Cardiac pathology is a group of diseases that occupy first place in the overall structure of population mortality throughout the Earth. The percentage of deaths from myocardial infarction (MI) in this group is 25-40%. Pain in the heart area is the main sign of the corresponding pathology. However, nerve diseases can also be accompanied by a similar clinical picture.
How to quickly distinguish heart pain from neuralgia? Intercostal neuralgia is characterized by constant pain that is present for a long period of time. It cannot be relieved with nitroglycerin; it will intensify with body movement. Pain caused by heart disease does not increase with movement. In addition, heart pain will be accompanied by irregularities in the pulse rate, a decrease or increase in blood pressure.
What is the difference?
Pain in the heart area is a group of symptoms that combine discomfort sensations localized in the middle of the chest in the projection area of the corresponding organ. The causes of the clinical picture can be diseases of both the membranes of the heart and the structures located nearby.
For the differential diagnosis of neuralgic and cardiac pain, a comprehensive analysis of the patient’s individual sensations, auxiliary laboratory and instrumental methods are used.
When the nervous system is damaged, the symptoms described are caused by compression of individual fibers at the exit site of the spinal cord. There is no actual damage to the myocardium, but due to the anatomical proximity and the characteristics of the propagation of impulses, a person mistakes the pain for heart pain.
Diseases that cause neuralgia:
- Osteochondrosis.
- Spondylosis.
- Infectious lesions of bone tissue due to tuberculosis or syphilis.
- Vertebral hernias.
- Traumatic injuries.
In controversial situations, it is important to recognize in time what specifically worries the patient. Depending on the preliminary diagnosis, therapy is selected.
Heart pathology is characterized by direct involvement of the membranes of the corresponding organ into the pathological process. The clinical picture differs depending on the disease. In 85% of cases, neuralgia must be quickly differentiated from myocardial infarction or angina pectoris. The reason is the need to choose a treatment method to prevent death or disability of the patient in the future.
According to the recommendations of European, American and Russian cardiologists, the patient has 2 hours to restore the patency of a coronary artery blocked by a thrombus. Therefore, it is necessary to differentiate the cause of discomfort in the chest as quickly as possible.
With myocarditis and pericarditis, the patient will also feel pain in the heart area. A pressing sensation prevails, shortness of breath increases. In addition to chest discomfort, the patient finds it difficult to perform physical exercise. However, in this case, the urgency of hospitalization of a person is not as critical as in case of MI.
Prevention
Due to the fact that it is quite difficult to distinguish the characteristic differences between heart pain and neuralgia, the disease can only be recognized through a comprehensive examination of the patient.
To prevent the development of neuralgia, you should avoid hypothermia, promptly treat inflammatory diseases and regularly carry out measures to strengthen the immune system. It is also necessary to prevent vitamin B deficiency and muscle strain. People exposed to stress are advised to take herbal sedatives at regular intervals.
It is impossible to find out the cause of the development of compression of nerve fibers without hardware examination. This condition is characterized by pain of varying degrees of intensity, and therefore neuralgia is often confused with heart pathologies.
Features of heart pain
An analysis of the accompanying symptoms will help determine whether the heart hurts or whether it is neuralgia. A brief survey of the patient is a simple way to differentiate the disease. Myocardial pathology such as heart attack or angina pectoris is characterized by a clear connection with physical activity and stress. The reason is an increased load on the myocardium, which in conditions of disease (narrowing) of the coronary vessels causes pain. The symptom occurs due to inappropriate oxygenation of muscle tissue. Cells stop “breathing” normally, which leads to gradual death. The result is necrosis (infarction) with increasing pain.
Fear of death is a characteristic symptom that accompanies patients when a heart attack occurs. The lethal outcome in 65-75% of cases is due to the development of fatal arrhythmias (ventricular fibrillation) against the background of a heart attack. When the nervous system is damaged, there is no corresponding sign.
Features of the clinic for ischemia:
- Increasing or occurring at the peak of emotional stress or during physical exercise.
