Chest burning develops in gastroenterological (ERGE, achalasia of the cardia), cardiological (angina pectoris, myocardial infarction), pulmonological diseases (bronchitis, pleurisy, pulmonary bleeding). The symptom occurs in intercostal neuralgia, as well as as a component of a panic attack. To find out the cause of chest burning, tests are prescribed (hemogram, blood biochemistry, myocardial markers), instrumental methods – ECG and EchoCG, radiography and CT of the chest organs, endoscopic visualization of the esophagus. Relief of burning pains includes antacids, antisecretory drugs, nitrovasodilators, antianginal medications.
Causes of chest burning
The symptom is often observed with heartburn, which is caused by eating fried, spicy or smoked food, drinking a large amount of carbonated drinks, strong coffee or tea. Burning sensation in the chest occurs 15-20 minutes after the end of the meal. Unpleasant sensations are usually localized behind the sternum, they spread from the xiphoid process to the throat. Heartburn is accompanied by an unpleasant taste in the mouth, sour belching. Symptoms disappear on their own after 30-60 minutes.
Diseases of the esophagus
Esophageal pathology is the most frequent factor in the development of chest burning. The sign manifests itself when acidic gastric contents are thrown into the esophagus, which is accompanied by damage to the mucous layer. Patients report that the painful symptom appears after eating, increases in a supine position, with the trunk tilted forward. The burning sensation is most intensely felt behind the sternum.
A similar clinical picture is characteristic of ERGE. In addition to these signs, patients complain of belching air or sour, nausea, bad breath. Chest burning is also observed with achalasia of the cardia. In such cases, in addition to the typical signs, there is a symptom of a “wet pillow” — regurgitation of stomach contents occurs in a dream.
Occasionally, burning is a sign of varicose veins of the esophageal veins. At the beginning of the disease, the symptoms correspond to esophagitis: burning sensations behind the sternum that occur after eating, nausea and vomiting, deterioration of well-being when bending and lying down. After physical exertion or overeating, burning pains in the chest increase, against their background, bleeding from pathologically altered veins often opens. Vomiting of blood, weakness and pallor, disorders of consciousness are noted.
A hernia of the esophageal orifice of the diaphragm is characterized by a burning sensation in the posterior region, which spreads along the esophagus and gives into the interscapular region. The discomfort starts suddenly. Usually it is preceded by a coughing fit, straining, physical exertion. The intensity of the symptom decreases after belching. vomiting. When the hernial sac is pinched, there is a constant burning pain in the chest, which is combined with shortness of breath, a decrease in blood pressure, tachycardia.
Coronary heart disease
In middle-aged and elderly people, chest burning is usually caused by cardiological pathology. Burning pains on the left side and behind the sternum occur during an attack of angina pectoris. The symptom is provoked by emotional shock, fast walking. At the beginning of a paroxysm, a person stops, sits down, takes the most stationary position. To stop burning, nitroglycerin is used, which eliminates discomfort in the chest in 5-10 minutes.
Severe burning pains that last 20 minutes or more indicate the development of acute coronary syndrome – myocardial infarction or unstable angina. In this case, the burning spreads over the chest area, radiates into the shoulder blade, left arm and collarbone, combined with a rapid heartbeat, falling blood pressure, cold sweat. Patients feel dizzy and fainting, often experience a panic fear of death.
Diseases of the bronchopulmonary system are also manifested by burning pain in the chest. They are more characterized by unilateral uncomfortable sensations that correspond to the localization of the pathological process. Burning occurs against the background of intoxication syndrome: fever, body aches, headache. The main respiratory causes of an unpleasant feeling in the chest:
- Bronchitis. With inflammation of the bronchi, burning is more often located in the middle of the chest, accompanied by soreness behind the sternum. The discomfort is noticeably worse when coughing. Burning pains persist for about 10-14 days, weaken as the frequency of coughing attacks decreases.
- Pleurisy. Intense burning in one half of the breast is typical for fibrinous inflammation of the pleura. Painful symptoms are aggravated by bending the torso in the opposite direction, with deep breaths, laughter or coughing. To relieve pain, a person lies on his side and tries not to move.
- Hemoptysis. Pathology is manifested by a painful paroxysm of cough with the development of severe chest burning. Blood impurities are noticeable in the sputum – from several veins to numerous clots, indicating pulmonary bleeding.
When the nerves are affected, the patient feels burning attacks that are localized on one side of the chest. Uncomfortable sensations begin simultaneously or undulate along the intercostal spaces from the spine to the sternum. Burning pains are very strong, they force a person to freeze and hold his breath so as not to aggravate the discomfort. The paroxysm ends after 3-5 minutes.
