the sternum and to the left of it, is characteristic of heart disease;
just below the sternum (in the epigastric region). Such pain is typical for diseases of the digestive tract (stomach or esophagus).

Chest pain without a clear localization may indicate lung cancer or tuberculosis.

Chest pain may be accompanied by symptoms such as:

shortness of breath, difficulty breathing;
cough, increased body temperature;
weakness, cold sweat;
belching, heartburn, nausea, vomiting;
changes in blood pressure.

The distribution of pain is also important for diagnosis. The pain may radiate to the arm. This type of pain is observed with myocardial infarction and osteochondrosis.

Diagnostics

The first thing the doctor will do is interview and examine the patient, which will allow him to narrow the search for pathology based on associated symptoms. After this, various diagnostic procedures may be prescribed to determine the cause of the pain. Magnetic resonance imaging may be helpful

or
computed tomography
,
x-ray
, ultrasound, blood tests, etc. This will determine why pain occurs in the middle of the chest, which radiates to the back, upper limbs or ribs.

Causes

Chest pain due to heart disease

Chest pain is a characteristic symptom of heart disease. It is observed, in particular, when:

coronary heart disease (caused by insufficient oxygen supply to the heart muscle). The most common form of coronary artery disease is angina pectoris, which manifests itself in the form of discomfort, a feeling of heaviness or compressive pain behind the sternum and to the left of it. An attack of pain is usually provoked by physical activity or emotional stress. The duration of the attack usually ranges from several minutes to half an hour. Relief occurs after taking nitroglycerin. The pain may be accompanied by shortness of breath, radiating to the left arm, under the shoulder blade, and the left half of the lower jaw;
acute myocardial infarction. Myocardial infarction is also a form of coronary heart disease that requires immediate medical attention. The pain during myocardial infarction is very intense and has a compressive, pressing or bursting character. It is observed behind the sternum and to the left of it, and can radiate to the left arm, under the shoulder blade, to the left side of the neck and lower jaw. The pain is accompanied by shortness of breath, fear of death, weakness, and cold sweat may appear. The pain lasts more than 15-30 minutes (i.e. longer than during an attack of angina) and is not relieved by nitroglycerin. If you suspect a myocardial infarction, you should immediately call an ambulance;
pericarditis (inflammation of the outer lining of the heart - the pericardium). In this case, the pain may be constant or intermittent. It is usually localized behind the sternum. The pain increases when lying down, and decreases if you lean forward;
myocarditis (inflammation of the heart muscle). Myocarditis occurs most often as a complication of an infectious disease. With myocarditis, chest pain is combined with fever and shortness of breath;
mitral valve prolapse. In most cases, this disease is asymptomatic, but sometimes there is pain in the left side of the chest, which may be accompanied by a feeling of shortness of breath, a feeling of rapid or slow heartbeat, dizziness and fainting.

Chest pain due to respiratory diseases

Chest pain can occur with diseases such as:

pleurisy (inflammation of the membrane of the lung - pleura). In case of pleurisy, the pain is usually acute and one-sided. Intensifies with deep breaths, laughter, and movement. The pain intensifies when bending to the healthy side. The pain decreases if you lie on the side where it hurts. Chest pain is combined with other symptoms - fever, chills, weakness, cough;
pneumonia (pneumonia). Chest pain with pneumonia is a concomitant symptom that occurs against a background of cough and fever. The pain is usually one-sided - corresponds to the side on which inflammation develops. The nature of the pain is sharp or aching;
bronchitis;
tracheitis;
pulmonary tuberculosis;
lungs' cancer.

Chest pain due to diseases of the digestive tract

Pain in the chest area can be caused by diseases such as:

stomach ulcer. With a stomach ulcer, the pain is usually described as “burning.” It is localized in the epigastric region and can radiate to the left half of the chest. Occurs after eating;
gastroesophageal reflux disease (reflux of stomach contents back into the esophagus). Acidic or alkaline contents irritate the lining of the esophagus, causing bloating and severe pain in the epigastric region and the left side of the chest. An attack can be triggered by eating too much at night, strong coffee, or alcohol abuse. In addition to chest pain, heartburn and belching may occur;
hiatal hernia. In most cases, the disease is asymptomatic. In some cases, aching or burning pain behind the sternum and in the epigastric region may be observed. Pain usually occurs after eating in a horizontal position. May be accompanied by hiccups, heartburn, belching, and sometimes vomiting (in obese women).

