Heart failure - symptoms and treatment

Causes of heart pain

Pain is a defensive reaction: this signal is the first to draw attention to changes in the functioning of organs.
A painful sensation in the heart area (cardialgia) may signal one of the dangerous diseases of the heart or blood vessels that participate in its blood supply. Sometimes pain that appears to be heart pain is actually caused by other illnesses. The reason for this phenomenon is the location of the structures of the peripheral nervous system, the irritation of which causes pain. Chest pain can be associated with the spine, intercostal nerves, esophagus and even the skin.

Cardialgia can be imitated by:

• Diseases of the musculoskeletal system: osteochondrosis of the thoracic spine, pain in the intercostal muscles.
• Pathologies of the nervous system: inflammation of the intercostal nerves, non-inflammatory intercostal neuralgia, panic attacks; vegetative-vascular dystonia, psychosomatics (pain that occurs due to psychological reasons without objective disturbances in the functioning of organs).
• Vascular pathologies: aortic aneurysm (thinning and dissection of the vessel wall), pulmonary embolism (PE) - blockage of a vessel with a blood clot.
• Diseases of the gastrointestinal tract: pathologies of the esophagus, gastritis, stomach ulcers, pancreatitis and other diseases of the pancreas, diseases of the gallbladder.
• Respiratory dysfunction: pneumonia (inflammation of the lungs), pleurisy (inflammation of the film of connective tissue that covers the lungs and chest from the inside), bronchial asthma, pneumothorax (penetration of air into the cavity where the lungs are located), tuberculosis and other pulmonary diseases.
• Pathological manifestations on the skin: herpes zoster (infection with the herpes virus in the form of a blistering rash).

Also, pain in the heart area can be a manifestation of the action of toxins - some narcotic substances and aggressive chemicals.

However, heart disease is suspected in every case of chest pain: first of all, it is necessary to exclude myocardial infarction, unstable angina, pulmonary embolism and other life-threatening heart diseases.

Risk factors for heart pain

First of all, it is important to assess the likelihood of cardiovascular disease: if it is high, any discomfort in the patient’s heart area may be a sign of acute pathology.

Risk factors for cardialgia can be divided into uncontrolled (which cannot be corrected) and controlled (lifestyle features, nutrition, medication, treatment of concomitant diseases).

Uncontrollable risk factors include:

• age over 55 years;
• male gender;
• genetic predisposition;
• racial characteristics.

Acquired risk factors most often arise due to non-compliance with the principles of a healthy lifestyle. Poor nutrition, lack of physical activity, smoking, emotional reactions to stress, alcohol abuse and other bad habits significantly increase the risk of cardiovascular disease.

Also controllable risk factors may be associated with concomitant diseases and borderline conditions. These include:

• overweight and obesity;
• high blood pressure;
• diabetes mellitus and prediabetes;
• imbalance of blood lipids.

On the other hand, there are positive factors that prevent the development of cardiovascular diseases (Fig. 1).

Figure 1. Factors that influence the development of cardiovascular diseases Source: MedPortal

Chest pain in children

Acquired heart pathologies in childhood are a rare situation. Pain in the heart area in children is most often associated with congenital conditions or diseases that are not related to the cardiovascular system:

• congenital heart defects;
• diseases of the gastrointestinal tract;
• neuralgia;
• inflammatory processes in the lungs;
• chest injuries.

Young children cannot indicate the specific point where the heart hurts or describe their sensations. Therefore, parents should be extremely careful to recognize alarming symptoms in time and consult a doctor.

Heart pain during pregnancy

Cardialgia during pregnancy is not always associated with cardiac disorders. Most often, discomfort in the chest of the expectant mother is associated with adaptation: the vessels of the unborn child are built into the woman’s circulatory system, and the heart needs to “rebuild” to perform its functions in new conditions.

Also, the cause of heart pain during pregnancy can be:

• anemia,
• toxicosis and gestosis - severe pregnancy,
• intercostal neuralgia,
• disturbances in the reactions of the nervous system,
• cardiomyopathy.

Heart pain can seriously frighten a pregnant woman. But don’t panic: in such a situation, it is important to remain calm and go to the hospital immediately.