- The nature of the symptom is sharp pressing or burning pain in the area of the heart.
- Irradiation (spread) of discomfort to the left arm, shoulder blade, corresponding side of the neck and jaw.
- Increased heart rate (tachycardia), the occurrence of arrhythmias.
- Reducing the severity of pain due to the use of Nitroglycerin.
Among other causes of heart pain, it is necessary to highlight inflammatory diseases of the membranes (myocarditis, endocarditis, pericarditis). In these situations, fever and a decrease in the pumping function of the myocardium come to the fore. Associated symptoms are a feeling of heaviness in the chest, swelling in the lower extremities, fluctuations in blood pressure.
Heart failure is additionally accompanied by shortness of breath and cough, which is caused by stagnation of blood in the lungs. In the absence of timely treatment, the problem progresses. Pulmonary edema occurs. Pressing pain in the chest is accompanied by difficulty breathing. Pink foam forms around the patient's mouth; the person takes a forced sitting position with emphasis on straightened arms to facilitate inhalation.
The nature of the pain syndrome: where and how does it hurt?
The first thing patients notice is pain. For each person, the concept of pain is unique, and even for the same diagnosis, different patients have different sensations.
Intercostal neuralgia is characterized by diffuse pain in the chest. It occurs due to compression of the nerve trunks or their irritation by infectious agents (for example, postherpetic neuralgia after shingles).
When moving, coughing or sneezing, symptoms intensify . Such people are easy to spot in line to see a cardiologist by their motionless body posture. Palpation of the intercostal spaces on the left side of the chest increases the pain syndrome.
With myocardial ischemia (angina at rest or exertion), there is insufficient supply of oxygen and nutrients through the coronary arteries to the heart muscle. But this is not a heart attack yet. Reducing physical activity or timely administration of drugs that dilate coronary vessels helps alleviate the condition.
What is the difference between heart pain during angina and neuralgia? The pain with this disease will be characterized as substernal and lasts for 3-5 minutes. The patient may even indicate a specific location of tenderness on the anterior chest.
Myocardial infarction is one of the most dangerous heart pathologies. It has age restrictions (from 35 and older), and occurs with equal frequency in both men and women. The pain is severe, unbearable, acute or stabbing in nature . Changing body position does not reduce the pain attack.
In such patients, intravenous morphine is prescribed to alleviate the condition. This disease is characterized by a sharp decrease in blood pressure (usually it is recorded within 80/40 mm Hg).
Cardioneurosis is a neurological disease in which cardiac symptoms come to the fore. In this case, how can we understand what hurts – the heart or neuralgia?
The pain syndrome is moderate, patients characterize the sensation as dull, aching or burning . Any neuralgia is manifested by symptoms that are incomprehensible to the patient, so it is quite difficult to determine the location of the pain.
Most often, patients explain their condition as if there is something aching and painful in the center of the chest. In combination with pain, arrhythmias, shortness of breath, and dizziness appear.
Human anatomy is interesting and unique for each individual. There is such a normal anatomical concept as dextrocardia (translated from Latin as “heart on the right”).
Given this structural anomaly, intercostal neuralgia on the left side should not cause patients to worry about heart disease.
Manifestations of neuralgia
Nerve damage is not accompanied by a clear symptom complex that would allow a final diagnosis to be made. Verification of the cause of the problem is carried out by excluding other, more dangerous pathologies.
Neuralgia has no connection with physical activity or stress. Certain sensations arise suddenly or disturb the patient throughout the day. Sharp pain occurs against the background of bending the body, coughing, sneezing. The reason is compression of the nerve fibers. To characterize this symptom in neurology, the term “lumbago” is used.
Causes
If we look at the causes of these disorders, we can understand the differences in heart muscle pain and neuralgia in adults. Pain in the heart develops due to myocardial infarction, pulmonary embolism, myocarditis, pericarditis, aortic aneurysm, hypertension, angina pectoris. Each of these factors leads to different symptoms.