During an attack, patients often experience a painful burning sensation throughout the chest, which is accompanied by a feeling of lack of air, inability to swallow. An unpleasant symptom is complemented by tachycardia, heart failure, chills or a feeling of heat. Uncontrolled fear and anxiety prevail among the mental manifestations. A panic attack lasts up to 10 minutes on average.
The initial examination of the patient is carried out by a therapist who makes a presumptive diagnosis and directs to a specialized doctor: a pulmonologist, gastroenterologist, cardiologist. During a physical examination, a specialist listens to the heart and lungs to detect typical auscultative changes, palpates the abdomen to identify gastroenterological pathology. To determine the causes of chest burning, the following methods are used:
- ECG. Burning pain behind the sternum is an indication for immediate registration of a cardiogram. ECG records signs of myocardial ischemia or necrosis, cardiac arrhythmias and conduction. In the presence of pathological abnormalities, an echocardiogram is performed to examine the anatomical structure and contractility of the myocardium, to assess cardiac output.
- Radiography. An X-ray of the chest organs is used as a screening method and allows you to detect signs of cardiac or pulmonological diseases manifested by chest burning. In the picture, you can see infiltration or disintegration of lung tissue, symptoms of pleurisy, a change in the configuration or size of the shadow of the heart. To clarify the diagnosis, a CT scan of the chest organs is performed.
- EGD. Chest burning, combined with digestive disorders, requires endoscopic diagnosis. When examining the esophagus, the doctor pays attention to the color of the mucous membrane, its integrity, the presence of erosions or ulcers. With EGD, the condition of the stomach and the duodenum is studied to exclude hyperacid conditions.
- Neurological examination. During the examination, the symmetry and severity of the main reflexes are evaluated, muscle tone is checked, and the vegetative status of the patient is studied. Of the instrumental methods, electroneuromyography is recommended. If the attack resembles a panic attack, you need to consult a specialist in the field of psychiatry.
- Blood tests. In the hemogram, leukocytosis is detected in inflammatory processes, a decrease in erythrocytes and hemoglobin is detected in hemoptysis. To quickly diagnose a heart attack, the level of myocardial markers is determined. In the biochemical analysis of blood, they look at the ratio of plasma proteins, the number of acute-phase indicators.
Help before diagnosis
Burning and heartburn, which are caused by errors in the diet, are easy to prevent: stick to a rational diet, do not go to bed immediately after eating, avoid tight belts and clothes that squeeze the stomach. Patients with previously diagnosed GERD can take antisecretory and antacid medications prescribed by a doctor to relieve the symptom. Nitrovasodilators are used for quick help with coronarogenic burning behind the sternum.
Treatment of chest burning is selected differentially, taking into account the underlying disease that provokes a debilitating symptom. Most pathologies require therapy on an outpatient basis, but if acute coronary syndrome or pulmonary bleeding is suspected, hospitalization of the patient is required. Treatment regimens include drugs of different pharmacological groups:
- Antisecretory agents. Medications from the category of H2-histamine blockers, proton pump inhibitors effectively cope with burning sensation caused by ERGE. Medications reduce acidity in the stomach, promote healing of inflammation and erosion of the esophagus, prevent exacerbations of the disease.
- Antianginal drugs. Beta-blockers, calcium antagonists, and myotropic antispasmodics are used to reduce myocardial ischemia and reduce the risk of myocardial infarction. They increase the delivery of oxygen to the heart muscle, dilate the coronary vessels, increase the resistance of the organ to hypoxia.
- Antibiotics. The drugs are used for infectious lesions of the respiratory organs. They are selected empirically and corrected after receiving the results of the antibioticogram. With pleurisy, targeted intrapleural administration of antibacterial agents is indicated.
- Anticonvulsants. Representatives of this group are prescribed for the treatment of resistant forms of neuralgia, which are not removed by conventional analgesics and anti-inflammatory drugs. If necessary, the therapy of chest burning of neurological origin is supplemented with antidepressants, tranquilizers.
In case of panic attacks, qualified psychiatric care is necessary. Patients are told about special techniques for controlling paroxysms. Methods of cognitive behavioral therapy are recommended for the formation of constructive and positive thinking patterns. Sometimes the treatment is supplemented with psychoanalysis, group or family psychotherapy.
The intervention of abdominal surgeons is necessary for complicated course of diaphragmatic hernia. Surgery for suturing and plasty of hernial gates, methods of gastropexy and fundoplication are used. To achieve stable remission, patients with achalasia of the cardia undergo esophagocardiomyotomy followed by plastic surgery. In case of hyperacidity, refractory to drug therapy, selective proximal vagotomy is prescribed.
In acute coronary syndrome, myocardial revascularization may be required using minimally invasive endovascular angioplasty or coronary bypass surgery. In case of bleeding from the varicose veins of the esophagus, emergency endoscopic clipping or electrocoagulation of the affected vessel is performed. In the case of massive pulmonary hemorrhage, the affected segment or lobe of the lung is removed.