Cardialgia and abdominalgia of vertebrogenic and myofascial origin

Chest pain can occur due to various diseases; it is sometimes difficult even for a doctor to understand it right away, so patients with such complaints usually undergo additional examination. Chest pain can manifest as diseases of the heart, respiratory system, gastrointestinal tract, spine, mediastinum, and central nervous system. All human internal organs are innervated by the autonomic nervous system, the trunks of which arise from the spinal cord. When approaching the chest, the nerve trunk gives off branches to individual organs. That is why sometimes pain in the stomach can be felt like pain in the heart - they are simply transmitted to the common trunk, and from it to another organ. Moreover, the spinal nerve roots contain sensory nerves that innervate the musculoskeletal system. The fibers of these nerves are intertwined with the fibers of the nerves of the autonomic nervous system, and therefore a completely healthy heart can respond with pain in various diseases of the spine.

Finally, chest pain may depend on the state of the central nervous system: with constant stress and high neuropsychic stress, a malfunction occurs in its functioning - neurosis, which can also manifest itself as pain in the chest.

Some chest pains are unpleasant, but not life-threatening, but there are chest pains that need to be relieved immediately - a person’s life depends on it. In order to figure out how dangerous chest pain is, you need to see a doctor. Perhaps this will save your life or calm you down if no serious problems with your health are found.

Causes of chest pain

• Heartburn. Acidic stomach acid that flows from the stomach into the esophagus (the tube that connects the mouth to the stomach) can cause heartburn, a painful burning sensation in the chest. It is often combined with a sour taste and belching. Heartburn chest pain is usually associated with food intake and can last for hours. This symptom most often occurs when bending or lying down. Taking antacids relieves heartburn.
• Panic attacks. If you experience attacks of unreasonable fear, combined with chest pain, rapid heartbeat, hyperventilation (rapid breathing) and profuse sweating, you may be suffering from “panic attacks” - a unique form of dysfunction of the autonomic nervous system.
• Pleurisy. Sharp, localized chest pain that gets worse when you inhale or cough may be a sign of pleurisy. The pain occurs due to inflammation of the membrane lining the inside of the chest cavity and covering the lungs. Pleurisy can occur with various diseases, but most often with pneumonia.
• Tietze syndrome. Under certain conditions, the cartilaginous parts of the ribs, especially the cartilage that attaches to the sternum, can become inflamed. Pain in this disease can occur suddenly and be quite intense, simulating an attack of angina. However, the location of pain may vary. With Tietze syndrome, pain may increase when pressure is placed on the sternum or ribs near the sternum. Pain during angina pectoris and myocardial infarction does not depend on this.

Osteochondrosis of the cervical and thoracic spine leads to so-called vertebrogenic cardialgia, which resembles angina pectoris. In this condition, there is intense and prolonged pain behind the sternum, in the left half of the chest. There may be irradiation into the arms and interscapular area. The pain increases or decreases with changes in body position, head turns, and arm movements. The diagnosis can be confirmed by performing an MRI of the spine. Magnetic resonance imaging of the spine will help determine the cause of pain in the chest if it is caused by pinched nerve roots or the presence of herniated intervertebral discs.