Diagnostics

The diagnosis of pathology of the heart or blood vessels is established based on the results of a clinical examination, a patient interview, and a number of instrumental and laboratory tests. The main instrumental methods used in the diagnosis of CVD:

1. Electrocardiography (ECG) is an electrophysiological method used in the diagnosis of arrhythmias and myocardial infarction. A variation is Holter monitoring, which allows you to take readings throughout the day using a portable device.
2. Echocardiography (EchoCG) is an ultrasound method of examining the heart that reveals both functional disorders and structural disorders (tumors, vegetations, defects, inflammation). It is also prescribed for suspected pulmonary embolism.
3. MRI, CT (magnetic resonance, computed tomography) of the brain - used in the diagnosis of strokes.
4. Ultrasound scanning and dopplerography of blood vessels - used in the diagnosis of chronic cerebrovascular accidents and peripheral vascular diseases.

Laboratory tests include:

• In the diagnosis of inflammatory heart diseases - biochemical study of the protein spectrum, general blood test, bacterial blood culture.
• In the diagnosis of atherosclerosis - a biochemical test for the level of cholesterol, LDL, triglycerides.
• If any CVD is suspected, a coagulogram is performed.

Modern equipment allows diagnosis without invasive procedures.

What are the dangers of heart pain?

Pain in the heart area is a dangerous symptom that may indicate the development of a fatal disease. According to statistics, heart disease causes death in 30% of adults in all countries of the world.

If cardialgia is a manifestation of a heart attack, ignoring it can lead to irreversible consequences:

• necrosis - “death” of part of the heart muscle (infarction),
• development of arrhythmia - irregular heart rhythm,
• heart failure - inability of the heart to perform its function,
• sudden death.

In the event of a myocardial infarction, when a vessel leading to the heart is blocked, minutes count: blood flow must be restored within 1.5 hours. If you seek medical help late, changes in the affected area of ​​the heart will be irreversible: the organ will no longer be able to work effectively (Fig. 2).

Figure 2. What is myocardial infarction Source: prostress.by

Treatment of heart failure

If acute heart failure develops, hospitalization is necessary. The main emphasis in treatment is both on eliminating the causes of heart failure (stress, excessive consumption of table salt, alcohol abuse, smoking, high blood pressure, as well as taking medications that promote fluid retention in the body, etc.), and on correcting it manifestations. Limiting physical activity. Physical activity is acceptable and desirable, but it should not cause significant fatigue or discomfort. The diet should be low in salt, with plenty of fruits and vegetables. It is very important to achieve a reduction in excess weight, as it creates a significant additional burden on a diseased heart.

Currently, the following medications are used to treat heart failure:

• increased myocardial contractility;
• decreased vascular tone;
• reducing fluid retention in the body;
• elimination of sinus tachycardia;
• prevention of thrombus formation in the cavities of the heart.

If medications used to treat chronic heart failure are ineffective, surgical treatment may be recommended - cardiomyoplasty, cardiac pacing. Typically, medical monitoring of patients with heart failure is necessary throughout their lives.

How to understand if pain is related to heart disease

The thought of heart disease is the first thing that comes to mind when pain appears in the chest. In this case, it is better to consult a doctor once again than to one day regret not taking your health seriously enough.

In order to promptly recognize cardialgia, it is important to know the localization of heart pain, their characteristics and features. A test will help determine the cause of the pain.

Where does your heart hurt?

The heart is located behind the sternum with a slight shift to the left. It is reliably protected by the chest and can change its location depending on the size and structure of the bone structures.

Cardialgia is usually not “point”: it is impossible to indicate a specific place where the pain is localized. In addition, the sensations often radiate—spread to other parts of the body.

The typical location of pain in the heart is directly behind the sternum or behind the chest on the left. In most heart diseases, including the most dangerous ones, heart pain moves:

• to the right side of the chest,
• under the left shoulder blade,
• in the axillary areas,
• in the shoulder and left arm, sometimes symmetrically on the right side,
• on the lower jaw and teeth,
• to the cervical spine,
• to the area under the sternum.

The area of ​​pain in heart disease can be extensive (Fig. 3). Irradiation of cardialgia can cause difficulties in diagnosing heart diseases: symptoms in this case will indicate diseases of other organs.

Figure 3. Localization and irradiation of pain in the heart. Source: MedPortal

How does your heart hurt?

The characteristics of cardialgia depend on the disease that causes pain. First of all, a distinction is made between periodic and constant chest pain. This is important for determining the nature of possible changes in the heart.

