Thoracic pain: It is not always the heart
People with chest pain often think of a heart condition or an impending heart attack. Pain in the chest is an ambiguous symptom and not every type of chest pain indicates an emergency. Medical examinations must take into account diseases of the lungs, esophagus, spine and many more in order to apply the right therapy concept.
Brief overview: chest pain
- Symptom: chest pain: If sufferers suffer from chest pain, they are often referred to as chest pain. These are different types of pain in the area of the burst, the breastbone and the chest. The exact pain characteristic is cause-specific. In addition to a harmless side effect, it can also be a symptom that indicates an emergency.
- Chest pain - causes: In addition to various heart diseases, chest pain can also be caused by completely different causes. In addition to cardiological and cardiovascular triggers, medical diagnostics must take into account various diseases of the lungs, esophagus, digestive system, musculoskeletal system and nervous system. Psychogenic disorders can also cause chest pain.
- Thoracic pain treatment: A reliable diagnosis is the basic prerequisite for using the right treatment method. If the underlying disease can be treated effectively, the chest pain usually also goes away. In some, lighter cases, naturopathic and holistic treatment options can also be used to relieve chest pain and remedy causes.
Definition chest pain
Thorax is the medical term for the chest. Chest pain refers to chest pain. The term chest pain (chest pain) is used synonymously and also includes all pain sensations in the anterior and lateral thorax. This also includes a feeling of pressure on the chest as well as a pulling, stinging and burning sensation in the chest.
If the chest pain (under physical exertion) is perceived as retrosternal pain (pain behind the breastbone), there is a feeling of pressure and the pain in the thorax (rarely also in the shoulder and arms) may be radiated on both sides. Angina pectoris is very likely. This is a typical sign of coronary artery disease (CAD), which can also indicate a life-threatening condition in acute cases. Medical experts then speak of an acute coronary syndrome (ACS).
The exact symptoms in the thorax vary according to the various diseases that can trigger the pain. For example, there are differences in the exact location and in the character of the pain. A close examination is always necessary to determine the underlying disease or to correctly diagnose asymtomatic courses.
In addition to the cardiac or cardiovascular causes that can cause typical chest pain, there are a variety of other possible triggers for chest pain. These range from harmless illnesses to emergency situations. The latter must always be excluded or identified first in order to arrange for rapid emergency medical treatment if necessary.
Causes of chest pain
There are many reasons for chest pain and they can come from a wide variety of diseases. It is often feared that serious heart or lung diseases trigger the pain in the chest. But there can also be completely different causes behind it. These include diseases in the area of the skeletal and muscular systems, the esophagus and the abdominal cavity or psychogenic disorders. A basic distinction is made between cardiac and non-cardiac causes.
Chest pain in heart disease
If chest pain is due to heart problems, there can be a wide variety of diseases of the heart or the cardiovascular system. Coronary heart disease (CHD) and acute coronary syndrome (ACS) are common causes. These diseases arise due to blockages in the heart (arteriosclerosis) and can have other consequences, including serious or even life-threatening, such as unstable angina or a heart attack.
Also high blood pressure (hypertension), Irregular heartbeat (Arrhythmias) or inflammatory diseases of the heartFor example, inflammation of the heart muscle (myocarditis) or inflammation of the pericardium (pericarditis) can cause chest pain.
Noncardiac chest pain
A number of different diseases that are not related to the heart can lead to chest pain. In addition to the diseases described below, these also include less common symptoms such as sickle cell anemia, Tietze syndrome or various tumors (e.g. gastric ulcer, duodenal ulcer, esophageal cancer or lung cancer).
The dangerous diseases that can lead to complaints in the thorax include other vascular diseases, such as one Aortic dissection or an aortic aneurysm at the level of the chest. This causes the vascular walls to split and local bleeding to occur, which can cause the main artery to rupture (aortic rupture) - this is a life-threatening situation.
With pulmonary embolism, the vessels in the pulmonary circulation become blocked, usually due to a blood clot. As a rule, those affected then have chest pain that is breath-dependent or occurs when inhaled. There is also a risk to life here.
Lung and pectoral disorders
At a Pneumothorax there is an accumulation of air in the chest; more specifically, between the inner and outer lungs, where there is usually no air. This affects the respiratory function. A spontaneous pneumothorax is - as the name suggests - an acute onset of this clinical picture without corresponding previous illnesses. Affected people suffer from unilateral chest pain and asymmetrical breathing movements with shortness of breath. With tension pneumothorax there is a progressive accumulation of air without the possibility that it can escape. This is a very critical situation.
Other lung diseases that can cause chest pain include: lung infection (Pneumonia) and the Pleurisy (Pleurisy). The latter is usually accompanied by severe chest pain, which leads to a careful posture.
Abdominal diseases in the gastrointestinal tract can also be accompanied by pain radiating into the chest. Acute inflammation of the pancreas (pancreatitis), among other symptoms, leads to sudden onset of chest pain, which is also felt in the back or upper abdomen in the form of a belt. This is a serious medical condition, and those affected must seek medical treatment.
Sudden, cramp-like chest pain, which can also be felt in the back and right shoulder, may indicate one Biliary colic (Biliary pain). Furthermore, excessive gas accumulation in the stomach and intestines (Roemheld syndrome) occasionally trigger violent pressure and also cause chest pain.