• Pulmonary embolism. This type of embolism occurs when a blood clot enters the pulmonary artery, blocking the flow of blood to the heart. Symptoms of this life-threatening condition may include sudden, sharp chest pain that occurs or gets worse with deep breathing or coughing. Other symptoms are shortness of breath, palpitations, anxiety, loss of consciousness.
• Other lung diseases. Pneumothorax (collapsed lung), high pressure in the blood vessels supplying the lungs (pulmonary hypertension), and severe asthma may also cause chest pain.
• Muscle diseases. Pain caused by muscle diseases usually begins to bother you when you turn your body or raise your arms. Chronic pain syndrome such as fibromyalgia. May cause persistent chest pain.
• Damage to ribs and pinched nerves. Bruises and fractures of the ribs, as well as pinched nerve roots, can cause pain, sometimes very severe. With intercostal neuralgia, pain is localized along the intercostal spaces and intensifies with palpation.
• Diseases of the esophagus. Some diseases of the esophagus can cause difficulty swallowing and therefore chest discomfort. Esophageal spasm can cause chest pain. In patients with this disease, the muscles that normally move food down the esophagus work uncoordinated. Since esophageal spasm can resolve after taking nitroglycerin - just like angina - diagnostic errors often occur. Another swallowing disorder known as achalasia can also cause chest pain. In this case, the valve in the lower third of the esophagus does not open as it should and does not allow food to pass into the stomach. It remains in the esophagus, causing discomfort, pain and heartburn.
• Shingles. This infection, caused by the herpes virus and affecting the nerve endings, can cause severe chest pain. The pain can be localized in the left half of the chest or be of a girdling nature. This disease can leave behind a complication - postherpetic neuralgia - the cause of prolonged pain and increased skin sensitivity.
• Diseases of the gallbladder and pancreas. Gallstones or inflammation of the gallbladder (cholecystitis) and pancreas (pancreatitis) can cause pain in the upper abdomen that radiates to the heart.
• Myocardial infarction - a blood clot that blocks the movement of blood in the arteries of the heart can cause pressing, squeezing chest pain that lasts more than a few minutes. The pain can radiate to the back, neck, lower jaw, shoulders and arms (especially the left). Other symptoms may include shortness of breath, cold sweats, and nausea.
• Angina pectoris. Over the years, fatty plaques can form in the arteries of your heart, limiting the flow of blood to the heart muscle, especially during exercise. It is the restriction of blood flow through the arteries of the heart that causes attacks of chest pain - angina. Angina is often described by people as a feeling of tightness or tightness in the chest. It usually occurs during physical activity or stress. The pain usually lasts about a minute and goes away with rest.
• Other causes of chest pain include inflammation of the lining of the heart (pericarditis), most often due to a viral infection. Pain with pericarditis is most often acute, stabbing in nature. Fever and malaise may also occur. Less commonly, the pain may be caused by a dissection of the aorta, the main artery in your body. The inner layer of this artery can separate under blood pressure and the result is sharp, sudden and severe pain in the chest. Aortic dissection can be the result of chest trauma or a complication of uncontrolled hypertension.

Because chest pain can have many different causes, do not self-diagnose, self-medicate, or ignore severe or prolonged pain. The cause of your pain may not be so serious - but in order to establish it, you need to contact a specialist.

Herniated disc

The word hernia itself means the protrusion of an organ beyond its anatomical location while maintaining the integrity of the membranes. In a herniated disc, the inner fibrous ring protrudes or ruptures, releasing the contents of the nucleus pulposus into the spinal canal.

Causes of intervertebral hernia formation:

• increase in internal pressure;
• chronic diseases of the spine;
• degenerative processes in the cartilage tissue protecting the nucleus pulposus.

The vertebral nucleus pulposus has a jelly-like structure. It is protected by a fibrous ring consisting of dense cartilage tissue. Due to the influence of various factors, the cartilage tissue of the annulus fibrosus is gradually destroyed, the soft contents of the annulus pulposus extend beyond the anatomical site and undergo ossification. The formed bone structures pinch nerve endings and blood vessels, causing pain.

When affected by herniated intervertebral discs of the thoracic region, the nature and intensity of pain can be different: a weak nagging pain in the middle of the spine or a burning, unbearable pain in the middle of the back, shooting into the lower back. Often pain from the middle of the spine can radiate to the ribs.

With an intervertebral hernia of the thoracic region, in addition to back pain, the following symptoms may occur:

• inability to fully straighten your back due to muscle strain;
• tingling and numbness in the limbs;
• loss of sensitivity in the area in the middle of the spine.

Chest pain caused by changes in the central nervous system

Chest pain can also occur with other diseases. One of the most common diseases that causes frequent and prolonged pain in the chest is cardioneurosis, which develops against the background of a temporary functional disorder of the central nervous system. Neuroses are the body’s response to various mental shocks (intense, short-term or less intense, but long-lasting).

Pain due to cardioneurosis can have a different character, but most often it is constant, aching and is felt in the area of ​​the apex of the heart (in the lower part of the left half of the chest). Sometimes pain due to cardioneurosis may resemble pain due to angina pectoris (short-term acute), but taking nitroglycerin does not relieve it. Often attacks of pain are accompanied by reactions from the autonomic nervous system in the form of facial flushing, moderate heartbeat, and a slight increase in blood pressure. With cardioneurosis, other signs of neuroses are almost always present - increased anxiety, irritable weakness, etc. Helps with cardioneurosis are the elimination of traumatic circumstances, the correct daily routine, sedatives, and for sleep disorders - sleeping pills.

Sometimes cardioneurosis is difficult to distinguish from coronary heart disease (CHD); the diagnosis is usually made based on careful observation of the patient, since there may be no changes on the ECG in either case.

