In the traditional sense, such a common symptom as burning in the chest is a sign of heart disease. Angina pectoris or myocardial infarction are usually the first candidates for the role of the cause of the burning sensation in the chest. However, this symptom often testifies in favor of other diseases, the differential diagnosis of which requires clarification of the nature of the burning sensation, its localization and features of the appearance, and the identification of concomitant complaints and disorders.
The medical meaning of the symptom
The burning symptom in the chest is very heterogeneous and can be caused by diseases of the digestive, bronchopulmonary, cardiovascular, musculoskeletal system. Less commonly, a source of burning sensation in the chest are diseases of the skin, lymphatic vessels, and systemic autoimmune pathologies. Even less often, the cause is damage to the peripheral nerves in the form of shingles, radiculopathy.
Primary doctors (ambulances and general practitioners), as well as general practitioners, cardiologists, surgeons, pulmonologists, and neurologists, are more likely to deal with this symptom. Burning complaints are extremely rare in the practice of hematologists and psychiatrists. For the specialist, the most obvious cause of the symptom is found out quite simply after a thorough examination of the patient, performing electrocardiography, interpretation of concomitant complaints.
Symptom of a cardiological profile
According to the well-established beliefs of patients, burning in the chest is a symptom of only a cardiological disease. In fact, this is not true, although this complaint is considered by cardiologists as specific for ischemic lesions in combination with chest pain. In the event of an attack of angina pectoris or as a result of the development of myocardial infarction, a bunch of these symptoms appears. Only burning without pain and shortness of breath is not specific to acute coronary events.
With myocardial infarction or an attack of angina pectoris, a complex of complaints appears in the chest: a compressive burning pain disturbs the left, which develops as a result of physical activity. Only occasionally, a heart attack or angina attack occurs at rest. The nature of these pains and burning does not change depending on the position of the body, movement in the shoulder girdle and trunk, and the depth of inspiration. Then the burning sensation bothers exactly the sternum, while the pain of a pressing nature is localized both behind the sternum and in the projection of the heart. Also, the pain can move to the neck and lower jaw, be reflected in the interscapular space or directly under the left shoulder blade, a little less often - in the left shoulder.
The nature of the pain in an acute coronary event depends on the location of ischemia or necrosis along the anterior, lateral or posterior wall of the ventricle, as well as on the volume of the lesion. In patients with concomitant peripheral neuropathies (alcoholic or diabetic), pain and burning sensation are slightly developed. Therefore, angina pectoris or heart attack can be accompanied by either the most severe symptoms characteristic of acute heart failure, or with a small lesion volume proceed without any significant violations.
Heart attack and angina pectoris
Complaints of pain and burning in the chest in the region of the heart as a signal of heart damage occur with an attack of angina pectoris or with a heart attack. In the second case, if the pain did not stop after a 2-fold intake of short-acting nitrates, seek medical attention. And in the first, in the case of angina pectoris, when burning and pain are always provoked by the same or equivalent load, Nitroglycerin is required. It is a burning sensation in the chest when walking or climbing stairs, which is accompanied by shortness of breath and a feeling of strong squeezing in the chest, is a symptom of angina pectoris.
This complaint arises as a result of episodic coronary spasm, due to which the load increases the energy expenditure in the heart, and due to the narrowed lumen of the arteries it is not possible to deliver the right amount of oxygen and an energy substrate. This condition disappears on its own after 3-15 minutes after the termination of the load or after 3-7 minutes after taking short-acting nitrates.
The appearance of a burning sensation in the left side of the chest or behind the sternum together with pain occurs during stereotypical exertion, for example, when walking from 250 to 500 meters or climbing 2-3 flights of stairs. The resource of each patient depends on the functional class of angina, which is determined depending on the tolerance of physical activity. Slightly less often anginal pain occurs with hypertensive crisis and paroxysms of tachyarrhythmias.
Digestive system
Burning in the chest is a symptom of diseases of the digestive system, although many patients are convinced that with diseases of the stomach, esophagus, liver and pancreas, pain is always disturbed in the stomach. In fact, there is a group of gastric and esophageal lesions that bother burning in the chest and chest pain. However, these symptoms are usually associated with either dyspepsia or an unpleasant aftertaste in the mouth and a feeling of bitterness in the morning, belching, nausea, or vomiting.
Burning in the epigastric region and in the heart, as well as in the projection of the sternum, is a specific common sign of diseases of the esophagus: esophagitis, reflux disease, tumors. Then the burning sensation in the chest is constant or associated with eating. With an esophageal lesion, complaints arise immediately at the time of ingestion of food, and with a stomach, for example, with a stomach ulcer, pain and burning in the epigastrium and chest occur 30 minutes or more after eating.
Verification of esophageal and gastric complaints
In patients presenting such complaints, GERD, esophagitis, chronic gastritis, or gastric ulcer are more often found. Less commonly, pyloric stenosis, esophageal stenosis, and Mallory-Weiss syndrome are associated with frequent vomiting. In this case, esophageal tumors are characterized by burning in the chest, and disturbances in swallowing food, and vomiting of unchanged (undigested and untreated gastric juice) food.
Esophageal vomiting may not be the first symptom of a tumor, as it occurs during obstruction of the lumen of the esophagus. Burning with cancer of the esophagus appears even later, which requires examination and resolution of the issue of surgery. Gastric and esophageal complaints can be verified by performing x-ray gastroscopy and fibrogastroscopy with a mandatory biopsy.
