Thoracic neuralgia in adults

The pain that occurs in the chest brings a lot of discomfort to a person. It interferes with full-fledged life activities and the performance of one’s duties. In some cases, it deprives a person of mobility - this often happens when the situation worsens and attacks become regular. In the vast majority of cases, the cause of such conditions is thoracic neuralgia . how to identify this pathology in yourself in the early stages of development, what to do to prevent its occurrence, what treatment methods and painkillers help with thoracic neuralgia .

What it is

Thoracic or so-called intercostal neuralgia is a condition in which a person develops a pathological process accompanied by compression and compression of the intercostal nerve. , thoracic neuralgia has the following symptoms - comprehensive and excruciating pain, which can be periodic or constant, a feeling of compression in the sternum. Due to the fact that the disease may be similar to dysfunction of the heart muscle and blood vessels of the body of different origins, patients may see a cardiologist instead of a neurologist or, even worse, ignore the situation. The result is a deterioration of the condition due to the continuation of the degenerative-dystrophic process.

Most often, the basis for this pathology is the development of osteochondrosis. Therefore, many patients believe that if they get rid of this disease of the musculoskeletal system, intercostal neuralgia will go away on its own. But this is a misconception that can lead a person down the wrong path. After all, it is in the thoracic region that the spine is the least mobile, in contrast to the lumbar and cervical regions. Therefore, the development of osteochondrosis here does not lead to pronounced symptoms. As a result, the body does not promptly push a person to take active action to eliminate the negative process. This is how the disease progresses into a severe form with complications, including the manifestation of neuralgia.

To understand what processes occur in the body, it is necessary to understand some anatomical features. For example, neuralgia in the chest has the following features, from the point of view of the anatomical structure of the body:

• Numerous nerve endings extend from the area of ​​the spinal column, which are collected in bundles and are localized mainly in the area of ​​the ribs. More precisely, in the intercostal spaces. They go around them along their entire length, extending from behind to the front and gradually, becoming thinner, moving into other parts of the body.
• Along the upper and lower surfaces of the ribs, muscle fibers are attached, which allow the chest to open for inhalation and close for exit; thin intercostal nerves are located between the individual bundles of muscle fibers.
• When they are compressed, for example, during muscle spasms, the nerve signal passes first to the spinal cord, and then directly to the part of the brain that transforms this sensation into a pain impulse.
• When a person develops osteochondrosis of the chest, sooner or later this will inevitably lead to the vertebrae shifting from their anatomically correct position. As a result, the nerve at the level of the reflex is pinched. The resulting pain covers, due to the transmission of a nerve impulse, the entire area of ​​the sternum.
• Due to the fact that such painful sensations cannot remain unnoticed by the human body for a long time, atrophy in the nerve endings (nerve roots) can gradually develop. This causes the pain to gradually go away. It may seem to a person that the problem has receded. But this is a wrong interpretation.
• The fact is that anatomically, nerve endings are directly involved in the act of inhalation and exhalation. And if they begin to atrophy, they can no longer fully perform their function. As a result, a person develops a characteristic feeling in which he experiences a certain heaviness when inhaling.

This is exactly how neuralgia of the thoracic spine and the symptoms that accompany this pathology are formed. If the situation is brought to this stage, then a lot of effort will have to be made in the future so that the treatment of thoracic neuralgia brings a certain result.

ethnoscience

Chest neuralgia (symptoms in adults require a full medical examination to make an accurate diagnosis) is treated with folk remedies, but strictly after consultation with a neurologist. It is necessary to take into account the fact that the components used may cause an allergic reaction or individual sensitivity.

Effective folk remedies:

Black radish juice has an analgesic effect. The product is used in its pure form. It is recommended to rub the juice on sore areas of the chest. Additionally, it is necessary to make compresses with steamed flax seeds. You can also take baths with sea salt and sage.

Chest neuralgia is a serious pathological condition in which the intercostal nerves are compressed. The main symptom in adults is severe pain. In most cases, neuralgia is a secondary disease and requires a comprehensive diagnosis. Properly selected therapy will help eliminate pain and prevent serious complications.