A similar picture can be caused by changes in the heart during menopause. These disorders are caused by changes in hormonal levels, resulting in neurosis and metabolic disorders in the heart muscle (menopausal myocardiopathy). Pain in the heart is combined with the characteristic manifestations of menopause: flushing of the face, bouts of sweating, chills and various sensory disturbances in the form of “goosebumps”, insensitivity of certain areas of the skin, etc. Just as with cardioneurosis, heart pain is not relieved by nitroglycerin; sedatives and hormone replacement therapy help.

Pain in the back muscles between the shoulder blades

One of the common causes of pain between the shoulder blades is spasm of the muscles located in the indicated area. A person feels aching, burning or heaviness in this place. After performing physical activities, the pain subsides or goes away completely.

As a rule, the following category of people suffers from muscle pain between the shoulder blades:

• Leading a sedentary and inactive lifestyle.
• Due to their profession, they are forced to stay in one position for a long time, sitting with their heads slightly lowered (cashiers, drivers, programmers). The muscles are constantly tense, which leads to vasoconstriction and provokes poor oxygen supply. Over time, dense painful nodes (myogelosis) form in the tense area.
• With poor posture (scoliosis, kyphosis, etc.), since the joints and intervertebral discs receive an uneven load, which leads to their premature wear.
• Susceptible to depression and stress. Doctors use the definition of “muscular rheumatism,” which appears due to the fact that, being in a nervous state, a person constantly tenses unnoticeably, which leads to muscle pain.

Elimination of muscle pain can usually be achieved by:

• physical therapy
• non-steroidal anti-inflammatory drugs (Nimica, Ketonal, Novartis)
• massages
• anti-inflammatory ointments (hydrocortisone, fastum, diclonac)
• external medications that irritate nerve endings (efkamon, menovazin)

In addition, physiotherapeutic procedures are indicated:

• electrophoresis
• reflexology
• ultrasound

You can relieve muscle pain yourself by doing the following:

• change awkward body position
• do simple physical exercises (shoulder rotations, shoulder blade retractions, arm raises)
• do a self-massage, stretching your muscles well
• use the Kuznetsov applicator

A movement that stretches the muscles in the indicated area helps a lot:

• standing or sitting, hug yourself with your arms so that your shoulder blades move apart to the maximum
• take a deep breath
• hold your breath for 15 seconds
• exhale
• repeat 7-10 times

Well, the most reliable prevention of this problem is:

• active but moderate lifestyle
• maintaining anatomically correct posture

Chest pain due to diseases of the spine and ribs

Chest pain, very similar to heart pain, can occur with various diseases of the spine, for example, with osteochondrosis, herniated discs, ankylosing spondylitis, etc. Osteochondrosis is dystrophic (metabolic) changes in the spine. As a result of poor nutrition or high physical activity, bone and cartilage tissue, as well as special elastic pads between individual vertebrae (intervertebral discs), are gradually destroyed. Such changes cause compression of the spinal nerve roots, which causes pain. If changes occur in the thoracic spine, the pain may be similar to pain in the heart or pain in the gastrointestinal tract. The pain can be constant or in the form of attacks, but it always intensifies with sudden movements. Such pain cannot be relieved with nitroglycerin or antispasmodics; it can only be relieved by painkillers or heat. Pain in the chest area can occur when a rib is fractured. These pains are associated with injury and intensify with deep breathing and movement.

Prevention recommendations

• Warm up more often, do physical exercise, swimming, yoga or fitness;
• Try to keep your back straight while walking and sitting;
• Avoid drafts, hypothermia, do not swim for a long time even in warm water;
• Avoid excessive physical exertion and lift heavy objects;
• Avoid sharp turns and bends;
• Avoid stressful situations, overwork;
• Monitor your diet and weight;
• Give up bad habits: smoking and alcohol;
• Get a preventative checkup every year.

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.

Treatment and diagnosis

Pain in the middle of the sternum, radiating to the back, and back pain, radiating to the chest, are the most common symptoms of a wide variety of diseases.

If they occur, you should consult a doctor and do not try to diagnose the disease yourself. After all, it often happens that people with increased suspiciousness and phobias can make a very dangerous diagnosis for themselves based on this symptom alone. And what’s worse is that they begin to treat him. You need to understand that if a physically healthy person starts taking medications for diseases of the liver, heart, stomach, and so on, then sooner and later the organ will refuse to work normally. An example of such treatment is the addiction of patients to drugs containing an enzyme that helps digest food, such as Mezim or Pancreatin. The product undoubtedly helps digestion, but at the same time the pancreas gradually ceases to produce this enzyme on its own. And this in turn can lead to necrosis, pancreatitis and death as a result of painful shock.

We advise you to study: Cyst on the coccyx in women

So it is better to entrust the diagnosis to professionals and carry it out in specialized clinics.