How to distinguish between intercostal neuralgia from the heart?

Author Ольга Кияница


Neuralgia can occur for various reasons, among which the greatest role is given to heart disease. But in some cases, the presence of cardialgia is not confirmed, and doctors start talking about intercostal neuralgia. Are there any differences between these two conditions, which are quite similar in their clinical signs?

Neuralgia is a common disease. This is due to the extensive spread of nerve fibers throughout the body.Neuralgia can arise at any age, in men and in women. In some cases, it does not portend anything wrong, whereas in others it is a sign of a formidable disease.

Most often, intercostal neuralgia and cardiac (neuralgia of the heart) are diagnosed, with the first disease being relatively favorable, while the second can be complicated by serious pathological conditions.

Both varieties of neuralgia are accompanied by a characteristic sign - a pain in the chest. But there are other clinical signs that help distinguish one disease from another. It is important to understand that the correct diagnosis allows the most rapid and effective release of the patient from unpleasant and sometimes even dangerous sensations.

Video: Heart or intercostal neuralgia

Chest pain

The presence of chest pain, especially if it is severe or severe, often causes concern about heart disease, such as a heart attack (myocardial infarction). However, this is not the only cause of severe chest pain. It is necessary to take into account a number of factors and characteristics that make it possible to distinguish between chest pain and cardiac pathology that is not related to the heart and the same intercostal neuralgia.

Pain in the chest with cardiac neuralgia

Heart pain in the chest is often caused by myocardial ischemia - deprivation of oxygen from the heart muscle. This should be taken very seriously, since this condition can progress to a heart attack (death of the heart muscle), especially in the absence of rapid and proper treatment. In other cases, the cause of pain can serve as angina (stable and unstable), pericarditis, heart failure.

In particular, cardioneurosis , that is, cardiac neuralgia or neuralgia of the heart, should be distinguished. This disease often develops with frequent physical exertion and a strong emotional experience. Due to the presence of psychological overtones in the development of pathology, cardioneurosis is often referred to as psychosomatic disorders. For his treatment, mainly requires consultation of three specialists - a cardiologist, a neurologist and a psychiatrist.

The mechanism of development

The work of all internal organs, including the heart, is regulated by the autonomic nervous system. It is divided into a parasympathetic and sympathetic department (or vagotonic and sympathoadrenal respectively). If in the first variant acetylcholine is used to transfer the pulse along nerve fibers, then adrenaline and norepinephrine are used in the second. As a result, clinical manifestations with the same neuralgia of the heart can be very diverse.

For pain in the chest with cardiac neuralgia, the following features are characteristic:

  • Occurs periodically
  • Not related to body movements
  • It is defined as a dull, constrictive, choking and / or crushing
  • Can be eliminated by "cardiac" drugs (nitroglycerin)
  • It is often spilled without a clear localization
  • Can give up in the lower jaw, in the left arm
  • Most often it is determined from the left side, where the heart is located

In addition, with cardiac neuralgia, there may be a disorder of cardiac activity (arrhythmia), or a rise or fall in blood pressure. If electrocardiography is performed during an attack, characteristic changes can occur, manifested in the form of rapid heartbeat, increase or decrease in the voltage of the teeth, extraordinary contractions of the myocardium,

Pain in the chest with intercostal neuralgia

Non-cardiac chest pain refers to pain due to other pathologies developing inside the chest. However, it should be remembered that certain conditions affecting the heart may not always lead to ischemia and therefore can not be present in a form reminiscent of ischemic heart pain. Example: GERD (heartburn), pleurisy or even pericarditis (inflammation of the pericardium bag). But since often during the diagnosis it is intercostal neuralgia that is confused with cardioneurosis, it is necessary to determine the characteristic differences between these diseases.

There is no convincing way to differentiate cardiac and non-cardiac pain in the chest in a home setting. There are many cases where severe heartburn causes chest pain resembling a heart disease, and only the use of nitrates can allow a person to differentiate cardiac and non-cardiac chest pain in this case.