Periodic pain

If pain in the heart is associated with a sharp narrowing of the vessels that fill the organ with blood, sharp but short-lived pain occurs - most often up to 30 minutes (Fig. 4). Taking heart medications helps the symptoms disappear quickly. A nitroglycerin tablet under the tongue is especially effective: the drug helps to immediately dilate the arteries and restore blood flow.

Figure 4. Short-term pain in the heart. Source: MedPortal

Constant pain

Prolonged acute pain in the heart most often signals dangerous disorders of the organ, for example, myocardial infarction. In this case, nitroglycerin does not help: poor circulation causes irreversible changes in the heart muscle.

Prolonged dull, aching, tingling pain may indicate chronic diseases of the cardiovascular system: heart defects, cardiomyopathies, inflammatory processes.

The nature of the pain

In the diagnosis of cardiovascular diseases, pain intensity plays an important role. For example, during an acute myocardial infarction, the sensations can be so intense that patients are given strong pain medications to prevent the development of shock.

Pain in the heart can be varied: sharp, burning, stabbing, pressing, aching, pulling, dull. Symptoms depend on the underlying disease, but the nature of the pain cannot accurately determine their cause: this requires certain research methods.

Also, pain syndrome is often complemented by other symptoms of diseases. For example, with acute pain in the heart, the rhythm often goes astray: there is a feeling of interruptions in its work, frequent or intermittent heartbeat.

Cardialgia can occur against a background of high blood pressure (BP). In these cases, signs of hypertension are added to the symptoms. Some heart diseases, on the contrary, are accompanied by hypotension - a decrease in blood pressure.

Myocardial infarction

When cardialgia manifests itself, it is first of all important to exclude acute myocardial infarction (MI) - the death of part of the heart muscle. Characteristic signs of MI:

• typical heart pain - behind the sternum, with reflection in the left arm, under the left shoulder blade, in the neck, lower jaw, ear;
• the nature of the pain is acute, burning, with extensive damage - unbearable;
• the severity of the sensations does not depend on the intake of nitroglycerin;
• the duration of pain is at least 30 minutes, with a large area of ​​infarction it can last several hours or days;
• the pain is accompanied by a sharp deterioration in the condition, additional symptoms appear - dizziness, pallor, nausea, shortness of breath, sweating, rapid heartbeat, anxiety, fear of death.

It is important to know the first signs of myocardial infarction - this can help save a person’s life (Fig. 5).

If symptoms that are characteristic of a myocardial infarction develop, you must call 112 and seek emergency medical help. It is important to act quickly: you have only 1-2 hours to “save” the myocardium.

Figure 5. First signs of myocardial infarction Source: MedPortal

Heart pain in various heart diseases

If the diagnosis of myocardial infarction is excluded, it is necessary to look for another cause of heart pain.
Information about the location, nature and duration of sensations helps to establish a preliminary diagnosis (Table 1). Table 1. Features of pain in major heart diseases.

Important! Pain in the pericardial region is not always a sign of heart problems. But sometimes the heart hurts in a different way than usual. Some cardiac pathologies may manifest as pain in other organs, which significantly complicates the diagnostic search. For example, there are atypical forms of myocardial infarction:

• painless - does not show characteristic symptoms for a long time,
• abdominal - pain is localized in the abdominal area, simulating gastritis or pancreatitis,
• asthmatic - resembles an asthma attack,
• arrhythmic - the main symptom of the disease is not pain, but heart rhythm disturbances.

Heart pain and intercostal neuralgia

One of the common types of “non-cardiac” chest pain is intercostal neuralgia. The condition occurs due to damage to one of the nerves that are located between two ribs (Fig. 6).

Figure 6. Cause of pain with intercostal neuralgia. Source: c-clinica.com

The pain becomes so acute that it can be confused with a symptom of a heart attack.
But there are several features that make it possible to distinguish a neurological disease from a serious heart pathology (Table 2). Table 2. Differences between pain in heart disease and intercostal neuralgia

In addition, the following symptoms are characteristic of intercostal neuralgia:

• burning sensation on the skin at the site of the damaged nerve;
• impaired skin sensitivity, numbness, tingling in the chest area;
• muscle stiffness - difficulty moving on the side of the affected nerve.

However, it is impossible to exclude serious diseases only by assessing the pain syndrome: for this you need to do an electrocardiogram (ECG) and undergo other examinations.

When should you see a doctor?

