Intercostal neuralgia is a very painful and unpleasant condition. It is caused by irritation of nerve fibers or their compression. Neuralgia in the heart area, the symptoms of which are most often detected in older patients, is associated with age-related changes characteristic of the condition of their blood vessels. In children, pathology is found relatively rarely. Next, let's take a closer look at what neuralgia in the heart area is. Symptoms and treatment will also be described in the article.
Reasons for development
Neuralgia in the heart area can appear due to various pathologies. In particular, these include spondylitis, hormonal spondylopathy, progressive kyphosis, ankylosing spondylitis, as well as neoplasms localized in the spine. An attack can be triggered by hypothermia, a cold, infection or poisoning, trauma or psychological stress. In addition to the above, factors that increase the likelihood of the disease include strong physical activity to which a person is exposed without prior necessary warming up or out of habit. Among the main reasons due to which intercostal neuralgia in the heart area can develop are infections, cooling, overexertion and intoxication.
Other factors
Quite often in clinical practice, neuralgia in the heart area develops as a result of herpetic lesions. Often the pathology acts as a specific response to irritation, which is aimed at the nerve trunks. This, in turn, is the result of the course of pathological processes in the area of neighboring organs and tissues. Such conditions, in particular, include diseases of the spine and ribs, pleurisy, chest deformation and others. The generalized intoxication variant also corresponds to such a reason as the use of a number of medications. Against the background of such drug therapy, pinched nerves are observed. With prolonged use of certain drugs, complications often arise that are caused by the breakdown of drug components in the patient's body. In general, experts note that staying in conditions with a high content of toxic compounds and inhaling metal salts contribute to the acceleration of damage to the nervous system, the accompanying syndrome of which is often neuralgia in the heart area.
Prevention
There are measures that allow you to prevent intercostal neuralgia. They are necessary to protect against complications. It is important to observe the following measures:
- you need to control your posture;
- blood circulation in the body and physical activity are ensured by sports;
- you should not carry heavy weights;
- there is no need to allow exposure to temperature changes, drafts, or hypothermia;
- proper nutrition is required, which includes the vitamins necessary for the body.
Treatment should be carried out under the supervision of a doctor, who will choose the appropriate treatment option, prescribe medications, and provide recommendations. Taking the necessary measures will improve a person’s condition.
Clinical picture
Signs of neuralgia in the heart area are not so difficult to distinguish from other pathologies. Manifestations are neuropathic in nature. The main symptom of neuralgia is pain in the heart area. This manifestation is due to certain pathologies associated with the nervous system and its components, as well as damage relevant to them. Despite its neuropathic nature, pain can be expressed in different ways. For example, it can be burning, dull, aching or sharp. At the same time, some patients may complain of episodic manifestations, while others may complain of its constant presence. As physical activity increases, the pain intensity also increases. This can occur with a sharp turn of the body, sneezing, or loud conversation.
Differentiation of neuralgia and heart pain
It is important to know the difference between heart pain and neuralgia in order to provide or receive timely help.
Important differences in the manifestation of pathologies:
- pain syndrome. With neuralgia, any body movements, including inhalation and exhalation and normal walking, lead to increased pain. When there is pain in the heart, its intensity does not change depending on the depth of breathing;
- duration of the attack. Heart pain can be relieved in 15-20 minutes by taking medicine (validol, nitroglycerin). These drugs will not help with neuralgia;
- arterial pressure. Cardiovascular disorders lead to increased blood pressure during a painful attack and increased heart rate. Neuralgia does not cause changes in blood pressure;
- nature of pain. Coronarogenic pain in the heart is strong, pressing, with neuralgia it is burning and short-lived;
- localization. In case of heart problems, the pain is concentrated on the left or behind the sternum, neuralgia is accompanied by pain along the affected nerve;
- additional symptoms. Coronarogenic pain syndrome can be accompanied by cold sweat, pallor, and a feeling of shortness of breath. If the pain is of neurological origin, sweating, increased blood pressure, and limited mobility are possible;
- provoking factors. Heart pain can be associated with physical and emotional stress. Neuralgia is caused by sudden movements and uncomfortable posture;
- reaction to medications. Pain in the heart is relieved by treatment with nitroglycerin; neuralgia can be relieved by taking NSAIDs.
