Heartache

Among heart pains, the most practical significance is that of pains in coronary heart disease. To understand the mechanism of pain sensations, the features of their localization and irradiation, it is necessary to briefly dwell on the anatomical and physiological features of the blood supply and innervation of the heart.

As is known, the blood supply to the heart is carried out by the right and left coronary arteries. The right one, starting from the aorta, goes further back along the coronary groove and, reaching the posterior longitudinal groove, goes down it. The left coronary artery also starts from the aorta, divides into two branches - descending and circumflex. The first goes to the anterior longitudinal groove, the second lies under the left auricle, and then goes to the posterior surface of the heart. The main trunks of both branches pass superficially and only branches of the 2-3rd order penetrate into the depth of the myocardium, and the latter extend perpendicularly from the surface. The right coronary artery supplies most of the right heart, the posterior part of the septum, part of the posterior wall of the left ventricle and the medial papillary muscle. The left coronary artery supplies the rest of the left ventricle, the anterior part of the septum and a small area of the anterior surface of the right ventricle along the septum.

The heart is innervated by 6 plexuses - two anterior, two posterior, one for the anterior surface of the atria and the plexus of Haller's sinuses. This entire complex network consists of branches extending to the heart from the superior, rarely - middle and inferior cervical nodes of the border sympathetic trunk. In addition, the heart receives nerve fibers from five to six thoracic nodes of the spinal nerve. Radiation of pain to the back, chest, left arm is due to the conduction of sensory impulses through the stellate ganglion to the spinal nerves of the cervical (CVI) and thoracic (ThI-ThIV) segments. Irradiation of pain to the shoulder, lateral surface of the neck and to the outer surface of the arms is carried out along the sensory fibers passing through the stellate ganglion, then along the cervical sympathetic trunk, spinal nerve and along the connecting branches of the spinal nerves of segments CV-CVIII to the corresponding cervical nerves. When pain radiates to the lower jaw, superficial pain appears, corresponding to the innervation zone of the CIII spinal nerve, and deeper pain in the teeth along the course of the mandibular nerve.

Thus, the features of the innervation of the heart - the richness of sympathetic fibers, the wide level of segmental innervation (from CVI to TIV) - determine a number of clinical features of "heart" pain, allowing them to be differentiated from pain of other origins, but creating the preconditions for errors.

Patient complaints of chest pain, "in the heart area", "in the heart" are primarily associated by a modern doctor with the possibility of coronary heart disease, although in reality non-cardiac causes of these pains, especially in people under 40-45 years of age, are much more common. Both hypo- and hyperdiagnosis of coronary heart disease are equally undesirable. The latter can lead to unnecessary and incorrect treatment, endless intake of various antianginal drugs; frequent hospitalizations, mental trauma, disability and, as a result, to a deterioration in the patient's quality of life. One of the reasons for the hyperdiagnosis of coronary heart disease is the insufficient use of the usual diagnostic capabilities available to every doctor. The main significance in the diagnosis of coronary heart disease still belongs to the clarification of the characteristics of chest pain, the identification and assessment of risk factors for this disease and ECG at rest and under physical exertion. The data of the physical examination of the patient are important mainly for excluding other pathologies, since even with severe and undoubted angina, uncomplicated myocardial infarction, the heart size and auscultation data may be normal. The diagnostic value of the combination of pain typical of angina and risk factors is very high - not lower than the use of bicycle ergometry, coronary angiography or myocardial scintigraphy. However, the characteristics of heart pain are often insufficiently defined, and the presence of risk factors in itself does not always lead to coronary heart disease. ECG at rest is often unchanged or insufficiently specific, and the results of stress tests can be false positive or false negative for various reasons. Coronary angiography also does not always solve the diagnostic problem, since typical angina can be with unchanged coronary arteries and absent with their severe stenosis.

Causes heart pain

Pain in the heart area can be caused by a variety of reasons, and it is not always associated with heart problems. Below are some of the possible causes of heart pain:

