Pain in the ribs above the heart

In our long life, everyone's body will get sick, especially our heart area. In front of the heart are our ribs. If there is pain in that area, angina pectoris is likely to occur. Moreover, when the ribs in the chest hurt, not only will your normal life be affected, but it will also lead to diseases such as malnutrition.

The direct cause of angina pectoris is absolute or relative insufficiency of myocardial blood supply. Therefore, various factors that reduce myocardial blood (blood oxygen) supply (such as intravascular thrombosis, vasospasm) and increase oxygen consumption (such as exercise, increased heart rate) can induce angina pectoris. Myocardial insufficiency is mainly caused by coronary heart disease. Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

If fat continues to accumulate in the blood vessels, plaques will form. If plaque occurs in the coronary arteries, it will cause them to narrow, further reducing their blood supply to the myocardium, leading to coronary heart disease. The process in which fat accumulates in the coronary arteries and gradually forms plaques is called coronary artery sclerosis. Some plaques are hard and stable, which can cause narrowing and hardening of the coronary arteries themselves. Other plaques are softer and break apart easily to form blood clots. The accumulation of this plaque on the inner wall of the coronary artery can cause angina in the following two ways: ① The lumen of the coronary artery narrows at a fixed position, which greatly reduces the blood flow through it; ② The formed blood clot partially or completely blocks the coronary artery.

It is often triggered by physical labor, emotional excitement, a full meal, fright and cold. Typical angina pectoris often occurs under similar working conditions. In severe cases, it may also occur during eating, dressing, defecation or resting. The pain occurs at the time of labor or excitement, rather than after a day or a period of fatigue. Angina pectoris that occurs at rest is the result of coronary artery spasm.

The mechanism of pain during myocardial ischemia may be that certain products of myocardial anaerobic metabolism (such as acidic substances such as lactic acid and pyruvic acid, or peptide substances similar to kinin) stimulate the afferent nerve endings in the heart, and often spread to the superficial skin nerves in the same spinal cord segment, causing radiation of pain.

Clinical manifestations

It often manifests as dull pain, squeezing pain, or tightness behind the sternum and throat. Some patients only have chest tightness. It can be divided into typical angina pectoris and atypical angina pectoris:

1. Typical symptoms of angina pectoris

Sudden onset of squeezing, stuffy or suffocating pain behind the upper or middle part of the sternum, which may also affect most of the precordial area, radiate to the left shoulder, the anterior and inner side of the left upper limb, and reach the ring finger and little finger, occasionally accompanied by a sense of impending death, often forcing the patient to stop activity immediately, and in severe cases, sweating. The pain lasts for 1 to 5 minutes, rarely more than 15 minutes; the pain disappears within 1 to 2 minutes (rarely more than 5 minutes) after resting or taking nitroglycerin. It often occurs when you are tired, emotionally excited (angry, anxious, over-excited), cold, full, or smoking. It can also be triggered by anemia, tachycardia, or shock.

2. Atypical angina symptoms

The pain may be located in the lower sternum, left precordial area or upper abdomen, radiating to the neck, mandible, left scapula or right chest. The pain may disappear quickly or only cause discomfort or stuffiness in the left chest. It is common in elderly patients or diabetic patients.

What should be checked?

1. Electrocardiogram

Electrocardiogram (ECG) is the most commonly used noninvasive test for diagnosing myocardial ischemia. Patients whose resting ECG is within the normal range may consider undergoing dynamic ECG recording and/or cardiac stress testing.

2. X-ray

No abnormalities may be found, but some patients may have changes such as enlarged cardiac shadow, widened aorta, and pulmonary congestion.

3. Radionuclides

Commonly used radionuclides include 201Tl or 99mTc-MIBI, which can visualize normal myocardium but not ischemic areas.

4. Selective coronary angiography

By injecting contrast agent into the coronary artery, obstructive lesions in the left and right coronary arteries and their branches can be displayed. Although it is an invasive examination, it is also the most valuable detection method for reflecting coronary atherosclerotic lesions.

5. Intravascular Ultrasound Imaging

A miniature ultrasound probe is sent into the coronary artery through a cardiac catheter, which can simultaneously reveal the stenosis of the coronary artery lumen and the pathological conditions of the coronary artery wall.

6. Angioscope

The coronary cavity can be directly observed, which is especially suitable for thrombotic lesions.