These signs are key in recognizing the nature of pain. But for an accurate diagnosis, additional examination is required. To identify the nature of the pathology, specialists from the IntegraMed CDC (formerly NDC) in St. Petersburg prescribe the following procedures:
- appointment with a cardiologist;
- appointment with a therapist;
- CT scan;
- Ultrasound;
- ECHO-cardiography;
- MRI of the spinal column.
Features of the clinical picture
Pain may appear when touching certain parts of the body. These include, in particular, the area of the spine and chest. Discomfort may also occur when palpating the intercostal area. It should be noted that this manifestation, regardless of its location, cannot be permanent. This is due to the fact that over time, necrosis of the nerve root occurs. This undoubtedly brings peace to the patient. However, this fact does not eliminate the pathology.
Other manifestations
In addition to what is described above, neuralgia in the heart area can be accompanied by quite noticeable muscle contractions or twitching. In some patients, sweating increases, and there may be a change in the color of the skin - it may turn pale or red. There is also often tingling of the skin or numbness in some areas. The pain is characterized by patients as “girdling.” This is explained by its development along the spaces of the bone elements of the sternum. There are also external signs of neuralgia in the heart area. So, for example, some patients may be in the so-called antalgic position. It looks like this: the torso bends towards the healthy side. This is how the patient stretches the intercostal spaces. This helps reduce pressure and reduce irritation of nerve endings. As a result, these manipulations reduce pain. In this tactic, psychological fear plays an additional role. It is associated with the anticipation of an attack of pain. As a result, the patient strives to stay in this position for as long as possible.
Treatment of cardiac neuralgia
Neuralgia of the heart muscle occurs for many reasons, so only a doctor can choose treatment based on the patient’s medical history, developing an individual program of therapeutic care. For some patients, drug therapy is sufficient; in some advanced cases, additional measures may be needed, such as physiotherapy and massage. Many people prefer to simply endure painful attacks, which is fundamentally wrong, because the disease will only progress and require more and more in-depth treatment.
Usually, for severe neuralgic pain, bed rest is prescribed, and the following types of treatment are used:
- Medication
Drugs that relieve inflammation in the muscles are prescribed - Nimesulide, Ibuprofen, Ketorolac. The next step is the prescription of antispasmodics, in order to relieve tension and pain resulting from pinched nerve endings - Baralgin, Papaverine, No-Shpa. To restore and maintain normal functioning of the skeletal system, injections of B vitamins are used.
Externally, it is recommended to apply gels and ointments with a warming effect, which will increase blood flow to tense, painful muscle areas. These products include ointments containing camphor, bee venom, and pepper extract. For the best effect, after applying the gel or ointment, you need to wrap the affected area of the body with a warm blanket or scarf. Such manipulations will help the muscles warm up and relax, relieving the patient of excruciating pain and tension.
- Physiotherapy
To relieve muscle spasms, the following physiotherapy procedures are widely used:
- acupuncture;
- vacuum, ultra-high frequency and magnetic therapy;
- ultraviolet and infrared irradiation;
- electrophoresis with painkillers.
Physiotherapy should be prescribed in combination with drug treatment; only this approach can achieve lasting positive results of therapy.
- Massage and physical therapy
It is recommended to perform exercises when treating neuralgia in the heart area under the supervision of medical personnel, in order to avoid pain and a reflex increase in muscle tone. It is prohibited to include exercises with weights (dumbbells, kettlebells) in the program. Movements and postures are chosen to be smooth and comfortable, restoring muscle mobility and strength, and also having a positive effect on functional systems.
Massage will help warm up the muscles, relieve the patient of pain and pinched nerve endings in the affected area. Cryo massage has a good effect.