1. Coronary artery disease (CAD): This is a condition in which the blood supply to the heart is restricted or interrupted due to narrowing or blockage of the coronary arteries. Pain from CAD may occur with physical exertion or stress.
2. Angina (angina): This is a form of coronary heart disease that causes attacks of pain or pressure in the chest area. They often occur with physical activity or stress and are usually relieved by rest or by taking nitroglycerin.
3. Myocardial infarction (heart attack): This is a condition in which part of the heart muscle dies due to lack of blood supply. The main symptoms are severe chest pain, a feeling of pressure, pain in the left arm, neck, jaw and nausea.
4. Pericarditis: This is an inflammation of the sac around the heart called the pericardium, which can cause severe chest pain.
5. Cardiomyopathies: These are a group of diseases that affect the heart muscle and can cause chest pain, shortness of breath, and fatigue.
6. Reflux disease (gastroesophageal reflux disease): This condition causes acidic stomach contents to flow back up into the esophagus, causing a burning sensation and discomfort in the chest.
7. Musculoskeletal problems: Problems with the muscles and bones in the chest area, such as intercostal neuralgia, osteochondrosis, or muscle strains, can cause chest pain.
8. Stress and Anxiety: Emotional factors, stress and anxiety can cause physical symptoms, including pain in the heart area.
9. Other causes: Heart pain can also be associated with diseases of the lungs, stomach, digestive system, or even with the muscles and tendons in the chest area.

There are 2 types of heart pain caused by heart disease:

• anginal pain associated with myocardial ischemia resulting from coronary circulatory failure;
• non-anginal pain, or cardialgia, which is based on mechanisms other than those that cause myocardial ischemia.

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Pathogenesis

The pathogenesis (mechanism of development) of heart pain can be associated with various factors and diseases, and it can vary depending on the underlying cause of the pain. Below is a general overview of the pathogenesis of heart pain associated with coronary artery disease (CAD), which is one of the most common causes:

1. Atherosclerosis: The first stage in the pathogenesis of coronary heart disease is the development of atherosclerosis, in which the arteries that supply the heart with blood become narrow and stiff due to the accumulation of cholesterol and other lipids on their inner walls.
2. Plaque formation: Plaques, which are made up of cholesterol, inflammatory cells, and other substances, can form inside atherosclerotic arteries. These plaques can grow in size and narrow the artery, limiting the flow of oxygen and nutrients to the heart muscle.
3. Ischemia: A narrow artery or a partially blocked artery can cause ischemia, which means there is not enough oxygen to the heart muscle. This can cause pain or discomfort in the heart area, called angina.
4. Myocardial infarction: If an atherosclerotic plaque ruptures or a thrombus (blood clot) completely blocks an artery, it can lead to a myocardial infarction, or heart attack. In this case, part of the heart muscle may die due to lack of oxygen.
5. Inflammation and remodeling: After a myocardial infarction, inflammation and remodeling of the heart muscle occurs. This can affect the function of the heart and cause pain in the heart area.
6. Arrhythmias: Coronary artery disease can also be associated with arrhythmias (abnormal heart rhythms), which can cause pain.

It is important to note that heart pain can also have other causes, such as inflammatory diseases, infections, stress, etc. Understanding the pathogenesis of heart pain is important for diagnosing and treating heart disease. If you have pain in the heart area or other symptoms of heart problems, consult a doctor for a detailed examination and appropriate treatment.

Symptoms

Heart pain can come in a variety of forms and characters, and these characteristics can help your doctor determine the possible cause of the pain. Here are some of the forms of heart pain:

1. Angina (angina):

   • Squeezing pain: Often described as a feeling of pressure, tightness, or squeezing in the center of the chest.
   • Discomfort or burning pain: May be accompanied by a burning, tingling, or stinging sensation.
   • Radiating pain: Pain may radiate to the left shoulder, arm, neck, jaw, back, or upper abdomen.

2. Myocardial infarction (heart attack):

   • Severe, sharp pain: Typically characterized by severe chest pain that may feel like squeezing or pressure.
   • Duration of pain: Pain from myocardial infarction often lasts more than 15 minutes and is not relieved by taking nitroglycerin.
   • Radiating pain: May also radiate to the left shoulder, arm, neck, jaw, or back.

3. Pericarditis:

   • Pain when inhaling: The pain increases with deep inhalation or movement and may decrease with rest.
   • Sharp and stabbing pain: May feel like a stabbing pain in the chest.

4. Cardiomyopathies:

   • Shortness of breath and fatigue: Along with pain, symptoms such as shortness of breath during physical activity and rapid fatigue may occur.
   • Pain in the heart area may be less characteristic and varied.

5. Reflux disease (gastroesophageal reflux disease):

   • Chest Burn: Often described as a burning or uncomfortable sensation in the chest area, often after eating.
   • Other symptoms: May include heartburn, excess saliva production, and throat discomfort.

6. Musculoskeletal problems:

   • Intercostal neuralgia: Sharp chest pain caused by irritation of the nerves between the ribs.
   • Osteochondrosis or muscle strains: Can cause pain or discomfort in the chest area, especially when moving.

7. Stress and anxiety:

   • Pain can be nonspecific and associated with emotional state.