Risk factors

Neuralgia , as well as the accompanying thoracic symptoms, can be formed under the influence of the following risk factors:

• Hypodynamic rhythm of life. Physical inactivity always negatively affects joints, as well as a variety of organs and systems. Due to the unsatisfactory intensity of blood circulation in this component of the body, there is a lack of biochemical components and oxygen. Improper functioning is formed and as a result it leads to pathology.
• Heavy lifting and sudden movements can cause shifts in bone and cartilage structures. As a result, the nerve endings are pinched, and the muscle structures go into a spasmodic state.
• Poor nutrition can also negatively impact your back health. As a result, tissues do not receive the biochemical components they need to function fully.
• Naturally, these are only predisposing factors that do not themselves cause neuralgia, but can push towards it.

Treatment of intercostal neuralgia. Main groups of drugs

NSAIDs

Non-steroidal anti-inflammatory drugs have a decongestant, analgesic and antipyretic effect and therefore are one of the main drugs in the fight against neuralgia. These include: ibuprofen, Diclofenac, Dexalgin, Ketorol, Ketanov, Meloxicam, Nimesil, etc.

Most drugs in this category tend to increase the acidity of the gastric juice, which can cause gastritis or ulceration. Therefore, it is not recommended to use them for a long time without supervision.

Muscle relaxants

Any disorder of the spinal nerve leads to myofascial syndrome, which is accompanied by muscle tension that increases pain. Therefore, the prescription of muscle relaxants is justified: Sirdaluda, Midokalm, Tizaluda.

Decongestants

In some cases, this effect of NSAIDs is not enough, and it is necessary to turn to the prescription of diuretics (Diacarb, Veroshpiron) or other agents that have this effect (25% solution of magnesium sulfate, L-lysine escinate).

Vitamins

B vitamins (Milgamma, Mombilipen, Neurorubin, Neurovitan) are considered one of the main “building blocks” of the nervous system, as they improve cellular metabolism and promote the resumption of axonal conductivity.

Drugs that restore the sheath of nerve fibers

Compression of nerve fibers is always accompanied by destruction of their myelin layer, which disrupts the transmission of impulses from neuron to neuron. Therefore, the prescription of drugs such as Celtican, Nucleo CMF is justified.

Vascular drugs

In order for the bioavailability of drugs to be higher and the treatment result to be achieved faster, it is necessary to use drugs that improve microcirculation (nicotinic acid, Cytoflavin, Trental).

Causes

Most often, neuralgia in the thoracic region occurs due to the following main reasons:

• Various diseases of the musculoskeletal system, such as lordosis, curvatures - scoliosis and kyphosis, osteochondrosis. All these diseases cause deformations in the spinal column in one area or another. Neuralgia of the thoracic spine occurs when these diseases affect the thoracic spine, or more precisely, the vertebrae, starting from D1 to D12.
• Various diseases of the central nervous system.
• Infections can also cause osteochondrosis or other pathology of the musculoskeletal system, as well as changes in the activity of the central nervous system.
• Hypothermia, especially in the back, regardless of location.
• Injuries. In this case, even old injuries in the spine can manifest themselves after a fairly long period of time. Moreover, if the thoracic region is affected, then the distances between the ribs change. And this can cause intense pain.
• Metabolic disorders lead to incorrect absorption of biochemical components. In this case, a deficiency of minerals and vitamins occurs - and, as a consequence, various pathologies of organs and systems, including the musculoskeletal system. For example, if there is not enough calcium, phosphorus and magnesium, then there is a high probability of damage to bone structures. If there is an excess of these substances, bone processes and spines may grow on the vertebrae, which lead to damage to soft tissues, including nerve endings. If there are not enough B vitamins, then pathologies of the central nervous system occur, which causes a restructuring of numerous processes in the body.
• Age-related changes will also lead to pathology of the musculoskeletal system, and, as a result, can form symptoms of intercostal neuralgia of the thoracic region.
• If the human body, regardless of age and state of health, has been intoxicated, this can also provoke neuralgia. That is why it is important to exclude alcohol, tobacco and other toxic substances. Not everyone understands that many foods, unfortunately, can lead to intoxication of the body. For this reason, experts recommend excluding industrially produced and ready-to-eat foods from your diet. This is due to the fact that they contain a lot of preservatives and other chemicals.
• And one more reason due to which thoracic intercostal neuralgia may develop is a general weakening of the immune system. This human condition can be caused by seasonal changes, intense physical or mental stress, improper diet, and incorrect day and night routine.

