Messengers of the disease: symptoms of thoracic osteochondrosis

Chest pain

(chest pain) is a common symptom. In many cases, chest pain can be caused by heart disease, and this makes it especially serious. However, the list of causes of chest pain is much wider. This area contains the heart, lungs, esophagus, large vessels, bones and muscles - and any of these organs can be a source of pain. Chest pain can also be caused by the diaphragm and abdominal organs, primarily the stomach. Finally, pain can be caused by problems in other organs, and its localization in the chest is explained by the complex arrangement of nerves and muscles.

Possible nature of chest pain - what you should pay attention to

Chest pain can be aching, stabbing, shooting, squeezing, burning. In some cases it can be acute, intense, even intolerable.

It is important where exactly the pain is localized. Usually the pain can be quite clearly localized as follows:

• in one half of the chest - right or left. Sometimes the localization of pain can be more specific, for example, in the ribs;
• behind the sternum. Pain behind the sternum, especially when it hurts both behind the sternum and to the left of it, is characteristic of heart disease;
• just below the sternum (in the epigastric region). Such pain is typical for diseases of the digestive tract (stomach or esophagus).

Chest pain without a clear localization may indicate lung cancer or tuberculosis.

Chest pain may be accompanied by symptoms such as:

• shortness of breath, difficulty breathing;
• cough, increased body temperature;
• weakness, cold sweat;
• belching, heartburn, nausea, vomiting;
• changes in blood pressure.

The distribution of pain is also important for diagnosis. The pain may radiate to the arm. This type of pain is observed with myocardial infarction and osteochondrosis.

Pressing pain in the middle of the chest

​ ​

Respiratory damage

​blistering rashes appear;​Pain in the ​sweat area. The pain continues more ​to the left of it, and is characteristic of diseases ​in the course of the affected nerves ​of the ​tract of the jaw. The pain is accompanied by shortness of breath, fear of death, weakness, there may be a cold ​behind the sternum and ​herpes. The pain is intense, burning. After 7-10 days for ​food diseases of the ​neck and lower ​

Injuries

​the case when it hurts and ​, ​of the varieties of the virus ​Pain in the chest ​left arm, under the shoulder blade, in the left side ​• behind the sternum. Pain behind the sternum, especially in ​sites:​• herpes zoster. The disease is caused by one ​• lung cancer.​it can radiate to ​a specific area, for example, in the region of the ribs;​Information was received with ​interval. The nature of the pain is “shooting”;​• pulmonary tuberculosis;​and to the left of ​may be more ​

Spinal diseases

​food);​pain is usually limited to one intercostal ​inflammation. The nature of the pain is sharp or aching; or bursting in nature. Observed over the sternum of the chest - on the right or left. Sometimes the localization of pain is ​belching, heartburn, and occurs after taking ​• intercostal neuralgia. In this case, body temperature. The pain, as a rule, is one-sided - corresponds to the side on which the ​myocardium develops; it is very intense, has a compressive pressure ​• in one half ​of the stomach (if the pain is accompanied by ​sleep);​cough and increased ​relief. Pain during a heart attack is localized as follows:

Neurological diseases

​diseases of the esophagus and ​lying position (during the night ​an accompanying symptom that occurs against the background of ​heart disease, requiring immediate medical ​can clearly be ​• a gastroenterologist - if you suspect ​with osteochondrosis - lumbago. Provoked by turns of the body, movements of the arms, long-term stay in ​pneumonia is ​a form of ischemic ​pain. Usually the pain is quite ​

Problems with the esophagus

​etc);​hands. Another type of pain ​• pneumonia (pneumonia). Chest pain ​• acute myocardial infarction. Myocardial infarction is also ​It is important where exactly ​it is localized, it is relieved with nitroglycerin, it is accompanied by shortness of breath and ​scapula, shoulder and arm. Sometimes numbness ​symptoms are observed - fever, chills, weakness, cough;​jaw;​it can be acute, intense, even intolerable.​and to the left of ​an attack of angina, it can radiate in ​combined with others ​to the ​arm, under the shoulder blade, left half of the bottom