Esophageal disorders (esophagus)
Retrosternal pain is usually referred to as a disease of the esophagus. This pain behind the breastbone is usually felt as a burning pain. This type of chest pain, acid regurgitation and later pain when swallowing can indicate reflux disease or reflux esophagitis. If the esophagus is permanently irritated by gastric contents flowing back again and again, this leads to a painful inflammation of the esophagus over time.
Primarily in children there is chest pain, which is caused by a swallowed foreign body (such as small toy parts, coins) in the esophagus. In addition to other esophageal diseases, the spontaneous Esophageal rupture (Tear through all wall layers of the esophagus) represents another - albeit rare - emergency situation in acute chest pain. This clinical picture is also referred to as Boerhaave syndrome.
Diseases of the ribs, spine, muscles and nerves
In most patient cases of general medical examinations, chest pain is the so-called Breast wall syndrome, where tension in the muscles or changes in the cartilage-bone structure of the chest trigger the painful symptoms. In summary, medical experts also speak of neuromusculoskeletal diseases.
Tension in the area of the intercostal muscles can, for example, lead to chest pain, which is often caused by diseases of the spine (e.g. osteochondrosis of the spine in the cervical and thoracic vertebrae area) (Rib fractures).
Pain that concentrates on the area of supply to a nerve and can also be felt in the thorax may be caused by one Shingles (Herpes zoster) conditional. In principle, this disease can occur anywhere, but is often manifested in the chest area. Affected people mostly suffer from massive, burning pain.
If there is no organic cause, you should also consider functional heart problems such as a cardiac neurosis (Da Costa syndrome) in the case of chest pain. Symptoms such as chest pain can also be found in various anxiety disorders.
Emergency situations for chest pain
In general, in the case of (acute) chest pain, the risk of a life-threatening situation must be assessed quickly in order to immediately call the emergency service in an emergency. In the first place, the following five dramatic causes (see above) are to be included, which require immediate medical treatment:
- Acute Coronary Syndrome (ACS),
- Pulmonary embolism,
- Aortic dissection,
- Pneumothorax (tension pneumothorax),
- Spontaneous esophageal rupture (Boerhaave syndrome).
Even laypeople can use typical signs of chest pain to assess whether a heart attack is imminent and make an emergency call in an emergency (see above).
If time-critical causes can be excluded by an initial medical assessment, an initial all-clear is possible. Afterwards there is usually more time for precise and diagnostic and cause research.
If there is no acute life-threatening condition, a detailed medical history and clinical examination are necessary when presenting the patient to determine the cause of the chest pain. Often the possibility of a coronary heart disease is examined first. This can be done, for example, according to the quick principle of the "Marburg Heart Score".
A further examination must include all possible organic and psychogenic causes equally, whereby a wide range of examination methods and specialist expertise may be required.
A diagnosis cannot always be made clearly, so that it may take a long time with repeated visits to the doctor until the cause is found.
Treatment for chest pain
Chest pain is a common accompanying symptom and can be attributed to a wide variety of causal diseases. With successful treatment of the underlying disease, chest pain also disappears in many cases. However, this always depends on the respective disease, as well as the respective stage, course and chances of recovery.
Thoracic pain: naturopathy and holistic medicine
If the chest pain does not occur due to a life-threatening or particularly serious illness, treatment methods from holistic medicine and naturopathy can under certain circumstances also supplement conventional treatment. As an alternative, naturopathic and holistic approaches are usually only possible in the case of mild illnesses. These must always be accompanied by a competent therapist.
For example, in the case of Roemheld syndrome (with excess gases in the digestive tract), naturopathic remedies can also relieve the symptoms of a bloated stomach. Various plants are used here that have an anti-flatulence effect. These include caraway, anise, coriander and fennel, which act as a tasty tea against the excessive air in the stomach and intestines.
If diseases of the spine or muscle tension are the cause, manual procedures can help against the symptoms after an orthopedic examination and in minor cases of illness. A variety of treatment methods come from the field of osteopathy.
In the case of inflammatory diseases, such as pneumonia, naturopathy - in addition to conventional medical treatment - can use agents that work against inflammation and pain or that strengthen the immune system. (sw, cs)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Eberli, F.R. and Russi, E.W .: Pain in the thorax, in: Battegay, Edouard (ed.): Siegenthalers Differentialdiagnose, Thieme Verlag, 2013, thieme-connect.de
- Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
- Medical editorial office Pschyrembel (ed.): Online information of the Pschyrembel www.pschyrembel.de, thoracic pain, status: January 2018, access: 02.10.2019, .pschyrembel.de
- German Society for General Medicine and Family Medicine (ed.): S3 guideline for chest pain, as of January 2011 (in revision), AWMF register no. 053-023, awmf.org
- German Society for Cardiology - Cardiovascular Research: ESC Pocket Guidelines. Acute coronary syndrome without ST elevation (NSTE-ACS), version 2015, leitlinien.dgk.org
- German Society for Pediatric Cardiology (ed.): S2k guidelines for chest pain in childhood and adolescence, as of June 2014 (revised), AWMF registry number. 023-003, awmf.org