Considering all of the above, doctors highly recommend adhering to a healthy lifestyle in various aspects of this term. That is, neuralgia and osteochondrosis of the thoracic region can be minimized if you exercise moderate and proper physical activity, balance your diet, get enough sleep and go to bed on time, and avoid stress and nervous strain.

But, if you were unable to protect yourself from this pathology, then it is important not only to know how to treat thoracic neuralgia , but, first of all, to detect this problem in time. Since in this case it will be possible to take all necessary measures at the early stages to prevent the situation from worsening.

First aid

The main symptom of chest neuralgia is severe pain, which causes significant discomfort to the person.

To cope with pain, just remember the simple rules of first aid:

1. Apply dry heat (a heating pad or salt) to the sore area.
2. You can rub the damaged area with warming ointment.
3. Take painkillers if necessary.
4. Sedative medications will help relieve nervous tension.

During the first days after injury, it is recommended to strictly observe bed rest and rest. Any physical activity or stress is unacceptable. You should sleep on a flat, hard surface; an orthopedic mattress is also suitable.

Characteristic symptoms

Doctors recommend listening to your health condition and trying to detect the following symptoms of thoracic neuralgia in men and women:

• Pain that extends throughout the entire chest. This is the main symptom that manifests itself in this pathology. Moreover, in different situations in different patients, the discomfort state can be localized in a specific area. This can be the left or right side.
• It is important to take into account that the pain may radiate to the area under the shoulder blades or even to the lower back, depending on which vertebrae is affected and where the nerve fiber is pinched.
• At the same time, you also need to pay attention to your posture. Often it begins to change, the body takes an unnatural pose. This is characterized by a tilt to one side. These poses are taken at the level of instinct and reflex. Thus, a person tries to avoid worsening the condition or minimize negative feelings. He tries subconsciously to either stretch or compress the intercostal space in order to eliminate the clamp on the nerve fiber.
• It is also important to note that pain may increase or decrease depending on the person's movement. Most often, when bending, tilting, or twisting the body, it will only intensify.
• It is important to consider that the pain can be either mild and not very disturbing, or one that interferes with normal life and work. This is due to how tightly the nerve fiber is compressed.
• Quite often, with neuralgia, the chest can hurt so much that it is difficult for a person to inhale and exhale.
• Intense lacrimation may also form.
• Where the pinched area is localized, a skin rash may occur.
• Temperature with thoracic neuralgia occurs when the inflammatory process enters the acute stage.
• When muscle fibers are involved in the pathology, the patient may experience twitching and trembling.
• Increased sweating may also occur.
• Areas of the skin may lose their sensitivity.
• Cough with thoracic neuralgia occurs if the pathological process involves smooth muscles that are in direct contact with the pleural area. But, if the patient has a cough that causes chest pain, it is necessary to undergo additional diagnostics and report this to the attending physician. The fact is that in this case the patient may experience other pathologies - tuberculosis, pleurisy, pneumothorax, malignant neoplasm, pulmonary infarction, pneumonia. Naturally, every disease requires the fastest possible diagnosis, which will be made correctly. Only in this case will appropriate treatment be prescribed, which means that the patient will not be neglected and his illness will not progress to a more severe stage. Therefore, cough with thoracic neuralgia requires especially careful attention from the doctor.

These signs of intercostal neuralgia of the thoracic region should alert a person and force him to contact a specialist as soon as possible, who will help clarify the diagnosis and prescribe appropriate treatment.

In addition, it is necessary to clearly understand that pinching of a nerve ending in the immediate vicinity of a certain vertebra will affect certain organs. This is due to the fact that the nerve fibers stretch in a certain direction. Therefore, it is necessary to consider the following relationship in damage to the thoracic vertebrae:

Vertebrae D1 and D2 are responsible for the functioning of the arms, wrists and hands, as well as the esophagus and trachea.

• D3 – for the functioning of the lungs, bronchi, pleura, chest and nipples.
• D4 – for the work of the gallbladder and ducts.
• D5 and D6 – for the work of the liver and solar plexus.
• D7 – for the pancreas and duodenum.
• D8 – for the functioning of the spleen and diaphragmatic region.
• D9 – for the work of the adrenal glands.
• D10 – for the kidneys.
• D11 – for the kidneys and also the ureters.
• D12 – for the small large intestine, as well as the inguinal rings and fallopian tubes.

Considering this feature of the distribution of nerve fibers in the thoracic region and their spread to other parts of the body, one should expect the manifestation of symptoms in those parts that have been listed if a particular vertebra is affected.

