What Is Substernal Chest Pain?

If an individual experiences pain just below the sternal bone, then it is termed as Substernal Chest Pain. Substernal Chest Pain can be quite painful and there are various factors which lead to Substernal Chest Pain, some of which can be extremely serious to include Pulmonary Embolism, Aortic Stenosis, Stable Angina Pectoris, Acute Coronary Syndrome, Myocardial Infarction, Atrial Fibrillation and the like. It is estimated that about 25% of people in the United States experience substernal chest pain for one reason or another.

What Is Substernal Chest Pain?

What Are The Causes Of Substernal Chest Pain?

As stated, there can be numerous causes which can cause Substernal Chest Pain. Some of the causes are:

  • Stable and Unstable Angina Pectoris
  • Acute Coronary Syndrome
  • Myocardial Infarction
  • Aortic Dissection
  • Pulmonary Embolism
  • Atrial Fibrillation.

There are also some medical conditions which can cause Substernal Chest Pain like:

  • Pneumonia
  • Pneumothorax
  • Hemothorax
  • Anemia
  • Pericarditis
  • Pulmonary Hypertension
  • Mitral Valve Prolapse
  • Uncontrolled High Blood Pressure
  • Hereditary hypercholesterolemia.

Some of the medical conditions which can cause Substernal Chest Pain albeit rarely are:

What Are Some Of The Associated Symptoms Along With Substernal Chest Pain?

It may be quite difficult to differentiate between chest pain caused by a cardiac disease and chest pain not caused due to cardiac disease. Some of the associated symptoms which can determine that the chest pain is less likely due to a cardiac cause are:

Substernal Chest Pain

  • Presence of a sour taste in the mouth or a sensation of regurgitation where that the swallowed food reenters the mouth
  • Individual having problems with swallowing
  • If the pain changes in character with changing positions, be it better or worse
  • Worsening Substernal Chest Pain with breathing or coughing
  • Presence of chest tenderness with deep palpation
  • Individual having symptoms of heartburn with a burning sensation behind the breastbone.

Why Is It Important To Undergo Diagnostic Tests For Substernal Chest Pain?

Even though an individual may have Substernal Chest Pain which may not be caused due to a cardiac cause but it is still imperative for the individual to undergo diagnostic studies to rule out a potentially cardiac cause of the pain, as it is difficult to differentiate Substernal Chest Pain caused due to cardiac causes or non-cardiac causes. Some of these tests are:

Electrocardiogram (EKG): This is one of the basic tests conducted on an individual complaining of chest pains, be it substernal or otherwise. In this test, electrodes are attached to various points in the skin and the electrical activity of the heart is monitored. If the heart is not functioning normally, it will clearly be shown on the EKG.

Blood Tests: The physician will also conduct blood tests checking for levels of the cardiac enzymes. Cardiac enzymes are those enzymes which are only produced in the heart muscle. In case if the heart is not functioning normally then these enzymes leak into the blood and will show up on the blood test.

Chest X-Ray: A chest x-ray is also an important tool in identifying whether the heart is functioning normally or not. The x-ray will check the condition of the lungs to determine if the heart is receiving appropriate supply of blood. It will also help in determining the structure of the heart and the major vessels surrounding it. Any problems in the lungs or the blood vessels surrounding the heart which may cause the heart to malfunction can be seen on the chest x-ray.

CT Scan: A CT scan of the chest is also important in that it gives a more accurate assessment of the lungs and the adjoining areas of the heart and the vessels surrounding the heart. It also helps in ruling out major causes of chest pain like Pulmonary Embolism or an aortic dissection causing the heart to malfunction.

What Are Treatments For Substernal Chest Pain?

The treatment for Substernal Chest Pain solely depends on the underlying cause of the pain. These pains are usually treated with medications but the medications are selected depending on the cause of the pain.

What Are Treatments For Substernal Chest Pain?

Artery Relaxing Medications: These medications are given in cases where the arteries get constricted so as to relax the arteries and allow them to function normally. The main medication used for this purpose is nitroglycerin which is used sublingually that is underneath the tongue which relaxes the arteries to facilitate smooth flow of blood through them. Certain antihypertensives also serve the same purpose of relaxing the arteries as well.

Cardiac Related Medications: If there is a suspicion that the chest pain an individual is experiencing is due to a cardiac cause then the physician may recommend an aspirin a day which is of tremendous help.

Medications to Dissolve Clots: These medications are usually given when there is confirmed evidence that the individual is experiencing a heart attack or the pain is caused due to a clot. These medications are normally given in an inpatient setting.

Blood Thinners: These medications are given when the physician identified that a clot in the artery is preventing adequate blood flow. These drugs act as blood thinners so that recurrent clots are not formed.

Acid-suppressants: These medications are given when an individual experiences pain due to excessive acid formation in the stomach or in other words due to gastroesophageal reflux disease. These medications cut down the production of acid in the stomach and help in reliving the pain caused by it.

Antidepressants: If all the tests conducted to identify a cardiac cause of chest pain come back negative and there is no suspicion of any other condition causing Substernal Chest Pain then it is more likely than not that the individual is experiencing pain due to a panic attack or anxiety. To help this, antidepressants are given to help relieve the symptoms. The individual is also referred to a psychiatrist or a psychologist for more detailed treatment of the psychiatric condition either through medications or through therapies like cognitive behavioral therapy or psychological therapy.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: June 1, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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