What real heartache looks like
Ischemic pain occurs when the heart muscle lacks oxygen. It feels like a heaviness, compression or burning behind the breastbone, often spreading to the left arm, neck, jaw or between the shoulder blades. Appears during physical activity, climbing stairs, in the cold or during excitement, usually lasts from two to fifteen minutes and subsides with rest. It is impossible to show it with a finger: a person more often puts his palm or fist to his chest. If such pain lasts longer and does not go away with rest, we may be talking about a heart attack.
- Presses, burns, squeezes - but does not stab
- Located in the center of the chest, behind the sternum
- Provoked by stress and anxiety
- Goes away in just a few minutes
- Does not depend on posture, inhalation or pressure
Cardiac causes of pain
The most common cardiac cause is angina due to atherosclerosis of the coronary arteries. In addition to it, pain in the heart area can be caused by pericarditis, myocarditis, valve defects, severe myocardial hypertrophy and rhythm disturbances. With pericarditis, the pain is usually acute, intensifies when lying down and when inhaling, and decreases if you bend forward. With arrhythmias, people often describe not pain, but interruptions, freezing or tremors in the chest. All these conditions are distinguished by ECG, echocardiography and daily monitoring.
- Angina and myocardial infarction
- Pericarditis
- Myocarditis
- Rhythm and conduction disorders
- Heart valve defects
- Hypertension with myocardial hypertrophy
When it's not the heart that hurts
Most complaints of heart pain are associated with the thoracic spine and intercostal nerves. This pain is point-like, lasts for hours or days, and changes with movement, deep inhalation and pressure. The second common cause is anxiety disorder: the pain is combined with a feeling of shortness of breath, a lump in the throat, fear and a feeling of palpitations with a normal ECG. The third group is the esophagus and stomach: a burning sensation on the left and behind the sternum occurs with reflux disease. Separately, there is shingles, in which the pain precedes the rash by several days.
- Intercostal neuralgia and thoracic osteochondrosis
- Inflammation of the costal cartilages
- Anxiety disorder and panic attacks
- Reflux disease of the esophagus
- Muscle strain after exercise
- Shingles
Survey
Basic set - examination with blood pressure measurement and ECG. If complaints occur sporadically, daily ECG monitoring is prescribed: it catches arrhythmias and episodes of ischemia in everyday life. Echocardiography evaluates cardiac contractility, valves and pericardium. To assess the risk of atherosclerosis, the lipid spectrum and blood glucose are examined. If the pain is clearly associated with exercise, and rest relieves it, a treadmill test is performed. If neuralgia is suspected, there are no cardiac findings, and the person is referred to a neurologist.
- ECG at rest
- Holter ECG monitoring
- EchoCG
- Lipid spectrum and blood glucose
- Treadmill test for stress pain
- Consultation with a neurologist for suspected neuralgia
Treatment and prevention
It is not the pain that is treated, but its cause. For coronary heart disease, the doctor selects medications that reduce the heart's need for oxygen and cholesterol levels, and if the arteries are severely narrowed, they discuss stenting or bypass surgery. For arrhythmia, antiarrhythmic therapy or intervention on the conduction pathways is used. Neuralgia requires rest, physical therapy and pain relief, anxiety disorder requires work with a psychotherapist and sometimes medications. Universal prevention for the heart is simple: do not smoke, keep your blood pressure below 140/90, control cholesterol, sugar and weight, and move regularly.
- Therapy of coronary disease as prescribed by a cardiologist
- Blood pressure and cholesterol control
- Quitting smoking and alcohol
- Regular moderate physical activity
- Treatment of neuralgia and anxiety by specialized specialists
- Annual examination for risk factors