With angina, pain radiates to the left arm, neck or under the shoulder blade.
The intensity of the syndrome varies. The pain lasts for several seconds or minutes (sometimes up to 20). At the end of an angina attack, the patient feels short of breath. There may be a fear of death.
During a heart attack the following are observed:
- paleness of the skin;
- profuse sweating;
- increased breathing and increased intensity of pain when moving;
- fear of death.
In inflammatory heart diseases (pericarditis, myocarditis), the pain syndrome usually becomes nagging in nature, and its intensity is increased by physical strain. At the same time, shortness of breath, arrhythmia and an increase in body temperature are noted.
ari class=”aligncenter” width=”700″ height=”420″[/img] shortness of breath
An aortic aneurysm is indicated by prolonged painful sensations that bother you for several days. Thromboembolism is indicated by signs characteristic of the first disease. But unlike angina, the pain does not spread to other parts and is localized in the chest. The following symptoms are also possible:
- blue lips and skin;
- a sharp drop in blood pressure;
- rapid heartbeat;
- dyspnea.
With hypertension, pain occurs sharply, which is caused by an increase in blood pressure. This heart disease is characterized by the following symptoms:
- headache;
- blind spots before the eyes;
- "goosebumps";
- gait disturbance.
In addition to these reasons, the heart often hurts from nerves. In this case, the symptom ceases to bother you as soon as the patient’s mental state is restored.
Neuralgia, like heart disease, occurs against a background of muscular and emotional stress. Provoking factors that cause compression of nerve fibers include:
- injuries or other damage to the chest;
- hernias and other pathologies affecting the musculoskeletal system;
- infectious and viral diseases;
- frequent hypothermia;
- pregnancy;
- salt deposits in the spine;
- deficiency of B vitamins.
Usually, when the chest is affected, the pain spreads along the rib (usually the lower one). This manifestation is not typical for a diseased heart.
Methods for determining the nature of pain
The nature of the sensations is the determining factor in understanding what hurts: the heart or the nerve. However, in 90% of situations the patient cannot independently determine the root cause of a particular symptom. Seeing a doctor is a person’s main task.
To verify the nature of the disease causing pain in the heart area and differential diagnosis, the doctor uses auxiliary instrumental methods:
- Electrocardiography (ECG) is a basic study in cardiology. The procedure is based on recording electrical potentials generated by the heart. Using an ECG, organic damage to the myocardium is diagnosed, which makes it possible to distinguish heart pain from neuralgia.
- Coronary angiography is an invasive method for assessing the condition of the vessels that supply blood to the heart. The essence of the study is to visualize the arteries on the screen after the injection of a contrast agent. If there are narrowings in the lumen of the bloodstream, the doctor will be able to see the problem on the monitor. With neuralgia, coronary angiography remains uninformative.
- Chest X-ray or computed tomography of the spine. These techniques are used to assess the intervertebral space. If there are narrowings, compression of the sensory roots is confirmed, which causes pain along the corresponding nerves.
- Echocardiography (EchoCG) is an ultrasound method of examining the heart that visualizes the organ. If there is a pathology that provokes pain, the doctor will register deviations from the norm on the monitor.
If a myocardial infarction is suspected, a laboratory test is additionally performed to determine the level of a specific protein, troponin, in the blood. A positive test result confirms the presence of necrosis of the heart muscle, which is one of the most common causes of severe pressing pain in the chest.
Diagnostics
To determine the source of pain, doctors interview and examine the patient. Then, based on the identified clinical picture, laboratory and instrumental examinations are prescribed. Usually carried out:
- A general blood and urine test, as well as blood biochemistry, which will help to immediately detect disorders in the body and provide detailed information about the functioning of the heart.
- An ECG (electrocardiography) is prescribed for suspected coronary heart disease and heart attack. At rest, an ischemia study may not reveal abnormalities; it will be necessary to conduct an ECG simultaneously with exercise.