Respiratory system injuries
Burning in the chest when coughing or breathing is a symptom of damage to the lungs, bronchi or pleural membrane. Most often, such a complaint is caused by the presence of pleuropneumonia. In this case, inflammation develops in a small marginal area of the lung, which is accompanied by a simultaneous lesion of the pleura. This means that along with pneumonia, dry pleurisy appears first, and then exudative.
Burning and pain in the chest at the site of the lesion, which intensify on a deep breath or when coughing, are a sign of dry pleurisy or a tumor of the pleura. In the event of the subsequent development of exudative pleurisy, the pain subsides, it seems to the patient that his condition is improving. However, in reality, exudative effusion aggravates the state of health, although there are fewer complaints.
Oncological damage to the chest cavity
In a symptom such as a burning sensation in the chest, the causes can be very diverse, up to the development of a tumor of the pleura, bronchi, mammary gland, esophagus or lung. Therefore, in the event of a similar complaint in the patient, a thorough examination of the symptom and appropriate examination are required. However, in medicine there is an unwritten rule that states that in all obscure cases, cancer should be suspected.
Although this phrase may sound dramatic, however, at the stage of differential diagnostics, if changes in laboratory analyzes and on an electrocardiogram are not determined, one should be oriented towards performing FEGDS and radiographs. The latter are necessary to exclude ulcers and pneumonia, and are also able to give information about the presence of a tumor in the digestive or bronchopulmonary system.
Cancer alertness
In the case of oncological diseases, there may be a burning sensation in the chest on the right or behind the sternum, often of a constant nature, which has a clear dependence on the phases of respiration or on food intake. Sometimes burning constantly worries and does not depend on movement. Very often, with cancer, it appears at the moment when the tumor from the primary focus metastasized and developed at the dropout site, squeezing the surrounding tissue or forming a fistulous passage.
For example, tumors of the esophagus initially appear not as a burning sensation in the chest, but as a violation of swallowing food, belching, and sometimes minor heartburn. Burning itself begins to bother at the moment when, due to constant obstruction of the lumen of the esophagus and food retention, its overlying areas expand. Also, the appearance of this symptom is observed in the case of the formation of the fistulous passage connecting the esophagus with the trachea.
Symptoms such as disturbances in swallowing, as well as weight loss for no apparent reason, are early warning signs of a tumor in the digestive system. Burning in the chest in this situation is not the primary symptom, because most often it appears late enough. However, the appearance of such a symptom requires examination and identification of the cause that caused it.
Burning in neurological diseases
In addition to oncological diseases, a symptom such as burning and tingling in the chest is also characteristic of neurological pathologies. For example, this is observed with shingles, radiculopathies, spinal column lesions, intercostal neuralgia. As a rule, chest pain comes to the fore here, which has a sharp stitching or cutting character, depends on the position of the body or intensifies with movement. Only occasionally, the pain is permanent and can mimic a sore throat, because it appears after exercise.
Burning in the chest on the right, as well as pain in the chest in the projection of the scapula or along the spinal column are typical symptoms of lesions of the musculoskeletal system: osteochondrosis, deforming arthrosis, ankylosing spondylopathy. In this case, the symptoms are attributed simultaneously to neurology for the reason that as a result of these diseases, compression of the roots of the spinal nerves occurs.
The stitching nature of pain with a clear connection with movement is specific for radiculopathies. Neurologists can also determine other radicular symptoms, each of which is specific to a specific lesion site. Often one does not even have to doubt whether pain and burning in the chest on the right or behind the sternum are a sign of a neurological disease, since the diagnosis is sometimes obvious. Regardless of this, the patient must perform an ECG and laboratory tests.
This is necessary to exclude heart damage, as well as for non-specific diagnosis of infectious diseases, leukemia or hematosarcoma. Many of the patients with hematologic tumor diseases confirm that their disease was detected without complaint as a result of performing a general blood test during a routine examination or a medical examination.
Treatment of specialized diseases
After examining the patient with a burning sensation in the chest, treatment is prescribed according to the violations found. If symptoms are associated with myocardial infarction, preparation for interventions is performed, and in the case of angina pectoris, the treatment regimen is adjusted. If tumors of the breast, lung, bronchus, pleura, pharynx, esophagus or stomach are detected, a comprehensive examination is required to plan the scope of the operation.
In the case of pneumonia, when the question of the origin of the symptom is removed by X-ray and a general blood test, antibacterial and physiotherapeutic treatment is prescribed. With a neurological disease, physiotherapy and analgesia are appropriate. Moreover, in everyday practice, detailing the symptom usually does not cause difficulties, since the accompanying complaints usually allow you to quickly and accurately diagnose.
Summary
For a symptom such as a burning sensation in the chest, the causes are very diverse. Among them are diseases of the respiratory, cardiovascular and digestive systems. Occasionally, burning is a sign of cancer, neurological and skin diseases. It is important to understand that in order to interpret a symptom, it is necessary to study the accompanying complaints, as well as the conditions and patterns of burning sensation, its constancy or paroxysmal nature. An isolated symptom of a burning sensation in the chest appears extremely rarely and testifies in favor of a skin lesion, which is almost always easy to notice.
Burning is a symptom, and there can be no talk of any treatment without an adequate diagnosis. The right tactic is to contact a specialist and an examination in order to identify a specific cause. You can start treatment immediately if there is an obvious cause of the symptom. However, in the absence of an effect, diagnostic questions should be addressed until a specific diagnosis is made and the symptom completely disappears as a result of treatment.