It is important to remember that heart pain requires serious attention and if it occurs, you should consult a doctor for diagnosis and determination of the cause. Only a doctor can accurately determine whether the pain is related to heart problems or other medical conditions and provide appropriate treatment or recommendations.

The nature of pain in the heart area

The nature of pain in the heart area can have different features and can be described by the following characteristics:

1. Pressing pain: This is one of the most typical characteristics of pain in heart problems. Patients feel pressure or heaviness in the chest, as if something is squeezing their rib cage.
2. Burning pain: Some people describe heart pain as a burning or stabbing sensation in the chest area.
3. Sensation of pressure or squeezing: The pain may be accompanied by a feeling of pressure or squeezing in the chest.
4. Heart pain can have different characteristics and can be caused by different reasons. Here are the types of heart pain that can occur:
5. Acute heart pain: This is an intense, sharp pain in the chest that may be associated with serious conditions such as a heart attack or acute pericarditis.
6. Aching Heart Pain: Aching, long-lasting pain that may be associated with chronic conditions such as angina, pericarditis, or chronic myocardial ischemia.
7. Dull Pain in the Heart: A dull, numb pain in the chest may be associated with chronic heart problems or inflammatory conditions.
8. Stabbing pain in the heart: This is a sharp, stabbing pain in the chest. Stabbing pain can be caused by a variety of reasons, including intercostal neuralgia or muscle tension.
9. Sharp pain in the heart: A sharp, stabbing pain that may indicate serious conditions such as a heart attack or acute pericarditis.
10. Constant Heart Pain: Constant or long-lasting chest pain that may be associated with chronic heart disease.
11. Heart pain at rest: Pain that occurs even at rest may indicate chronic heart problems or inflammatory conditions.
12. Referred pain: Pain from the heart area may spread to other parts of the body, such as the left arm, shoulder, neck, jaw, back, or upper abdomen. This is called referred pain and may be a sign of heart problems.
13. Short-term or long-term pain: The pain may be short-term and last only a few minutes, or it may be long-term and last for a long time.
14. Worsening pain with activity: If pain gets worse with activity or stress and gets better with rest, it may be a sign of coronary artery disease.
15. Pain not relieved by nitrates: Nitrates, such as nitroglycerin, can temporarily relieve the pain of angina (strep throat). If the pain is not relieved by nitrates, it may be a sign of a serious heart problem.
16. Associated symptoms: Heart pain may be accompanied by other symptoms such as shortness of breath, nausea, vomiting, loss of consciousness, weakness, or angina (chest pain caused by coronary artery disease).

It is important to remember that heart pain can have a variety of causes, and not all pain is necessarily related to heart problems. It can also be caused by other medical conditions or factors such as stress or anxiety. If you are experiencing heart pain or have any concerns about your health, it is important to see a doctor for a more accurate diagnosis and assessment of your condition.

Diagnostics heart pain

Diagnosis of heart pain requires a comprehensive approach and the use of various methods and studies to accurately determine the cause of pain and the condition of the heart. Here are the main diagnostic methods:

1. Electrocardiography (ECG): An ECG measures the electrical activity of the heart and can detect abnormalities in heart rhythm, myocardial infarction, or other abnormalities. An ECG is often performed at rest and during pain to detect changes in the heart's electrical activity.
2. Blood chemistry tests: Measuring levels of certain biochemical markers, such as troponins and creatine phosphokinase (CPK), can help identify myocardial damage characteristic of a myocardial infarction.
3. Echocardiography: An echocardiogram (ultrasound of the heart) uses sound waves to create an image of the heart and its structures. This allows the heart function, valves, and blood flow to be assessed.
4. Stress testing: This test involves physical activity (such as running on a treadmill or cycling on a bicycle) while simultaneously recording an ECG. It can help detect angina, arrhythmias, or other abnormalities that may occur with physical activity.
5. Holter monitoring: This involves wearing a portable ECG monitor for an extended period of time (usually 24-48 hours) to record the heart's electrical activity in everyday settings. This can help identify arrhythmias and abnormalities that may be missed on a standard ECG.
6. Coronary angiography: This is a procedure that involves injecting a contrast agent into the coronary arteries and taking x-rays. It helps determine the degree of narrowing of the arteries and the presence of coronary disease.
7. Magnetic resonance imaging (MRI) and computed tomography (CT): These imaging tests can be used to look at the structure of the heart and nearby tissues in more detail and to look for abnormalities.
8. Pericardiocentesis: This is a procedure that removes fluid from the pericardium (the sac around the heart) for testing. It may be done if pericarditis is suspected.

