概述

胸部疼痛有多种形式,从刺痛到钝痛。有时,胸部疼痛会伴随挤压感或灼热感。在某些情况下,疼痛会蔓延到颈部,再到下颚,然后再辐射到背部或向下延伸到一只或两只手臂。

许多问题都可能导致胸部疼痛。最危及生命的病因是心脏或肺部问题。由于胸部疼痛可能意味着某种严重问题,因此必须立即寻求医疗帮助。

症状

胸部疼痛会产生多种不同的感觉,具体取决于是由哪种因素诱发的症状。虽然胸痛的原因有时和心脏没有关系,但是不看医生就很难分辨。

心脏相关胸部疼痛

虽然胸部疼痛通常和心脏病有关,但是一些心脏病患者表达含混的不适症状不一定是疼痛。一般来说,与心脏病发作或其他心脏病有关的胸部不适可能被描述为下列症状或者与下列症状有关:

  • 胸闷、胸痞、灼热感或紧迫感
  • 放射至背部、颈部、颚、肩部和一侧或两侧手臂的压迫痛或烧灼痛
  • 疼痛可能持续数分钟、在活动后加重、时好时坏,或者每次疼痛的严重程度不同
  • 气短
  • 出冷汗
  • 头晕或无力
  • 恶心或呕吐

其他类型的胸部疼痛

可能很难鉴别出是心脏相关胸部疼痛还是其他类型的胸部疼痛。但是那些不太可能与心脏病有关的胸部疼痛更有可能伴发下列症状:

  • 嘴巴里有酸味,感觉食物回到口腔内
  • 吞咽困难
  • 疼痛会随体位改变时轻时重
  • 深呼吸或咳嗽时疼痛加剧
  • 按压胸部时压痛
  • 疼痛持续数小时

典型症状胃灼热(胸骨后疼痛的灼热感)可以由心脏病或胃病引起。

何时就诊

如果您有新发的或不明原因的胸部疼痛,或怀疑自己心脏病发作,请立即拨打急救电话。

Heart-related chest pain

Although chest pain is often associated with heart disease, many people with heart disease say they have a vague discomfort that isn't necessarily identified as pain. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:

  • Pressure, fullness, burning or tightness in your chest
  • Crushing or searing pain that spreads to your back, neck, jaw, shoulders, and one or both arms
  • Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity
  • Shortness of breath
  • Cold sweats
  • Dizziness or weakness
  • Nausea or vomiting

Other types of chest pain

It can be difficult to distinguish heart-related chest pain from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:

  • A sour taste or a sensation of food reentering your mouth
  • Trouble swallowing
  • Pain that gets better or worse when you change your body position
  • Pain that gets worse when you breathe deeply or cough
  • Tenderness when you push on your chest
  • Pain that persists for many hours

The classic symptoms of heartburn — a painful, burning sensation behind the breastbone — can be caused by problems with the heart or the stomach.

When to see a doctor

If you have new or unexplained chest pain or think you're having a heart attack, call 911 or emergency medical assistance immediately. Don't ignore the symptoms of a heart attack. If you can't get an ambulance or emergency vehicle to come to you, have a neighbor or a friend drive you to the nearest hospital. Drive yourself only if you have no other option.

病因

胸部疼痛可能有多种病因,每个病因都需要接受医生诊疗。

心脏相关病因

胸部疼痛的心脏相关病因例子包括:

  • 心脏病发作。因流向心肌的血流受阻(通常是血凝块所致)引起的心脏病发作。
  • 心绞痛。心绞痛是指流向心脏的血流不畅所引起的胸部疼痛。通常是由于向心脏供血的动脉内壁出现厚斑块堆积所致。这些斑块会导致动脉管腔变窄并限制向心脏供血,尤其是在劳累时。
  • 主动脉夹层。这种危及生命的疾病会累及起自心脏的大动脉(主动脉)。如果这根血管的内膜剥离,血液就会流入动脉壁中层,并导致主动脉破裂。
  • 心包炎。这是包裹心脏的囊发生的炎症反应。通常会引起锐痛,并在吸气或平躺时加剧。

消化道原因

胸部疼痛可能由消化系统疾病引起,包括:

  • 胃灼热。这种胸骨后灼痛感发生于胃酸从胃部反流至食管(连接咽喉和胃的管道)时。
  • 吞咽障碍。食管疾病会引起吞咽困难甚至是吞咽疼痛。
  • 胆囊或胰腺疾病。胆结石或者胆囊炎或胰腺炎会引起辐射至胸部的腹痛。

肌肉和骨骼原因

有些类型的胸部疼痛与累及胸壁组成结构的损伤和其他问题有关,包括:

  • 肋软骨炎。患上该病后,肋软骨(尤其是连接肋骨和胸骨的软骨)发炎疼痛。
  • 肌肉酸痛。慢性疼痛综合征(例如纤维肌痛)可能产生持续性的肌肉相关胸部疼痛。
  • 肋骨损伤。肋骨瘀伤或骨折会引起胸部疼痛。

肺脏相关病因

多种肺部疾病都会引起胸部疼痛,包括:

  • 肺栓塞。当血凝块嵌入肺动脉、阻塞流向肺组织的血流时,就会发生肺栓塞。
  • 胸膜炎。如果覆盖肺表面的膜发炎,可能引起胸部疼痛,并在吸气或咳嗽时加重。
  • 肺萎陷。与肺萎陷有关的胸部疼痛通常突然发生,持续数小时,并且一般会出现气短。当空气渗入肺和肋骨之间的空隙时,就会发生肺萎陷。
  • 肺高压。当将血液运送至肺脏的动脉血压持续升高时,就会发生该病,并引起胸部疼痛。

其他原因

胸部疼痛还有以下病因:

  • 惊恐发作。如果您会时常出现强烈恐惧伴胸部疼痛、心跳加快、呼吸加快、大量出汗、气短、恶心、头晕和濒死恐惧,则您可能患有惊恐发作。
  • 带状疱疹。带状疱疹是由水痘病毒再激活引起,会引发疼痛和从后背至胸壁的带状分布水疱。

Heart-related causes

Examples of heart-related causes of chest pain include:

  • Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to the heart muscle.
  • Angina. Angina is the term for chest pain caused by poor blood flow to the heart. This is often caused by the buildup of thick plaques on the inner walls of the arteries that carry blood to the heart. These plaques narrow the arteries and restrict the heart's blood supply, particularly during physical activity.
  • Aortic dissection. This life-threatening condition involves the main artery leading from the heart (aorta). If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture.
  • Inflammation of the sac around the heart (pericarditis). This condition usually causes sharp pain that gets worse when breathing in or lying down.

Digestive causes

Chest pain can be caused by disorders of the digestive system, including:

  • Heartburn. This painful, burning sensation behind the breastbone occurs when stomach acid washes up from the stomach into the tube that connects the throat to the stomach (esophagus).
  • Swallowing disorders. Disorders of the esophagus can make swallowing difficult and even painful.
  • Gallbladder or pancreas problems. Gallstones or inflammation of the gallbladder or pancreas can cause abdominal pain that spreads to the chest.

Muscle and bone causes

Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall, including:

  • Costochondritis. In this condition, the cartilage of the rib cage, particularly the cartilage that joins the ribs to the breastbone, becomes inflamed and painful.
  • Sore muscles. Chronic pain syndromes, such as fibromyalgia, can cause persistent muscle-related chest pain.
  • Injured ribs. A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung disorders can cause chest pain, including:

  • Blood clot in the lung (pulmonary embolism). A blood clot that gets stuck in a lung (pulmonary) artery can block blood flow to lung tissue.
  • Inflammation of the membrane covering the lungs (pleurisy). This condition can cause chest pain that worsens when you inhale or cough.
  • Collapsed lung. The chest pain associated with a collapsed lung typically begins suddenly and can last for hours and is generally associated with shortness of breath. A collapsed lung occurs when air leaks into the space between the lung and the ribs.
  • High blood pressure in the lung arteries (pulmonary hypertension). This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Other causes

Chest pain can also be caused by:

  • Panic attack. If you have periods of intense fear accompanied by chest pain, a rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be having a panic attack.
  • Shingles. Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from the back around to the chest wall.

在 Mayo Clinic 治疗

Jan. 13, 2022
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