Other Possible Causes of Chest Pain

Chest pain can also be caused by:

osteochondrosis of the cervical and thoracic spine. Pain with osteochondrosis can be similar to an angina attack and can radiate to the shoulder blade, arm, or shoulder. Sometimes there is numbness in the hand. Another option for pain with osteochondrosis is lumbago. It is provoked by turns of the body, movement of the arms, prolonged exposure to a lying position (during night sleep);
intercostal neuralgia. In this case, the pain is usually limited to one intercostal space. The nature of the pain is “shooting”;
shingles. The disease is caused by one of the varieties of the herpes virus. The pain is intense, burning. After 7-10 days, blistering rashes appear along the affected nerves;
vegetative-vascular dystonia.

Pain or heaviness in the right hypochondrium

Hepatitis

Jaundice

Vomit

43560 05 April

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Pain or heaviness in the right hypochondrium: causes of occurrence, what diseases it occurs with, diagnosis and treatment methods.

Definition

The right hypochondrium is one of nine areas into which the anterior abdominal wall is conventionally divided. This area belongs to the so-called “upper floor” of the abdominal cavity.

In the right hypochondrium there are the liver, gallbladder, hepatic angle of the colon, and swollen loops of the small intestine can also be projected into this area. The organs listed above belong to the digestive system.

The liver is a parenchymal (spongy) organ with a very good blood supply. The outside of the liver is covered with a capsule in which nerve endings are located. The liver is involved in the metabolism of proteins, fats, carbohydrates, vitamins, and plays a vital role in detoxification of the body.

Harmful substances that enter the liver are subjected to “chemical” processing, which makes them less toxic to the body and promotes faster elimination through the gastrointestinal tract and urine.

In addition, liver cells produce bile necessary for digesting food, primarily fats. Bile enters the gallbladder, located on the lower surface of the liver, where bile accumulates, which is released from it into the duodenum during the next meal.

From above, the liver is adjacent to the diaphragm - a kind of muscular partition between the abdominal and thoracic cavities. From below, from the side of the abdominal cavity, the diaphragm is lined with peritoneum (which covers the entire abdominal cavity and organs located in it from the inside), and from above, from the side of the lungs, by the pleura, which lines the pleural cavity from the inside and covers the lungs from the outside. Both the pleura and peritoneum have good innervation, which is important to know to understand the causes of pain and heaviness in the right hypochondrium. The peritoneum also covers the gallbladder and intestinal loops.

Types of pain or heaviness in the right hypochondrium

The pain in the right hypochondrium can be acute, sometimes “dagger-like”, which makes you think about a serious illness. This pain is characteristic of hepatic colic and is often accompanied by nausea, vomiting, increased sweating, increased heart rate and a drop in blood pressure.

In chronic diseases and the gradual development of acute diseases, the pain is often dull, bursting in nature, or is described by the patient as “heaviness, discomfort” in the area of the right hypochondrium.

Pain syndrome can be spontaneous, or it can be provoked by food intake, alcohol, physical activity, change in body position, etc.

Possible causes of pain or heaviness in the right hypochondrium

There is only one mechanism for the development of pain: stimulation of pain receptors. As mentioned above, the peritoneum has good innervation. Also, a large number of nerve endings are localized in the wall of hollow organs (intestines, gall bladder). Therefore, inflammatory processes in these organs naturally manifest themselves as pain.

Pain also occurs when the liver capsule is stretched. This can occur due to an increase in the volume of the organ (which in most cases is associated with tissue swelling), due to the accumulation of any fluid (most often blood) under the capsule (with a traumatic rupture of the liver), or damage to the capsule.

Unpleasant sensations in the area of the right hypochondrium are caused by excessive distension of the intestinal loops by intestinal contents or gases. In addition, since the organs of the chest are located close to the right hypochondrium, in case of development of pleurisy (inflammation of the pleura), the pain syndrome can also be localized in the right hypochondrium and imitate diseases of the abdominal organs.

Diseases that cause pain or heaviness in the right hypochondrium

Among acute diseases accompanied by pain in the right hypochondrium, it is worth mentioning first of all those that require emergency surgical intervention.

These include
acute calculous cholecystitis
and
renal colic
.
Both conditions are a consequence of cholelithiasis
. Inflammation of the gallbladder (cholecystitis) develops against the background of an already advanced process of stone formation or, conversely, is the cause of the formation of stones. With renal colic, a calculus (stone) becomes wedged into narrow segments of the biliary tract, which is accompanied by severe pain, impaired bile outflow, and in more severe cases – jaundice (yellowing of the sclera and skin).