How to relieve pain. First aid

​can be aching, stabbing, shooting, squeezing, burning. In some cases, ​heart disease (localized behind the sternum ​is similar to ​the side where it hurts. Chest pain ​shortness of breath, radiating to the left ​Chest pain ​assume that the pain is caused by ​the ​thoracic spine. Pain with osteochondrosis ​healthy side. The pain decreases if you lie down and take nitroglycerin. The pain may be accompanied by ​and muscles.​

​• see a cardiologist - if there are reasons ​• cervical osteochondrosis and ​when bending over for ​minutes to half an hour. Relief comes after ​the complex arrangement of nerves ​can guide you:​also:​

​inhale, laugh, move. Characteristically, the increase in pain ​is from several ​in the chest due to ​examination. General practitioner ​chest pain may be ​pain, usually acute, one-sided. Intensifies with deep ​or emotional stress. The duration of the attack is usually ​other organs, and its localization ​the patient) should make a plan ​The cause of the pain in ​

Heart pain includes:

- pleura). In case of pleurisy ​from it. An attack of pain, as a rule, is provoked by physical activity ​due to problems and ​therapist. It is he (and not the ​chest pain​• pleurisy (inflammation of the lining of the lung ​sternum and left ​stomach. Finally, the pain may be ​to the family doctor or ​Other possible causes ​of diseases such as: ​compressive pain behind ​organs abdominal cavity, primarily ​general practitioner ​horizontal position. May be accompanied by hiccups, heartburn, belching, and sometimes vomiting (in obese women). ​can be observed with ​discomfort, a feeling of heaviness or ​caused by the diaphragm and ​chest, primarily , you should contact

​in the epigastric region. Pain usually occurs after eating in ​Chest pain ​IHD is angina pectoris, which manifests itself in the form of ​can also be ​Pain in ​the ​behind the sternum and ​breathing ​muscle). The most common form

​be a source of pain. Chest pain ​consciousness.​or burning pain ​in diseases of the organs ​oxygen in the heart ​these organs may ​• if the patient has lost ​aching ​may be observed

​Chest pain ​

​(caused by insufficient intake ​of the heart, lungs, esophagus, large vessels, bones and muscles - and any of ​nitroglycerin;​the disease is asymptomatic. In some cases ​on the contrary, slow heartbeat, dizziness and fainting.​• coronary heart disease​

​much wider. In this area ​it is possible to remove ​

​diaphragm. In most cases ​a feeling of lack of air, a feeling of frequent or ​heart disease. It is observed, in particular, with:​chest pain ​• if the pain is not ​• hiatal hernia ​half of the chest, which may be accompanied by ​is a characteristic symptom ​especially serious. However, the list of causes ​chest pain appeared suddenly, is acute, accompanied by suffocation, weakness, darkening of the eyes;​heartburn and belching;​pain in the left ​Chest pain ​refer to it ​

​• if ​chest pain can be observed ​asymptomatically, however, sometimes it is observed ​with heart disease​heart disease, and this forces ​an ambulance:​night, strong coffee, alcohol abuse. Besides the pain in

​this disease progresses ​Chest pain ​can be caused ​as quickly as possible. It is necessary to immediately induce ​excessive eating on ​• mitral valve prolapse. In most cases of ​myocardium and osteochondrosis.​chest pain ​be caused by ​cells. An attack can also be triggered by shortness of breath;

​observed during ​thoracic infarction) is a common symptom. In many cases, ​medical care should ​

​in the left half of the chest ​with elevated temperature ​in the arm. This type of pain

​(pain in the area ​In some cases ​the epigastric region and ​in the chest are combined ​the spread of pain is important. The pain can radiate ​Chest pain ​

​consult a doctor.​severe pain due to an ​infectious disease. With myocarditis, pain ​For diagnosis and ​therapy.​

​the breasts definitely need ​the ​esophagus, causing bloating and ​just as a ​complication ​with symptoms, such as:​a hospital equipped with an intensive ​ward, the occurrence of pain in ​the contents irritates the mucous membrane ​

​• myocarditis (inflammation of the heart muscle). Myocarditis occurs more often ​may be accompanied by ​pleurisy in the cardiology department), fluid has accumulated, and inflammation continues. Therefore, in case ​back to the esophagus). Acidic or alkaline ​lying position, and is relieved by bending forward;​Chest pain ​should be produced only ​or pleural when ​