Difference from cardiovascular pathologies
Here, a special role belongs to determining the nature of the pain. It is a thorough analysis of the patient’s condition that allows us to identify its cause. It should be noted that, despite the fact that pain is the main manifestation of both neuralgia and cardiovascular pathologies, its nature is different in different cases. So, in the first case, the condition differs in duration. The pain in most cases is constant, lasting for a relatively long time. Accordingly, it cannot be eliminated using traditional means, such as Nitroglycerin. If we talk about any cardiovascular disease, the pain is most often short-term and periodic. When taking the same drug “Nitroglycerin” it is usually suppressed. In addition, pain in cardiovascular pathologies does not increase during body movement. At the same time, there is a change in pressure and rhythm. Neuralgia in the heart area, the treatment of which will be described below, is not accompanied by these manifestations. Pulse and blood pressure remain normal.
Intercostal neuralgia - symptoms and treatment
Physical examination is usually minimal unless the patient has a history of chest surgery (thoracic or subcostal surgery) or herpes zoster. It is preferable to conduct the examination of the thoracic spine with the patient in a sitting position and include examination at rest and palpation of the vertebrae and paravertebral structures. Provocation of pain by passive forward rotation, flexion, reverse flexion, and lateral flexion in particular may indicate that the pain is of spinal origin.[9]
As a rule, during the examination, the patient tilts the torso in the healthy direction, thus reducing the pressure on the affected intercostal nerve. If several nerves are damaged, a neurologist, upon examination, can determine an area of decreased or loss of sensitivity in certain areas of the skin of the body.
If the pain is localized in the heart area, differential diagnosis is carried out with diseases of the cardiovascular system (for example, angina pectoris, which, unlike MPH, is relieved by taking nitroglycerin). MRNs provoke movements in the chest and palpation of the intercostal spaces. Angina pectoris is characterized by a painful attack of a compressive nature, it is provoked by physical activity, and it is not associated with turning the body, sneezing, etc. To exclude coronary heart disease, you need to perform an ECG and, if necessary, refer the patient for a consultation with a cardiologist.
If the lower intercostal nerves are affected, the pain syndrome is similar to diseases of the gastrointestinal tract (gastritis, gastric ulcer, acute pancreatitis). It should be noted that with stomach diseases, the pain is usually longer and less intense and is usually associated with food intake. Pancreatitis is characterized by girdle pain of a bilateral nature.
To exclude pathology of the gastrointestinal tract, it is advisable to conduct additional examinations: analysis of pancreatic enzymes in the blood, gastroscopy, etc. If intercostal neuralgia occurs as a symptom of thoracic radiculitis, then painful paroxysms occur against the background of constant dull pain in the back, which decreases when the spine is unloaded in a horizontal position.
To analyze the condition of the spine, an X-ray of the thoracic region is performed, and if an intervertebral hernia is suspected, an MRI of the spine is performed.
MRN occurs in some lung diseases (atypical pneumonia, pleurisy, lung cancer).
When diagnosing intercostal neuralgia, one should keep in mind syringomyelia, meningoradiculitis, intradural tumors, as well as referred pain from internal organs – Hed’s area.[2]
Neuralgia in the heart area: treatment
Therapeutic measures should be aimed primarily at eliminating the main manifestation.
You can get rid of pain when the influence that provokes it is completely eliminated. If there is displacement of certain elements of the spine, a specialist can prescribe procedures to help put them in place. This includes, in particular, massage and physiotherapy. In some cases, your doctor may prescribe a visit to a chiropractor. All manipulations must be carried out by a qualified doctor. Otherwise, there is a high risk of serious complications, including disability. Osteopathy is used as an additional measure. During the procedures, the position of each incorrectly positioned segment of the spine is restored. This contributes to the rapid normalization of blood and lymph flow, which has a beneficial effect on the condition of nerve endings, muscle fibers and the body as a whole. For neuralgia, reflexology is also recommended. Physical therapy with a specially designed set of exercises can be added to it. As adjuncts, you can use various kinds of external (local) medications in the form of ointments, gels with an analgesic effect (Diclofenac, Capsicam, etc.). In particularly severe cases, the doctor may prescribe analgesics (Ketorolac, Lornoxicam, etc.) orally (by mouth).
