When pain occurs in the area in front of the heart, it is prudent to see a doctor, or even go to the emergency room if the pain is severe. Fortunately, these pains called precordialgia are not always of cardiac origin and can reveal various pathologies which sometimes turn out to be benign … Anxiety or taking stimulants can also be involved.

Definition

Etymologically, a precordialgia is a pain (algia) felt in front of the heart (horn), in the left anterior thoracic region. We also speak of precordial pain. It can be acute or chronic, and is sometimes very intense.

Causes

Precordial pain characterizes angina pectoris (angina), which occurs mainly in people with coronary artery disease, when the oxygen supply to the myocardium is insufficient. Nevertheless, the term precordialgia is generally used to designate pain different from that of angina.

Among the many possible causes, we can distinguish:

• cardiac and pulmonary pathologies such as pericarditis (inflammation of the pericardium), aortic dissections (tears in the wall of the aorta), pulmonary embolism, pneumonia, pleurisy or pneumothorax,
• gastrointestinal pathologies, in particular gastroesophageal reflux,
• chest trauma (rib fractures)
• muscle pain and intercostal neuralgia
• rheumatism,
• infections such as shingles
• intense stress,
• anguish,
• taking exciting …

Diagnostic

The type of pain, the examination of the patient and his medical history as well as a careful clinical examination often make it possible to guide the diagnosis.

If this is not the case, all the necessary examinations should be carried out to rule out the various possible causes. The doctor first looks for signs of seriousness, and seeks to rule out pathologies likely to be life-threatening, starting with acute coronary syndrome.

For example, the doctor may order an electrocardiogram, an echocardiogram, a coronary angiography, an x-ray of the lungs, a blood test, etc. 

Risk factors

These are those of the pathology in question. Involved in various cardiovascular and pulmonary pathologies, smoking is associated with precordialgia in many patients. 

It should also be noted that neurogenic and psychogenic precordial pains, linked to stress or anxiety, are extremely frequent, with or without associated pathology.

Precordial pain can occur in seizures or chronically, under the left breast or next to the nipple. They can be very localized or on the contrary radiate towards the upper left limb or the neck.

In consultation, patients evoke discreet or on the contrary very intense pain, felt like needle strokes, burns, cramps, or even associated with a feeling of crushing or twisting …

The conditions of the onset of pain are valuable indications:

• To differentiate precordialgia in the restricted sense of the term from angina attack, the doctor will check in particular that the pain is not related to the effort.
• Left chest pain of cardiac origin is often associated with a feeling of discomfort.
• Those of pulmonary origin can be aggravated by respiratory movements.
• When a digestive pathology such as gastroesophageal reflux is involved, the pain appears more when lying down.

The management of precordial pain depends on the nature of the pain. Suspicion of cardiac or pulmonary pathology can constitute a life-threatening emergency. For the rest, the treatment is primarily that of the organic cause of the pain.

When no organic cause is detected, removing stimulants (coffee, alcohol, cocaine, etc.) can often help to remove pain. Managing anxiety is also very helpful.

Alternative medicine can be tried as long as the underlying condition is correctly identified and taken care of. Homeopathy could, for example, be useful when precordial pain is due to shingles or intercostal muscle damage, while osteopathy can help relieve tension. 

In anxious patients, psychotherapy may be of benefit.

Very often, a good hygiene of life and of sleep could prevent the appearance of a precordialgia. Watch out for the exciting!