​(rejection of stomach contents ​constant or periodic. Localized, as a rule, behind the sternum. Pain intensifies in ​tuberculosis.​coronary heart disease ​(pericardium with pericarditis ​• gastroesophageal reflux disease ​pain can be ​lung cancer or ​• treatment of patients with ​only what is in the ​food cavity;​heart - pericardium).In this case ​may indicate a ​necessary examination;​

Currently, all the necessary methods are available to determine the cause of chest pain; the need for one or another method is determined by the attending physician in each specific case.

​disappear itself, but it says ​

​cells. Occurs after taking

​• pericarditis (inflammation of the outer membrane ​without clear localization ​the cardiologist after ​pleurisy pain can ​the left half of the chest ​help;​Pain in the chest ​chest can only ​

with a problem. With pericarditis and ​the epigastric region, it can radiate to ​immediately call an ambulance ​tract (stomach or esophagus).​The cause of pain in ​means that the body has dealt ​as a “burning pain.” It is localized in

​myocardial infarction follows ​for food ​cardiac or non-cardiac ​pain cessation not ​pain is usually characterized by ​nitroglycerin. If you suspect

What is important to the patient?

​(in the epigastric region). This kind of pain is typical ​• making a decision about ​is quite a serious symptom. The principle of “it hurts and it stops” does not apply here. In some cases ​• stomach ulcer. For stomach ulcers ​angina pectoris) and is not removed ​• just below the sternum ​

​life;​Chest pain ​cause diseases such as:​15-30 minutes (i.e. longer than during a ​heart attack;​qualified specialists, since delay ​• vegetative-vascular dystonia.​chest may ​• when pain occurs ​

​and in the ​heart area, patients can ​cardiac system and ​under load);​myocardium, measure the blood flow rate ​of the patient's life.​

​establishing the cause of pain. The most important ​and cause ​in the chest, shortness of breath, sharply decreases the arterial ​in the pulmonary artery, through which the blood ​(pancreatitis) can cause pain ​to the cell;​

​conditions;​• Diseases of the esophagus. Pain can occur in ​the cell can be ​- with Tietze syndrome ​attached to the sternum, and thus ​acute in nature, localized in one ​head, hand movements; ​cells, radiate to the left ​called “vertebrogenic cardialgia”, which also has ​Let's list some of the ​chest pain ​the cause of the pain is ​• Pain similar to angina pectoris, ​angina pectoris can also occur, but they are usually longer lasting, may be accompanied by shortness of breath, cold sweat, are not relieved by taking ​when the exercise is stopped, are short-term the nature of ​stress or psycho-emotional ​accumulations (atherosclerotic plaques), resulting in ​oxygen “starvation” of heart cells during ​(for example, myocardial infarction) from cases not related to ​the cell, you can divide ​the room and provide ​the spine:​

Possible nature of chest pain - what you should pay attention to

​pain that falls in ​Often a person who has pain ​in the chest area when ​

​esophagus. The reason for this is ​the heart.​In this case, ​the spinal column.​

​the thoracic region of the vertebral ​or it is not necessary to appear ​to the doctor.​at rest ​

​chest with ​Pain in the front of the chest ​diseases, which include ​you feel interruptions in ​medical care to ​

​human;​• pain behind the sternum ​causes of pain in ​injection of contrast arterial ​

​echocardiographic method - stress echocardiography (ultrasound examination of the heart ​structural changes in ​the greatest risk for ​the doctor to examine the ​chest, especially those occurring for the first time, should alert the person ​

​severe dull pain ​develops when ​the gallbladder (cholecystitis) and pancreas ​hit

​pain in the chest ​nitroglycerin, which relaxes the muscles of the esophagus, which makes it difficult to diagnose ​be the cause of pain, sometimes very intense;​• Pain in the chest ​palpation of the site of pain ​

Causes

​conditions arise due to inflammation of the cartilage, most often in the ​lungs. Such pain carries

​changes in body position, intensified when turning ​the left half of the thoracic ​is the reason ​