How to distinguish membranous neuralgia from heart pain

It is important to understand that in most cases, neuralgia and symptoms of the thoracic region on the left side can most often be confused with pathology of the cardiovascular system. To avoid this, you need to understand how the two diseases differ in their symptoms:

• With cardiac pathology, a person experiences a state of shortness of breath, which intensifies with acceleration of movement; dizziness due to lack of oxygen; Heart rate will be disturbed; your general condition will be unsatisfactory due to increased fatigue.
• If it is impossible to establish an accurate diagnosis on your own at home, you can conduct the following experiment - start breathing deeply. If this is a cardiac pathology, then the painful sensations subside. But if this is a pathology of the musculoskeletal system, then the pain, on the contrary, will become more pronounced.
• If a person’s condition improves after taking nitroglycerin, then the problem is really in the heart. If the drug does not give the desired effect, then most likely this is a problem with intercostal neuralgia.
• If a person feels his heart squeezing and a burning sensation arises in his chest, then most likely this is a symptom of angina pectoris.
• It is also necessary to pay attention to the symptoms of a heart attack, in which nitroglycerin has no effect. And the patient may experience fainting, cold sweat and cyanosis of the skin. In this case, a sharp pain forms behind the sternum, which is described as cutting.

In any case, if there are doubts about making an accurate diagnosis, the specialist should be referred to another doctor for further examination. So, for example, if a patient consults a neurologist and the symptoms resemble pathology of the cardiovascular system, then an ECG and other necessary manipulations and tests will be recommended.

Physiotherapy and exercise therapy

Additionally, chest neuralgia is treated with special exercises. Physiotherapeutic procedures eliminate the present symptoms. Therapeutic gymnastics allows you to restore the anatomical position of the spine.

Chest neuralgia (symptoms in adults will help a neurologist establish a preliminary diagnosis and prescribe an informative examination) is treated with the following physiotherapeutic procedures:

Therapeutic exercise in the complex therapy of thoracic neuralgia helps to influence the main cause of the pathological condition.

In most cases, patients are offered a standard set of classes:

1. Lying on your back, pull your legs towards you one by one, bending them at the knee. It is advisable to reach the forehead.
2. Lie on your stomach, stretch your arms forward. In this position, arching your back, rise with your upper body.
3. Standing with a straight back, spread your arms to the sides and straighten them. In this position, it is necessary to make rotational movements with your shoulders. First forward, then back.
4. Lie on your back. Bend your arms at the elbow. In this position, you need to raise your arms up and down, while straining your pectoral muscles.
5. Clasp your hands behind your head. In this position, sitting on a chair, bend forward.

All exercises must be performed slowly, without unnecessary stress. Classes are allowed when the period of exacerbation subsides. It is important to prevent the occurrence of painful sensations that may indicate a deterioration in health.

Diagnostics

When it is suspected that a person is developing thoracic neuralgia, treatment should be prescribed immediately. To do this, it is necessary to undergo a complete diagnosis, as only this will allow an accurate diagnosis to be made. In this case, the doctor will do the following:

• Collect a primary medical history, which consists of asking the patient about the presence of certain symptoms.
• After this, appropriate blood tests will be prescribed, by which it will be possible to determine the presence of an inflammatory process.
• CT and MRI help identify the cause of the disease. Using this diagnosis, you can determine the condition of muscle fibers, bone structures and cartilage tissue. And also, most importantly, what condition the nerve roots are in.
• ECG - to exclude pathology of the heart and blood vessels.
• A myelographic examination is performed using a contrast agent. This method helps to establish the condition of the nerve fibers and spinal substance.
• Electrospondylography is used to monitor the effect of treatment.
• A discographic examination helps determine the condition of the cartilage structure between the vertebrae.
• An X-ray image determines the pathology in the spine.

Only after these manipulations have been carried out can treatment be prescribed for thoracic neuralgia .

Prevention of intercostal neuralgia

This type of pain can be observed in various pain conditions resulting from damage to various systems and organs.

Prevention of intercostal neuralgia is similar to any other neurological disease of the spine and consists of the following well-known principles:

• The need for constant physical activity, personally selected taking into account gender, age and related pathologies;
• nutrition should be balanced and complete;
• all infectious processes should be cured if possible;
• It is important to monitor for spinal injuries, chest injuries, weight gain, and hypothermia;
• From an early age you should take care of your posture.