The expressed chest pain should always be taken seriously, and a trip to the emergency room often requires the elimination of more serious underlying disorders. This can only be done under the supervision of a medical professional in combination with appropriate tests and studies.

Distinctive signs of chest pain developing with intercostal neuralgia

  • Often, its appearance depends on the movements of the body, especially pain is exacerbated by sharp corners of the body, sneezing, laughter, coughing
  • In general, it is constant, although sometimes patients note its episodicity
  • It is not removed by nitroglycerin or other "cardiac" drugs
  • There is increased pain when palpation of the affected area


Possible differences between intercostal neuralgia and cardiac

Nature of sensations

  • Cardioneurosis
    • Unpleasant sensations can be defined by the type of burning or severity
    • Sometimes you can just feel discomfort, so the nature of heart pain in the chest can be as misleading.
    • A common, but unconvincing manifestation of pain in the chest against the background of neuralgia of the heart is, as it were, contraction of the thorax.
  • Intercostal neuralgia
    • Pain can range from a burning sensation to a sharp, dull, aching and burning, pounding and stitching
    • Chest pain because of anxiety can also lead to pain, which is similar to heart pain.


  • Cardioneurosis
    • Unpleasant sensations usually occupy a central position (closer to the center of the chest) and spread outward (diffusely).
  • Intercostal neuralgia
    • Discomfortable sensations can be far from the center of the chest, where the patient can clearly identify it as right or left chest pain.
    • Pain manifestations are usually localized and located only in one place, which can be clearly defined by a sick person.


  • Cardioneurosis
    • Pain is often transmitted to the jaw, neck, shoulder, arm (either in one place or in several at the same time), and recurrent irradiation can also be determined.
    • Sometimes the pain can be transmitted to the upper abdomen.


  • Intercostal neuralgia
    • There can not always be any irradiation of pain or it is transmitted to other places than the above.
    • If a patient besides intercostal neuralgia has a gastritis with concomitant GERD, then there may be burning pain in the chest, as well as pain in the upper abdomen, and this is often perceived as irradiation.

The provoking factors

  • Cardioneurosis
    • The aggravation of the condition can occur with tension or emotional experience.
    • From time to time, excessive food intake or even extreme temperature changes, especially cold, can cause or exacerbate the pain.
  • Intercostal neuralgia
    • Spontaneous occurrence is characteristic, although the disease can be aggravated by stress (usually after, but not during physical activity).
    • Changing the posture, deep or rapid breathing can also aggravate the patient's condition.

Facilitating factors

  • Cardioneurosis
    • Pain noticeably subsides during rest and after taking nitrate preparations.
  • Intercostal neuralgia
    • It is difficult for a patient to occupy a comfortable position of the body, even during rest.
    • Disease does not respond to nitrates or too slow response may be noted.
    • There is relief from local exposure to heat or the use of warming aids.

It is important to know that the pain caused by antacids can be associated with gastrointestinal disorders. The pain that subsides when tilted forward may be associated with pericarditis (inflammation of the pericardial sac).

Concomitant / related signs and symptoms

  • Cardioneurosis
    • Severe shortness of breath - the patient may report suffocation.
    • Dizziness
    • Fainting (darkening in the eyes)
  • Intercostal neuralgia
    • There may be other signs and symptoms that are often helpful in determining the cause of the pain.
    • Gastrointestinal tract - bloating, belching, nausea, vomiting and / or regurgitation.
    • Respiratory organs - shallow breathing, sometimes there is a persistent cough, abnormal respiratory sounds during auscultation, difficulty breathing when lying down, taking expectorants or coughing up blood.
    • The musculoskeletal system is a limited range of motion, the pressure on the affected area is heavily borne. It is important to eliminate pain in the muscles and bones.
    • Psychological - the state is defined as deplorable, depressed, agitated, agitated, panic.

Video: How to distinguish between intercostal neuralgia from heart disease. Symptoms, character, localization of pain

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