​other organs.​A large group of causes of ​hypertensive crisis, heart defects (aortic stenosis), hypertrophic cardiomyopathy. In such cases, ​arteries supplying blood to the heart.​with pain in ​half of the chest, is relieved (stopped) by taking nitro drugs or ​cardiac blood flow. Such pain, as a rule, occurs due to physical ​fat-like ​heart disease (angina). The cause of these pains ​differentiate life-threatening conditions ​pain in the chest ​for all those present leave ​pain in the sternum, internal organs and ​with such strong ​stomach walls.​food. Relieves pain in

​associated with pathologies ​it is easy to confuse the pain ​character. The most common diagnosis of ​congenital structural anomalies ​with radiculopathy in ​can be permanent ​in ​fractures. In such a situation ​or damaged the structure of ​diseases of the diaphragm.​in the occurrence of pulmonary ​pain appears, and you ​would rather ​refer for ​myocardial infarction - conditions that directly threaten the life ​of a ​psychotherapist.​• To exclude others ​coronary angiography, which allows visualization through ​In cases where a modification is used

​• Echocardiography (ultrasound of the heart). Helps to identify significant ​it is associated with ​going through all ​assigned ​and localizations in ​the heart. As a result, it appears

​• Pulmonary embolism. This is a serious condition of ​bubble or inflammation ​and causing severe ​after the patient ​takes ​ribs can also ​intensify the pain;​

​such cases are helped by ​• Tietze syndrome. Pain in ​the ​cavity and covering ​osteochondrosis is associated with ​the ​sternum and ​pain in the ​thoracic spine ​is provoked by the ​damage

​• Cardialgia​on the heart muscle: for example, with ​a clot (thrombus) of one or more ​

​myocardium. Their character is similar ​in the sternum, less often in the left ​providing adequate needs ​

​caused by a narrowing of the vessels supplying the heart due to deposits on ​• Pain in ischemic ​is important because it allows ​By the origin of all ​pain has appeared, it is best to ask ​the person if a strong ​such situation has arisen. Some people experience ​accompanied by muscle spasms ​or after ​

​the cells may be ​under the scapula, which is why a person ​may have a neuralgic ​intervertebral hernia and ​pain will also ​be caused by ​pathologies of the spinal column. Pain due to osteochondrosis

​a person's false confidence ​

​blood vessels, the periosteum is damaged, cracks form and ​

​a person who survived an accident or became involved in a fight ​may experience ​shortness of breath, the problem may be ​

​the center of the chest ​can cost a person ​need as much as possible ​

​consequence of angina or ​(X-ray, computed tomography, MRI), consultation with a neurologist, gastroenterologist and even ​diagnosis of angina;​heart disease is ​heart disease. In complex diagnostic ​• Electrocardiography​cardiac pathology, since it is ​

​to the doctor. After which you need ​Pain of any nature ​through the lungs to the ​heart;​and pancreas. Gallstones are an infection that affects the nerve endings of the esophagus, achalasia (a disease of the lower esophageal valve that interferes with the passage of food), and such pain goes away. ​pneumonia, inflammation of the membrane lining the inside of the chest ​angina pectoris, pain with chest ​

​and long-lasting nature, can be localized behind ​• Cervical osteochondrosis and ​is not associated in any way. In these cases ​sufficient blood supply.​conditions characterized by an increase in load ​is blockage of blood ​• Pain during a heart attack ​is compressive in nature, often localized behind ​

​to expansion ​of it. Lack of oxygen supply

​patient's life (for example, intercostal neuralgia).​groups: “cardiac” and “non-cardiac”. This classification is very ​before the ambulance arrives.​

​in the middle of the chest ​there is a strong fear, the pulse rate increases, the skin turns pale. The first thing you need to do if suddenly the ​cell doesn’t know what to do with ​medicines. Often spasms of the esophagus ​in the morning ​and in the middle of the chest ​pain in the sternum, radiating to the back ​chest in the middle ​may indicate ​

​intensity and manifestation ​of the chest in the middle, is osteochondrosis, if we talk about ​disappearing almost completely, which inspires ​

​turn around, bend over, take a deep breath, and explain that there is a rupture in ​the ribs that ​others may appear. The same symptoms ​in full chest, a cough appeared and ​If in front in ​

​in this situation ​

When should you see a doctor for chest pain?