Treatment tactics

It is also important to understand that the approach to correcting the problem requires a comprehensive approach. Only medications for intercostal neuralgia in the thoracic region are not able to correct the situation. Other manipulations will also be required. It can be:

• Exercise therapy. Gymnastics for thoracic neuralgia helps improve blood circulation and prevent the situation from getting worse. But, you need to understand that it should become part of your lifestyle, and not be performed periodically.
• Massage for thoracic neuralgia can be performed only at the stage of remission. It improves blood circulation and relaxes muscle tissue that is overly tense.
• At the stage of acute pain, doctors prescribe injections for thoracic neuralgia. They help to quickly relieve negative symptoms.

Next, we will consider in more detail which treatment tactics are most effective when a patient is diagnosed with thoracic neuralgia and whether it is possible to allow treatment at home .

First aid

Most often, unfortunately, patients consult a doctor when they are tormented by acute, paroxysmal pain. Therefore, the specialist’s main task is to relieve negative symptoms and return the person to a normal lifestyle. In this case, injections are prescribed, but only when the chest pain due to neuralgia becomes unbearable. These are so-called blockades, which deliver the medicine directly to the affected area. That is why the effect is felt in the shortest possible time. Injections for intercostal neuralgia in the thoracic area are most often prescribed with Novocaine.

Drug therapy

Any thoracic neuralgia and symptoms that appear in women and men require the following medications:

• Painkillers such as Analgina, Ketonal, Ketorol. It is important to remember that these medications help eliminate symptoms, but their long-term use can cause problems with the gastrointestinal tract.
• Also, when neuralgia in the thoracic region is diagnosed and the symptoms are quite pronounced, patients are prescribed medications from the non-steroidal group. They most often come in the form of a gel or ointment and are applied topically. Ketonal, Voltaren, Nise gel, Diclofenac have proven themselves well. The advantage of these drugs is that they have few side effects and virtually no contraindications.
• Vitamin and mineral preparations can be used as complex therapy. They allow you to saturate the body with the missing biochemical elements and restore normal functioning. But, at the same time, it is important to realize that the use may extend over time, since short-term use will not have the desired effect.
• Symptoms of thoracic neuralgia in women and men on the left and right can be eliminated with drugs based on poisons. True, they should not be used by pregnant and lactating women, those with elevated body temperature, those suffering from allergic reactions, as well as those who individually cannot tolerate the components of such compositions. Apizartron and Viprosal ointments have a pronounced effect.
• If a patient has a fever due to chest neuralgia, then he needs drugs from the group of non-steroidal anti-inflammatory drugs. These include Celecoxib, Meloxicam, Nabedolac, Ketoprofen, Diclofenac, Naproxen, Ibuprofen, Indomethacin. It is important to understand that it is better to choose drugs of a new generation, since they are devoid of ulcerogenic side effects, or rather, do not affect the mucous membrane of the gastrointestinal tract in the case of long-term course use.

Massage

The doctor may also prescribe a course of massage when neuralgia manifests symptoms and affects the thoracic region on the right side or the left region. In this case, the following pronounced effects are expected:

• The proper level of blood circulation is established, due to which nutrients are supplied in an enhanced manner to the affected area. Oxygen saturation also occurs.
• Overly tight muscle structures relax. As a result, nerve roots may be released.
• The inflammatory process is relieved and swelling is eliminated.

Due to this, the symptoms of intercostal neuralgia of the thoracic region in men and women gradually weaken and then disappear completely. But, to carry out a complex or segmental massage, the following rules must be taken into account:

• You can only act if there are no pronounced symptoms. That is, at the stage of remission. But in the acute phase of the disease, massage cannot be used.
• It must be carried out in a course of 10–15 procedures. You can repeat the procedure after a certain period of time.
• The manipulations must be performed by a high-level professional, since otherwise the opposite effect can be achieved.
• Under no circumstances should you prescribe a massage yourself, as this is a full-fledged physiotherapy procedure. It can only be recommended by the attending physician, based on the symptoms and severity of the disease.
• Remember that massage will have a positive effect only if the neuralgia of the chest in the middle or side of the body is subjected to a complex effect.

By the way, the person who will perform the massage must have a complete medical history. This way it will be easier for him to navigate what can and cannot be done in each specific case.

