Cardialgia

Pain in the heart area, differing in its symptoms from angina pectoris; characterized by stabbing, burning, aching, less often pressing pain in the heart area; they can radiate throughout the left half of the chest, left arm and left shoulder blade; they can be fleeting (lightning-fast “puncture”), short-lived (minutes, hours) and very long (days, weeks, months). As a rule, cardialgia does not stop after taking nitrates. The presence of cardialgia does not exclude atherosclerosis of the coronary arteries of the heart in some patients and can sometimes alternate or be combined with true attacks of angina.

Any pain in the left side of the chest can be regarded as cardialgia until the diagnosis is clarified. Cardialgia occurs in a number of clinical syndromes and pathological conditions.

Cardialgia with lesions of the peripheral nervous system.

Cervical osteochondrosis and intervertebral disc herniation can cause compression of the nerve roots; Cardiac syndrome can also be a consequence of irritation of the sympathetic plexus of the vertebral artery. In the first and second cases, the appearance of pain in the left half of the chest is associated with certain positions and movements of the arm and head, but not with physical stress; pain may intensify or occur at night, with tension on the cervicothoracic roots (abducting the arm behind the back, pulling it to the side). There is an increase or decrease in reflexes and hypo or hyperesthesia on the hand.

In the third case - with compression of the sympathetic plexus of the vertebral artery - swelling of the hand is sometimes added to the described symptoms, which is associated with a violation of the vasoconstrictor sympathetic innervation; When pressing on the head in the direction of the longitudinal axis of the spine and when bending the head turned towards the affected side, pain occurs. Treatment of the underlying disease is necessary. The prognosis is favorable.

Cardialgia may be a consequence of cervicobrachial syndrome, which appears as a result of compression of the subclavian arteries, veins and brachial plexus with an additional cervical rib (Falconer-Weddell syndrome) or with pathological hypertrophy (“syndrome”) of the anterior scalene muscle (Naffziger syndrome). Features of the pain syndrome in these cases include the appearance of pain when carrying small weights in the hand, when working with raised arms. On examination, a thickened, painful anterior scalene muscle is detected, there is dilation of the saphenous veins over the pectoralis major muscle, a decrease in temperature, and sometimes swelling of the hand, and a decrease in blood pressure in the radial artery on the affected side.

An X-ray may reveal an additional rib and an increase in the transverse process of the VII cervical vertebra. Treatment. With an additional cervical rib, in case of severe pain and compression of the subclavian vessels, removal of this rib is indicated; for anterior scalene muscle syndrome, in mild cases, analgin, indomethacin (metindol) are prescribed in usual doses; for severe lesions, a 2% solution of novocaine (2 ml) or a solution of hydrocortisone (2 ml) is injected into the hypertrophied anterior scalene muscle - 2-3 times, after day.

In very severe cases, it is necessary to resort to cutting the muscle. The prognosis is usually favorable.

Cardialgia can occur with left-sided intercostal neuralgia, herpes zoster, or root neuroma (in the latter case, the pain can be so intense that it is not even inferior to the administration of morphine - this has diagnostic significance). With herpes zoster, ECG changes are sometimes observed in the form of a decrease in the ST segment, flattening or inversion of the T wave. Treatment of the corresponding diseases is necessary.

Painful, thickening of the costal cartilages (usually II-IV ribs), or Tietze syndrome, is a fairly common disease in people over 40 years of age, accompanied by cardialgia. Etiology unknown. The pathogenesis is based on aseptic inflammation of the costal cartilages. Treatment is symptomatic (analgia