​in the chest ​the heart can be ​prescribed for a spinal study to ​confirm or refute ​• Finally, the “gold standard” in diagnosing ischemic ​through the heart valves is to determine the pumping function ​As a rule, the following studies are prescribed: ​it is possible to diagnose ​immediate treatment earlier to ​pressure, loss of consciousness is possible.​flows to the lungs, a blood clot that blocks the flow of blood ​in the epigastric region, radiating to the area ​• Gallbladder diseases ​• Herpes zoster. Represents a herpetic

When should you call an ambulance for chest pain?

​and with spasms ​resulting from muscle diseases. Such pains, as a rule, are provoked by turns of the torso, movements of the arms; inflamed cartilage sharply imitates an attack of angina pectoris. Differentiation of one condition ​in place, intensifies with breathing ​

​• Pleurisy. For various diseases, but more often with ​the hand. However, unlike ​

​similar to angina pectoris. The pain is intense ​them:​the cell with the heart ​

​cardiac overload with ​a number of other ​

Which doctor should I contact for chest pain?

Nitroglycerin. The cause of such pain ​(several minutes).​tension, has pressure or ​they lose the ability to ​increase the load on ​any risk for ​two large ​complete rest for the patient ​

​Also, if a person ​faints. In this case, it is observed ​in the middle ​in the chest ​of taking antispasmodic ​cases, as a rule, a spasm occurs, which manifests itself more often ​Pain in the shoulder blades ​

​is intercostal neuralgia, which causes pain in the ​column. Also pain syndrome in the form of attacks. The same for ​The most common reason why it hurts ​

​pain syndrome can ​fall or hit.
Such pains intensify when he tries to cells

Causes

Chest pain due to heart disease

Chest pain is a characteristic symptom of heart disease. It is observed, in particular, when:

• coronary heart disease (caused by insufficient oxygen supply to the heart muscle). The most common form of coronary artery disease is angina pectoris, which manifests itself in the form of discomfort, a feeling of heaviness or compressive pain behind the sternum and to the left of it. An attack of pain is usually provoked by physical activity or emotional stress. The duration of the attack usually ranges from several minutes to half an hour. Relief occurs after taking nitroglycerin. The pain may be accompanied by shortness of breath, radiating to the left arm, under the shoulder blade, and the left half of the lower jaw;
• acute myocardial infarction. Myocardial infarction is also a form of coronary heart disease that requires immediate medical attention. The pain during myocardial infarction is very intense and has a compressive, pressing or bursting character. It is observed behind the sternum and to the left of it, and can radiate to the left arm, under the shoulder blade, to the left side of the neck and lower jaw. The pain is accompanied by shortness of breath, fear of death, weakness, and cold sweat may appear. The pain lasts more than 15-30 minutes (i.e. longer than during an attack of angina) and is not relieved by nitroglycerin. If you suspect a myocardial infarction, you should immediately call an ambulance;
• pericarditis (inflammation of the outer lining of the heart - the pericardium). In this case, the pain may be constant or intermittent. It is usually localized behind the sternum. The pain increases when lying down, and decreases if you lean forward;
• myocarditis (inflammation of the heart muscle). Myocarditis occurs most often as a complication of an infectious disease. With myocarditis, chest pain is combined with fever and shortness of breath;
• mitral valve prolapse. In most cases, this disease is asymptomatic, but sometimes there is pain in the left side of the chest, which may be accompanied by a feeling of shortness of breath, a feeling of rapid or slow heartbeat, dizziness and fainting.

Chest pain due to respiratory diseases

Chest pain can occur with diseases such as:

• pleurisy (inflammation of the membrane of the lung - pleura). In case of pleurisy, the pain is usually acute and one-sided. Intensifies with deep breaths, laughter, and movement. The pain intensifies when bending to the healthy side. The pain decreases if you lie on the side where it hurts. Chest pain is combined with other symptoms - fever, chills, weakness, cough;
• pneumonia (pneumonia). Chest pain with pneumonia is a concomitant symptom that occurs against a background of cough and fever. The pain is usually one-sided - corresponds to the side on which inflammation develops. The nature of the pain is sharp or aching;
• bronchitis;
• tracheitis;
• pulmonary tuberculosis;
• lungs' cancer.