If intercostal neuralgia of the chest responds to the massage therapist’s actions with painful sensations, then the specialist must change the tactics of influence. The patient should not experience obvious discomfort. Therefore, during the manipulation, he must inform the massage therapist about his feelings.

Also, everyone should know that massage has a number of contraindications. Therefore, before prescribing it, the doctor must be informed about all existing chronic pathologies.

ethnoscience

Traditional recipes can be used when thoracic neuralgia and symptoms appear in men and women. But in no case should you rely only on these methods, since they can only be additional. Otherwise, you can start the disease and cause a serious condition.

The following recipes can be used to help in situations where thoracic neuralgia shows symptoms in women and men:

• Boil the egg hard and, while it is in this state, peel it and apply it to the sore spot. This ensures uniform and not too pronounced heating, which reduces the inflammatory process and improves blood circulation.
• You can also degrease the area of ​​skin in the sore spot using alcohol. Then stick a pepper patch there.
• You can do the same with a horseradish leaf. The skin must also be degreased first, and then a whole leaf of the plant must be applied. Remember that horseradish quite effectively removes all salts from the body. Therefore, it can be used for various pathologies that are characterized by disruption of bone and cartilage structures, as well as the development of degenerative processes in them.
• You can use willow bark in an amount of 10 g in dry form. It must be filled with 250 ml of boiling water and brought to a boil. After this, the composition is cooled and filtered through a strainer or gauze. The resulting decoction is drunk in an amount of 15 ml (equal to 1 tablespoon) three times a day, spread as much as possible during the waking period.

Effective exercises

When a patient suffers from neuralgia on the left or right side of the chest , it is necessary to perform exercise therapy. Moderate and feasible physical activity in the form of specially selected gymnastics will help:

• Establish the blood circulation process.
• Strengthen the muscle frame and remove excess stress from the spine.
• Enrich damaged organs and tissues with oxygen and all necessary nutrients.
• Relieve muscle spasms.

Gymnastics for intercostal neuralgia of the thoracic region should become part of the patient’s life, since performing it periodically will not bring the desired effect. Remember that it is intended more to prevent the progression of pathology than to eliminate its consequences.

Most often, exercises for intercostal neuralgia of the thoracic region include the following set of exercises:

• Smooth sideways bends of the body are performed from a standing position with legs spaced shoulder-width apart. At the same time, it is also necessary to raise your arms to increase the load on the body and achieve maximum stretching of the muscle tissue.
• Squats are performed with complete control of posture. The depth of the squat is not important here - the main thing is to maintain the correct position of the body.
• Exercises with an expander and football. You need to sit on a fitball. Place the rubber band on your feet and grab the opposite end with one hand. The second palm rests on the thigh. Then, while inhaling, you need to lift the tape, smoothly stretching it with your hand. In this case, you need to feel the stretch in the side of the body. Then repeat the same thing, but with the other hand.

If the patient suffers from shortness of breath due to thoracic neuralgia , before performing physical activity, it is important to analyze the functioning of the cardiovascular system. If there are pathologies in the functioning of the heart, then exercise therapy should be completely different, and not the same as for pathologies of the musculoskeletal system.

Taking into account all these recommendations, you can detect a similar pathology in yourself in the early stages and take emergency measures to prevent its development and eliminate severe symptoms.

Drug therapy in adults

Chest neuralgia (symptoms in adults are taken into account by the neurologist when prescribing a medical examination) is treated using complex methods. First of all, the doctor prescribes drug therapy. Additionally, patients are recommended to attend physiotherapeutic procedures and massage.

It is also necessary to engage in physical therapy. If there are no serious contraindications, recipes from witch doctors and healers are used, but after consultation with a specialized doctor.

Drug therapy involves the use of the following drugs:

Additionally, patients with neuralgia are prescribed vitamin-mineral complexes (Neurorubin), which not only increase the body's defenses, but also enhance the process of regeneration of damaged tissues.

Differences between intercostal neuralgia and heart pain

With intercostal neuralgia, the pain deepens with deep inhalation and exhalation, changes in body position, coughing or sneezing when walking, as well as when palpating the intercostal spaces, in a state of anxiety and stress. Such pain cannot be eliminated with nitroglycerin.

The intensity of heart pain does not change with deep inhalation or exhalation, or with changes in body position. As a rule, the painful condition is accompanied by an increase in blood pressure, and the pulse is often interrupted (heart rate fluctuations). Pain can be relieved with nitroglycerin.

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