Seeking medical help is an important issue on which a person’s life may depend. It is better not to wait until the pain reaches its peak, but to immediately call an ambulance.

Even if pain does not initially seem like a serious symptom, it is better to be safe than sorry. However, some features of pain may indicate that acute myocardial infarction and other severe pathologies are unlikely.

Signs of a “relatively safe” variant of heart pain:

• the pain is stabbing in nature and lasts several seconds - most likely the cause of the symptom is overexertion or short-term dysfunction of the heart;
• it becomes easier during movements - in case of heart disease, pain intensifies with exertion;
• pain is associated with breathing - in acute heart diseases, shortness of breath may occur, but pain when inhaling, rather, indicates pathologies of the pulmonary system.

You should definitely not delay seeking medical help if:

• acute unbearable pain with a characteristic spread to the left shoulder blade lasting longer than 5 minutes;
• pressing pain in the heart for 30 minutes or longer;
• a sharp increase or decrease in pressure;
• shortness of breath or difficulty breathing;
• loss of consciousness;
• repeated episode of chest pain.

In any of these conditions, you must immediately call an ambulance - the wait can cost not only your health, but even your life.

Acute pain in the heart is an indication to immediately consult a doctor and get a cardiogram, even at a young age. And after 40 years, both women and men should be especially wary of myocardial infarction. In such situations, it is better to be safe than to waste time and not have time to save the heart.

Treatment of heart pain

Pain is a symptom and therefore cannot be treated in itself. The method of therapy is selected only after determining the cause of pain.

Treatment begins with lifestyle changes: it is important to include all recommended ways to prevent heart disease in your list of daily activities.

Diet plays an important role: fried and fatty foods and sweets are excluded from the diet. The daily menu should contain a sufficient amount of fresh vegetables and fruits and fiber.

The patient is also offered to add physical activity to his daily routine - the duration and types of exercise are determined individually, depending on the identified disease.

Drugs for the treatment of heart disease are prescribed in a course or for long-term use. It is important to control blood pressure: for hypertension, medications must be taken daily, following the doctor's recommendations.

“Work pressure” is a harmful myth

There is an officially permitted maximum upper limit for blood pressure: 140/90 mmHg. Art. - this is the limit after which hypertension is already diagnosed.

But there is a widespread myth among the people that there is so-called working pressure - it can be above this limit, but it is believed that if a person feels well, then there is nothing to worry about, there is no need for treatment. This is a dangerous misconception!

The risk of complications from hypertension is equally high, regardless of whether you feel unpleasant symptoms or not! Yes, hypertension is often asymptomatic. But the risks of hypertensive crisis, stroke, heart attack, etc. remain. Therefore, the main indicator for prescribing treatment is the results of measuring blood pressure, and not the patient’s well-being. High blood pressure must always be reduced - this is the only way to avoid complications and serious consequences of hypertension.

Another common misconception is that medications to normalize blood pressure cannot be taken constantly, but only during episodes of high blood pressure. This is wrong. Arterial hypertension is a chronic disease. And in order for the patient’s condition to remain stable, medications must be taken as prescribed by the doctor - regularly. Agree, it’s not such a big price to pay for good health and reducing the risk of stroke and other complications - take a pill once a day!

Extrasystole - what is it? Extrasystole is one of the types of heart rhythm disturbances. Quite a lot of people are diagnosed with extrasystole on the ECG; this disorder is quite common. Only a doctor can determine how serious this is. Most likely, if you have been diagnosed with extrasystole, this is not a reason to panic; even a completely healthy heart can cause such a rhythm disturbance. But it is important that such arrhythmia can be provoked by serious heart diseases, that is, in this case, extrasystole will be one of the symptoms. That is why you should not ignore such “findings” and definitely need to be examined by a cardiologist.

Prevention

Preventing a disease is always better than treating it. Therefore, even at a young age, you should think about the state of the cardiovascular system (Fig. 7). It is especially important for people at risk to follow all measures to prevent heart disease:

• to refuse from bad habits,
• control weight (body mass index should be less than 25),
• follow the principles of proper nutrition,
• avoid excess salt in dishes,
• exercise,
• avoid stressful situations and learn to react correctly to them,
• control blood pressure.

It is also important to promptly treat diseases of other organs. Hormonal diseases, inflammatory processes and other pathologies can cause heart complications.

Figure 7. Principles of prevention of cardiovascular diseases Source: MedPortal