Heart pain diagnosis should be performed by experienced doctors, taking into account the clinical symptoms and medical history of the patient. Accurate diagnosis helps to determine the cause of pain and prescribe appropriate treatment. Do not delay contacting a doctor for pain in the heart area, especially if it is accompanied by shortness of breath, nausea or vomiting.

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Differential diagnosis

Differential diagnosis of heart pain involves identifying and distinguishing this pain from other types of pain and medical conditions. It is important to consider various factors and symptoms to determine whether the heart pain is a serious heart problem or caused by another cause. Here are some conditions and factors to consider in the differential diagnosis:

1. Angina (angina):

   • This is a condition in which the arteries that supply the heart with blood are partially narrowed, causing chest pain with exercise or stress. However, this pain usually improves with rest and nitroglycerin.

2. Myocardial infarction (heart attack):

   • This is a serious condition in which the blood supply to part of the heart muscle is blocked. The pain of a heart attack is often intense, long-lasting, and may be accompanied by nausea, vomiting, and loss of consciousness.

3. Pancreatitis:

   • Inflammation of the pancreas (pancreatitis) can cause severe pain in the upper abdomen that may spread to the chest and back.

4. Reflux disease (gastroesophageal reflux disease, GERD):

   • GERD can cause heartburn and chest pain that may be mistaken for heart pain.

5. Musculoskeletal disorders:

   • Various conditions such as osteochondrosis, intercostal neuralgia and muscle pain can cause chest pain, which may be mistaken for heart pain.

6. Lung diseases:

   • Some lung conditions, such as pleural effusion, infections, or pulmonary embolism, can cause chest pain and difficulty breathing.

7. Psychosomatic factors:

   • Stress, anxiety, and panic attacks can cause physical symptoms, including chest pain that may be mistaken for heart pain.

8. Other cardiac and vascular conditions:

   • Besides angina and myocardial infarction, there are a number of other heart conditions that can cause chest pain, such as pericarditis, aortic disease, and myocarditis.

For accurate differential diagnosis of heart pain, it is important to conduct a complete clinical examination, including physical examination, ECG, blood biochemistry, echocardiography and other necessary studies. Only an experienced medical specialist can accurately determine the cause of pain and decide how to treat it.

Treatment heart pain

Treatment for heart pain depends on the underlying cause of the pain and can range from conservative treatments to surgery. Below are some of the possible treatments:

1. Drug therapy:
   • Nitrates: Drugs such as nitroglycerin can help dilate blood vessels and improve blood supply to the heart.
   • Beta blockers: These drugs can reduce the workload on the heart and slow your heart rate.
   • Cholesterol-lowering drugs: Statins and other drugs can help lower blood cholesterol levels, which is important for preventing coronary heart disease.
   • Blood pressure medications: If you suffer from high blood pressure, your doctor may prescribe medications to control it.
2. Procedures and surgery:
   • Angioplasty and stenting: These procedures can be used to open up coronary arteries and improve blood supply to the heart muscle.
   • Coronary Artery Bypass Surgery: If the coronary arteries become severely diseased, it may be necessary to create new pathways for blood through bypasses.
   • Myocardial revascularization: This is a surgical procedure to restore blood supply to the heart muscle.
3. Treatment of arrhythmias: If heart pain is due to abnormal heart rhythms, antiarrhythmic drugs or procedures such as ablation may be needed.
4. Treating the Underlying Condition: If your heart pain is associated with other conditions such as hypertension, diabetes or hypercholesterolemia, treating the underlying condition will also be an important aspect of treatment.
5. Lifestyle changes: Lifestyle changes such as eating a healthy diet, being physically active, stopping smoking, and managing stress can go a long way in treating heart pain and reducing your risk of heart complications.
6. Heart Attack Rehabilitation: People who have had a heart attack may need a cardiac rehabilitation program to regain physical activity and strengthen their heart.

Treatment for heart pain should be done under the supervision of a doctor, who will determine the best approach for your situation based on your diagnosis and your health. If you experience symptoms of heart pain, it is important to seek immediate medical attention, especially if they are accompanied by shortness of breath, nausea, vomiting, or other alarming symptoms. Your doctor will conduct the necessary examination and prescribe treatment to eliminate or control the problem.

What to do if your heart hurts?