- Coronary angiography is a study using a contrast agent that determines the patency of blood vessels. By its distribution, you can find the location and degree of pathological narrowing of the blood vessels of the main artery of the heart. If problems are detected, immediate surgical intervention is usually required.
- Echocardiography is an ultrasound examination that is performed if heart pathology is suspected. Using an ultrasound, you can see how the heart valve is working. Thanks to this method, heart defects and inflammatory processes are detected.
- Tomography of the spine is prescribed if pain in the chest may be associated with diseases of the spine. It is also carried out if there is a suspicion of a hernia in the spinal region or tumors of the soft tissues and spine. Determination of antibodies to herpes viruses - if postherpetic neuralgia is suspected.
Important! You cannot treat yourself or take medications without the knowledge of your doctor. Instead, it is better to take preventive actions in the form of eating healthy foods and doing exercise.
First aid
Only a doctor can accurately determine whether the heart hurts or whether intercostal neuralgia is progressing. However, even before the doctor arrives, the patient tries to reduce the severity of the symptom. To minimize discomfort in the chest, medications of two basic groups are used - nitrates and non-steroidal anti-inflammatory drugs.
If relief occurs after using nitroglycerin, then it can be argued that there is heart pain such as angina or heart attack. A decrease in the severity of the symptom while taking paracetamol or ibuprofen indicates the neuralgic nature of the symptom.
In addition to taking specialized medications, the patient is advised to lie down and calm down. Before the doctors arrive, any physical activity is not recommended. Even going up or down stairs can cause aggravation of clinical symptoms.
Clinical picture of neuralgia
Let's look at the symptoms of the disease. Intercostal neuralgia is characterized by the appearance of neuropathic pain. For some people, neuralgia is associated with mental disorders. Unpleasant sensations in the ribs appear due to the fact that the nerves are compressed, in addition to this, they are irritated. Attacks occur constantly, but for some people they are episodic. Intercostal neuralgia is a serious pathology that requires proper treatment. If you feel the skin under the ribs, an attack may occur. Some people experience pain when they feel the spine. This symptom leads to breathing problems. With intercostal neuralgia, the muscles contract intensely, and “twitching” of the limbs is possible. This pathology leads to profuse sweating. The skin may become very pale and red.
Neuralgia manifests itself:
- tingling;
- burning of the dermis;
- loss of cell sensitivity.
During attacks, a person tries to take a forced position that helps dull the pain. As a rule, he manages to find such a position: some nerve endings experience less pressure and irritation. Pain due to heart pathologies is stable, it does not intensify with physical activity. With angina pectoris, a dull, burning pain appears - “angina pectoris”. Unpleasant sensations with neuralgia appear pointwise. Heart pain is inherently diffuse.
How does cardiac neuralgia manifest?
The clinical picture of the disease manifests itself in a paroxysmal form. Rolling pain in the heart area brings with it unpleasant sensations:
- burning;
- numbness;
- tingling.
Localization of symptoms can be not only in the chest area, but also in the area of the back, ribs, and shoulder blades.
The development of intercostal neuralgia is provoked by pathological conditions of the nervous system, infections, and weak immunity. The attacks vary in duration and usually begin in the evening or at night. With sharp turns, deep breathing, and coughing, the pain intensifies.
In addition to pain, intercostal cardiac neuralgia is accompanied by other symptoms associated with irritation and further compression of the nerve roots. Along with pain, isolated muscle contractions with twitching may be observed.
With neuralgia of the heart, increased sweating may occur. The color of the skin changes - it becomes pale or turns red. In the area of direct damage to the nerve fibers that cause neuralgia in the heart area, a burning sensation, tingling sensation appears, loss of sensitivity, and numbness are observed.
The patient may remain in an antalgic position. A person suffering from cardiac neuralgia bends the body in the healthy direction and strives to maintain this position. At the same time, the intercostal spaces are stretched, which reduces compression and irritation of the nerve endings, thereby reducing pain.
For treatment of this disorder, you can contact a therapist, neurologist or cardiologist. These specialists know exactly how to distinguish intercostal neuralgia from heart pain.