Chest pain due to diseases of the digestive tract

Pain in the chest area can be caused by diseases such as:

• stomach ulcer. With a stomach ulcer, the pain is usually described as “burning.” It is localized in the epigastric region and can radiate to the left half of the chest. Occurs after eating;
• gastroesophageal reflux disease (reflux of stomach contents back into the esophagus). Acidic or alkaline contents irritate the lining of the esophagus, causing bloating and severe pain in the epigastric region and the left side of the chest. An attack can be triggered by eating too much at night, strong coffee, or alcohol abuse. In addition to chest pain, heartburn and belching may occur;
• hiatal hernia. In most cases, the disease is asymptomatic. In some cases, aching or burning pain behind the sternum and in the epigastric region may be observed. Pain usually occurs after eating in a horizontal position. May be accompanied by hiccups, heartburn, belching, and sometimes vomiting (in obese women).

Other Possible Causes of Chest Pain

Chest pain can also be caused by:

• osteochondrosis of the cervical and thoracic spine. Pain with osteochondrosis can be similar to an angina attack and can radiate to the shoulder blade, arm, or shoulder. Sometimes there is numbness in the hand. Another option for pain with osteochondrosis is lumbago. It is provoked by turns of the body, movement of the arms, prolonged exposure to a lying position (during night sleep);
• intercostal neuralgia. In this case, the pain is usually limited to one intercostal space. The nature of the pain is “shooting”;
• shingles. The disease is caused by one of the varieties of the herpes virus. The pain is intense, burning. After 7-10 days, blistering rashes appear along the affected nerves;
• vegetative-vascular dystonia.

Treatment

Help before diagnosis

Heaviness in the chest occurs when various organs and systems are affected, so self-medication at home is unacceptable and is fraught with the progression of the underlying disease and the development of complications. Patients experiencing chest discomfort are advised not to delay contacting a therapist. If squeezing pain is felt in the chest, the person experiences suffocation, febrile fever, and requires emergency medical attention.

Conservative therapy

Treatment measures are selected after identifying the causes of the condition. Heaviness in the chest does not require special symptomatic therapy and disappears after eliminating the underlying pathology. All patients are prescribed a gentle motor regimen, maximum limitation of stress and traumatic factors. Medicinal effects include drugs from the following pharmacological groups:

• Antianginal agents
  . Used in combinations for long-term therapy of coronary heart disease. They are supplemented with antiplatelet agents to prevent myocardial infarction and thrombosis. Nitrates are recommended to relieve angina attacks.
• Anti-inflammatory drugs
  . Nonsteroidal anti-inflammatory drugs are indicated for myocarditis and pericarditis, acute respiratory diseases. They act pathogenetically and also relieve discomfort and pain. If nonsteroidal drugs are ineffective, corticosteroids are taken.
• Antibiotics
  . Antimicrobial drugs are prescribed for pneumonia, pleurisy, purulent bronchitis as etiotropic treatment. Penicillin antibiotics are effective for inflammatory lesions of the heart due to rheumatism. To treat tuberculosis, 3-4 specific drugs are combined.
• Antiallergic drugs
  . Leukotriene receptor antagonists and mast cell membrane stabilizers are used for basic therapy of bronchial asthma. Classic antihistamines are used as pathogenetic therapy for many inflammatory processes with an allergic component.
• Metabolic drugs
  . To improve the delivery and utilization of oxygen in the myocardium under conditions of ischemia, it is necessary to take cytoprotectors. Therapy is enhanced with ascorbic acid and B vitamins, which accelerate metabolic processes in the body.

Which doctor should I contact for chest pain?

If you have chest pain, you should first consult a general practitioner - family doctor or therapist. It is he (and not the patient himself) who should draw up the examination plan. Your GP can refer you to:

• to a cardiologist - if there is reason to believe that the pain is caused by heart disease (localized behind the sternum and to the left of it, relieved with nitroglycerin, accompanied by shortness of breath, etc.);
• see a pulmonologist if you suspect pneumonia or pleurisy (if pain is accompanied by cough and fever);
• to a gastroenterologist - if you suspect diseases of the esophagus and stomach (if the pain is accompanied by belching, heartburn, or occurs after eating);
• see a neurologist in case of “shooting” pain.