If you experience pain in the heart area, it may be a serious symptom and it is important to follow certain steps:

1. Call an ambulance: Call an ambulance immediately by dialing the emergency number such as 112 (depending on your country). The ambulance will provide a professional medical examination and, if necessary, transport you to a hospital for further diagnosis and treatment.
2. Take nitroglycerin (if prescribed by your doctor): If you have previously been prescribed nitroglycerin to relieve symptoms of angina (strep throat) and it is available, take one dose as directed by your prescription or doctor. Nitroglycerin can help dilate blood vessels and relieve pain.
3. Sit or lie down in a comfortable position: If possible, sit or lie down in a semi-sitting position with your head and upper body semi-elevated. This can help improve blood flow to the heart and make breathing easier.
4. Follow medical staff's instructions: When the ambulance arrives, tell medical staff about your symptoms, medical history, and any medications you are taking. Follow their instructions and answer their questions.
5. Do not self-medicate: Do not take any medications that have not been prescribed by your doctor or try to relieve pain in other ways without consulting a healthcare professional.
6. Report all symptoms: In addition to heart pain, ask your healthcare provider about other symptoms you may be experiencing, such as shortness of breath, nausea, vomiting, dizziness, or weakness.

Do not delay seeking medical help for heart pain. A quick and correct response in such situations can save lives and prevent serious complications.

What to take for heart pain?

If you experience heart pain or chest discomfort, it may be a sign of serious heart problems and requires immediate medical evaluation and care. Self-medication for heart pain is not recommended, as it can have different causes, including heart disease, and require different treatment approaches.

In case of heart pain, you should:

1. Call an ambulance: If you suspect a heart attack (myocardial infarction) or other serious heart problems, call an ambulance immediately. This is important to get professional medical help.
2. Rest: Lie down or sit in a comfortable position to reduce the strain on your heart.
3. Don't take pain relievers unless directed by your doctor: Don't take aspirin or other pain relievers without first talking to your doctor, as they can have different effects depending on the cause of your pain.
4. Breathe slowly: Deep, slow breathing can help improve the supply of oxygen to the body.
5. Avoid physical activity: Avoid physical exertion that may worsen your condition.
6. Follow the instructions of medical personnel: Once medical assistance arrives, follow the instructions of doctors and nurses.

It is important to remember that heart pain can be a sign of various conditions, including angina, myocardial infarction, arrhythmia, and other heart diseases. Only a medical professional can accurately determine the cause and provide the necessary treatment. Do not delay seeking medical help for heart pain, as time is of the essence in treating heart problems.

First aid for heart pain

If pain occurs in the heart area, the following steps must be taken immediately:

1. Call an ambulance: Call an ambulance immediately by dialing the emergency number (e.g. 112, depending on your country). Emergency medical care can be life-saving for heart problems, so do not delay this step.
2. Calm down: Try to stay calm, as stress can make the situation worse. Breathe slowly and deeply, try to relax.
3. Take aspirin (if not contraindicated): If aspirin has not been previously contraindicated for you and you are not allergic to it, take one aspirin tablet (chewable if possible) with a small amount of water. Aspirin can help thin the blood and improve blood flow in the heart vessels.
4. Take nitroglycerin (if prescribed by your doctor): If you have a prescription for nitroglycerin, take it as directed. Nitroglycerin helps dilate blood vessels and reduce the strain on your heart.
5. Avoid increased physical activity: Try to minimize physical activity and remain calm until emergency services arrive.
6. Tell medical personnel about your symptoms: When medical personnel arrive, tell them about your symptoms, medical history, and medications you are taking. Answer their questions and follow their instructions.

Don't try to manage heart pain on your own, don't take unprescribed medications, and don't delay calling an ambulance. A quick response and timely medical care can save lives in heart problems.

Complications and consequences

Pain in the heart area may be a sign of serious problems with the heart or blood vessels. Complications associated with heart pain may include:

1. Myocardial infarction (heart attack): This is the most dangerous complication, when part of the heart muscle dies due to lack of blood supply. It can lead to damage to the heart and weaken its function.
2. Heart failure: Constant or frequent heart pain can lead to heart failure, in which the heart is unable to pump blood effectively throughout the body.
3. Arrhythmias: Heart pain may be due to abnormal heart rhythms such as atrial fibrillation, ventricular fibrillation, or other arrhythmias. These abnormalities can increase the risk of heart complications.
4. Coronary artery disease (CAD): If your heart pain is caused by coronary artery disease, it can progress, reducing your quality of life and increasing your risk of heart complications, including myocardial infarction.
5. Psychological complications: Long-term heart pain can cause stress, anxiety and depression, which affects the patient’s psychological and emotional well-being.
6. Arterial hypertension: Constant pain in the heart area can increase blood pressure, which increases the risk of developing hypertension and its complications.
7. Acute conditions:
   • Acute heart pain may lead to loss of consciousness or presyncope (a feeling of loss of consciousness).
   • Uncontrollable pain in the heart can cause panic attacks or agoraphobia (fear of open spaces).
8. Treatment complications: Treatments designed to manage heart pain, such as medication or surgery, may have their own risks and complications.