Pain Behind Breastbone (Retrosternal Chest Pain)

Retrosternal chest pain refers to pain that is felt behind the breastbone that covers the central part of the chest on the anterior side. Pain in this region may be associated with heart problems. However, retrosternal pain could also arise from other organs that lie in the chest cavity. The main structures that lie behind the sternum include the heart, thymus gland, esophagus, parts of the great blood vessels, initial part of bronchi, trachea, and thoracic and cervical vertebrae.

Parts of lungs, pleura, pericardium and mediastinum also lie behind the sternum. Retrosternal pain could arise due to problems emanating from any of these structures in the central region of the chest cavity.
In some rare cases, retrosternal pain may also be referred pain that travels from other neighboring structures. For example, pain from some organs in the abdominal cavity such as the stomach, gallbladder and pancreas may get referred to the chest region.

Read more on breastbone pain.

Signs and Symptoms

Pain is a symptom and other signs and symptoms that accompany the retrosternal chest pain depends on the underlying cause. For example, cardiovascular problems can cause retrosternal chest pain that is accompanied by dizziness, shortness of breath and significant weakness. Respiratory problems can cause retrosternal chest pain accompanied by productive cough.

It is therefore important to seek medical attention for pain behind the sterum. However, there may be some red flag signs that requires emergency medical care. If retrosternal chest pain is accompanied by sweating, shortness of breath, dizziness, syncope, and pain that radiates down the left arm or up the left side of the neck or jaw, one must immediately seek medical help. These symptoms could be associated with a potentially fatal heart attack.

Causes of Retrosternal Chest Pain

Most cases of retrosternal pain arise from problems in structures that lie behind or in the vicinity of the breastbone. In some rare cases, retrosternal pain may also be a referred pain that originates from structures in the abdomen. Therefore, it is difficult to know the exact cause of retrosternal pain without considering other factors that accompany the pain.

The medical history of a patient may also provide clues to the underlying cause of retrosternal pain. For example, a person may have a history of heart or lung problems. Further clinical investigations may also be required in order to arrive at an accurate medical diagnosis of the cause of retrosternal pain. The most common sources of retrosternal pain are cardiovascular, respiratory and gastrointestinal problems. Sometimes, retrosternal pain may also be due to a cancer in the chest cavity.

Read more on central chest pain.

Cardiovascular

The most common cause of retrosternal pain is cardiovascular disease. The heart is located just behind the sternum. The great blood vessels that connect to the heart also lie in this region. Therefore, the source of retrosternal pain frequently lies in the heart or the great blood vessels.

Due to the potentially lethal nature of cardiovascular ailments, any retrosternal pain should be taken seriously. The following are some cardiovascular problems that are characterized by retrosternal pain:

  • Angina: Angina refers to a squeezing type of chest pain that occurs in coronary artery disease.
  • Myocardial infarction: Commonly known as heart attack, myocardial infarction is an emergency condition that arises when blood flow to the heart muscle is obstructed due to a blocked coronary artery.
  • Atrial fibrillation: Atrial fibrillation refers to a rapid and irregular heart rate. This condition is commonly known as heart palpitation.
  • Aortic dissection: Aortic dissection refers to a serious emergency resulting from a tear in the inner wall of the aorta.
  • Mitral valve prolapse: The mitral valve lies between the left upper and lower chambers of the heart. It is responsible for the one way flow of the blood in the left side of the heart. Mitral value prolapse refers to a condition in which the mitral valve fails to close properly.
  • Pericarditis: The heart is covered by a membranous sac known as the pericardium. Inflammation of this pericardium is referred to as pericarditis.

Respiratory

The retrosternal space is also occupied by parts of the lungs, trachea, and bronchi. Therefore, retrosternal pain could also arise from these structures. The following are some of the respiratory conditions that may cause retrosternal pain:

  • Pleuritis: Like the heart, the lungs are also covered by a membranous sac. This membranous covering of the lung is known as the pleura. Pleuritis refers to an inflammation of the pleura.
  • Tracheitis: Trachetitis refers to an inflammation of the trachea. Tracheitis typically occurs after throat infections.
  • Cancer: Cancer of the respiratory tissues such as the lungs, pleura, and airways can spread to the mediastinal lymph nodes. This may cause retrosternal pain.

Gastrointestinal

Some parts of the gastrointestinal system such as the eosphagus and upper part of the stomach also lie in the retrosternal space. Therefore, conditions affecting these structures may also be responsible for retrosternal pain. The most common gastrointestinal causes of retrosternal pain are irritation or disease of the esophagus.

  • Acute acid reflux: Acid reflux refers to a backward flow of stomach acid into the esophagus. This backward flow is prevented under normal conditions by the lower esophageal sphincter (abbreviated as LES). However, problems with the lower esophageal sphincter may fail to prevent the backward flow of stomach acid, which can then irritate and damage the lining of the esophageal wall.
  • Gastroesophageal reflux disease: Unlike acute acid reflux, gastroesophageal reflux disease (commonly abbreviated as GERD) is a chronic condition in which stomach acid repeatedly enters the esophagus. The retrosternal pain caused by gastric acid reflux into the esophagus is commonly referred to as heartburn.
  • Esophageal spasms: Esophageal spasms refer to irregular and uncoordinated contractions of the esophageal wall.
  • Esophagitis: Esophagitis refers to inflammation of the esophageal wall.
  • Esophageal tear: Esophageal tears are perforations or tears in the mucosal layer of the esophagus. An esophageal tear is a medical emergency since it can be life-threatening.
  • Foreign body in the esophagus: Sometimes, retrosternal pain may result from the presence of a foreign body in the throat or esophagus.

Tumors

Both malignant (cancerous) and benign (non-cancerous) tumors in the chest can cause retrosternal chest pain. Thymoma and mediastinal lymphadenopathy caused by mesothelioma or lung cancer are examples of rare conditions that can cause retrosternal chest pain. Although tumors are rare, they need to be investigated if other potential causes of retrosternal chest pain have been excluded.

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