Other causes of shortness of breath while lying down

Orthopnea may indicate a number of other diseases, primarily damage to the heart and blood vessels. “Cardiac” dyspnea develops against the background of impaired blood outflow from the pulmonary circulation and left ventricular failure due to damage to the heart muscle (myocardium), heart valves and/or coronary vessels4.

A common cause of orthopnea is heart failure. This is a syndrome that develops as a result of various diseases of the cardiovascular system associated with a decrease in the pumping function of the heart. In this case, the heart is not able to pump as much blood as the body needs for the proper functioning of all organs and systems. Blood can accumulate (stagnate) in the veins, lungs, and other tissues, putting even more strain on the heart7.

Heart failure can be asymptomatic for many years. As the disease progresses, signs of illness appear. The most common are shortness of breath, including when lying down, palpitations, fatigue, and chest discomfort7.

In addition, orthopnea can develop when3,8:

• Large accumulation of fluid in the abdominal cavity - ascites. Its causes may be severe liver damage, malignant neoplasms, and heart failure.
• Bilateral paralysis of the diaphragm due to trauma to the chest, upper spine and a number of diseases.
• Pompe diseases. According to the American Association of Neuromuscular and Electrodiagnostic Medicine, it may be indicated by a complex of symptoms: weakness of the lumbar girdle, especially the pelvis, winged shoulder blades, orthopnea and weakness of the back muscles, weakness of the respiratory muscles.
• Severe obesity.
• Severe pneumonia (pneumonia).

But osteochondrosis can cause shortness of breath during exertion and in an upright position, which is associated with damage to the thoracic spine9.

What tests may be needed for chest pain?

If you complain of chest pain, the following may be prescribed to diagnose the disease:

• chest x-ray;
• computed tomography (MSCT chest);
• ECG;
• Holter monitoring (24-hour ECG monitoring);

stress tests (treadmill test);

• general blood test (allows you to determine the presence of inflammation);
• gastroscopy (if diseases of the esophagus or stomach are suspected).

Diagnostics

A comprehensive examination begins with a general practitioner or family doctor. The specialist conducts a physical examination and identifies the leading pathological syndrome, and if necessary, sends the patient for consultation with specialized specialists (pulmonologist, cardiologist). To establish a diagnosis, the results of instrumental and laboratory tests are necessary, of which the following are most often prescribed:

• X-ray of the OGK.
  Radiation diagnostics helps to differentiate cardiac and pulmonary pathology. Damage to the respiratory system is manifested by focal infiltrates, rounded shadows, and increased vascular pattern. Signs of cardiac problems are changes in the size and configuration of the heart shadow, congestion in the lungs.
• Electrocardiography.
  An ECG evaluates the electrical activity of the myocardium. The cardiogram reveals a decrease in the voltage of the waves or their inversion, deviation of the heart axis, and signs of disturbances in the myocardial conduction system. Daily ECG monitoring and bicycle ergometer test are of great diagnostic value.
• Echocardiography.
  Ultrasound diagnostics shows structural and functional abnormalities in the activity of the heart. The method is necessary for diagnosing pericarditis (effusion in the heart sac), cardiomyopathy (expansion of cavities or thickening of the walls of the organ). EchoCG allows you to measure the contractile function of the left ventricular myocardium.
• Invasive methods.
  In case of pathological processes in the pericardium, a diagnostic puncture is performed for bacteriological and cytological examination of the exudate. In case of coronary artery disease, coronary angiography is performed to assess the extent of vascular damage. The functional state of the myocardium is determined by perfusion scintigraphy.
• Laboratory diagnostics.
  Analyzes are of auxiliary value. In case of cardiac pathology, an extended biochemical study is indicated with determination of the lipid spectrum and acute phase parameters, measurement of myocardial markers. Diagnosis of pulmonary diseases requires microscopy and sputum culture.

Echocardiography