Other diseases of the biliary tract, such as
biliary dyskinesia
,
chronic cholecystitis
, cause recurrent pain in the right hypochondrium, usually associated with an error in diet.

Another disease classified as an “acute abdomen” that can cause pain in the right hypochondrium is appendicitis.

(inflammation of the appendix).

Despite the fact that the classic position of the appendix corresponds to the right iliac region, an abnormal position of the appendix in the right hypochondrium is quite common, especially in children.

Overdistension of intestinal loops can develop as part of
intestinal obstruction
.

Swelling of the liver tissue is characteristic of hepatitis (inflammation of the liver parenchyma). Hepatitis can have a variety of origins: viral hepatitis A, B, C, etc., autoimmune, toxic, incl. alcoholic. These diseases are usually accompanied by pain, as well as weakness, nausea and vomiting, yellowing of the skin and sclera, change in the color of urine and feces.

Subcapsular hematomas of the liver (accumulation of blood between the liver tissue and its capsule), as well as ruptures of the liver capsule, are usually traumatic in nature.

Among the diseases of the chest that can cause pain in the right hypochondrium, it is worth mentioning pleuropneumonia (inflammation of the lung tissue and pleura), heart failure, intercostal neuralgia and herpes zoster. The latter is characterized by the appearance of blistering-type skin rashes, which are preceded by severe pain.

Which doctors should you contact if you experience pain or heaviness in the right hypochondrium?

If sudden, progressively increasing pain appears in the area of the right hypochondrium, you should contact a doctor to exclude acute surgical pathology. If the pain is not acute, the examination can begin at or. If necessary, the patient can get advice from a hepatologist (a specialist in liver diseases) and other specialized specialists.

Diagnostics and examinations for pain or heaviness in the right hypochondrium

After a detailed survey and comprehensive clinical examination, the doctor, as a rule, needs laboratory and instrumental confirmation of the diagnosis. For this purpose, the following studies are used:

A clinical blood test with determination of the leukocyte formula, based on the results of which one can suspect the presence of an inflammatory process in the body and determine its severity.

Which doctor should I contact for chest pain?

If you have chest pain, you should first consult a general practitioner - family doctor or therapist. It is he (and not the patient himself) who should draw up the examination plan. Your GP can refer you to:

to a cardiologist - if there is reason to believe that the pain is caused by heart disease (localized behind the sternum and to the left of it, relieved with nitroglycerin, accompanied by shortness of breath, etc.);
see a pulmonologist if you suspect pneumonia or pleurisy (if pain is accompanied by cough and fever);
to a gastroenterologist - if you suspect diseases of the esophagus and stomach (if the pain is accompanied by belching, heartburn, or occurs after eating);
see a neurologist in case of “shooting” pain.

Chest pain due to lung diseases

The lungs occupy a significant part of the chest. Chest pain can occur against the background of inflammatory diseases of the lungs, pleura, bronchi and trachea, with various injuries to the lungs and pleura, tumors and other diseases.

Chest pain occurs especially often when there is a disease of the pleura (the serous sac that covers the lungs and consists of two layers, between which the pleural cavity is located). With inflammation of the pleura, pain is usually associated with coughing, deep breathing and accompanied by fever. Sometimes such pain can be confused with heart pain, for example, with pain due to pericarditis. Very severe chest pain occurs when lung cancer grows in the pleural area.

In some cases, air (pneumothorax) or fluid (hydrothorax) enters the pleural cavity. This can happen with a lung abscess, pulmonary tuberculosis, etc. With spontaneous (spontaneous) pneumothorax, sharp sudden pain appears, shortness of breath, cyanosis, and blood pressure decreases. The patient has difficulty breathing and moving. The air irritates the pleura, causing severe stabbing pain in the chest (in the side, on the affected side), radiating to the neck, upper limb, and sometimes to the upper abdomen. The patient's chest volume increases and the intercostal spaces widen. Help for such a patient can only be provided in a hospital.

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).

Treatment

If you have pain in the chest when moving your arms, the doctor will prescribe treatment for you depending on the pathologies that caused the pain. If you have problems with diseases of the gastrointestinal tract, to alleviate the condition, you need to cure the ulcer or gastritis before the pain subsides. In the case of lung pathologies, you will need to take antibiotics or even undergo surgery. Treatment of the spine in a condition where pain in the chest on the left appears when moving, may include taking anti-inflammatory drugs, applying ointments, massage and physical exercises prescribed by a neurologist

for each case individually.