Chest distress (oppression in chest) is a subjective feeling that refers to the patient’s perception of chest blockage, fullness and discomfort, which may be accompanied by chest pain, palpitations, shortness of breath and even dyspnea. Chest tightness is also known as chest fullness, chest fullness, chest fullness or chest obstruction in traditional Chinese medicine, which belongs to the category of diseases such as “chest paralysis”, “heart failure”, “asthma syndrome”, “lung distension” and other diseases in traditional Chinese medicine. Chest tightness may be a functional manifestation of the body’s organs, or it may be one of the earliest symptoms of organic diseases, so if the symptoms persist or are accompanied by other discomforts, you should seek medical treatment as soon as possible to avoid serious damage to the body’s health.
symptom
classify
Traditional Chinese medicine divides chest tightness into four types of symptoms, namely dampness and heat disturbance syndrome, phlegm and dampness internal obstruction syndrome, heart qi deficiency syndrome and lung qi weakness syndrome.
1. Damp heat disturbance chest syndrome
Chest tightness, accompanied by lack of desire to eat, sometimes nausea, fever, limb soreness, heaviness and fatigue. The tongue coating is thin white or yellowish, and the pulse is wet and fast.
2. Phlegm and dampness internal obstruction syndrome
Chest and diaphragm tightness, exhalation is relaxed, accompanied by abdominal swelling, dizziness, nausea, vomiting, or coughing, sputum and white stickiness. The tongue coating is white and greasy, and the pulse is moist and smooth.
3. Insufficient heart qi
Chest tightness, sometimes it comes and goes, repeatedly does not heal, accompanied by palpitations, shortness of breath, and mental fatigue. The tongue is pale red or purple-dark, the moss is mostly clean or thin white, and the pulse is weak.
4. Lung qi weakness syndrome
Chest tightness occurs from time to time, inhaling quickly, and there is shortness of breath, spontaneous sweating, especially when moving, or coughing, or usually easy to catch a cold. The tongue is pale, the coating is thin and white, and the pulse is weak.
Typical performance
Chest tightness is mainly manifested as chest blockage, fullness and discomfort, mild without obvious discomfort, severe cases may feel like the chest is pressed by stones, and even difficulty breathing. In addition, patients may be accompanied by chest pain, palpitations, shortness of breath, nausea, cough, sputum and other symptoms.
complication
1. Emotional problems
Long-term chest tightness will not only cause discomfort in the patient’s body, but also cause psychological pressure due to worry about their own health, and it is easy to experience emotional problems such as anxiety and depression.
2. Activities are restricted
People with chest tightness may experience worsening symptoms due to poor breathing and insufficient oxygen supply during activities. To avoid discomfort, patients may reduce their activity levels, which can affect their daily activities and athletic abilities.
cause
Summary
Chest tightness can be caused by a variety of reasons, which can be mainly divided into two categories: Western medicine and traditional Chinese medicine. The causes of Western medicine mainly include environmental factors, mental factors, respiratory diseases, cardiovascular diseases, etc., while the causes of traditional Chinese medicine include dampness and heat disturbance of the chest, internal obstruction of phlegm and dampness, insufficient heart qi and weak lung qi.
Symptom causes
1. Western medicine reasons
(1) Environmental factors: In the physiological state, chest tightness can occur in a closed or crowded environment for a long time, but it can be relieved and disappeared by entering an open and airy environment.
(2) Mental factors: such as mental stress, emotional agitation, etc., can also cause chest tightness, but it can be relieved after rest, stress reduction, and emotional adjustment.
(3) Respiratory diseases: such as chronic obstructive pulmonary disease, emphysema, bronchitis, bronchial asthma, pneumothorax, etc., which can lead to alveolar ventilation and/or ventilation dysfunction, which can cause chest tightness, often accompanied by cough, sputum, shortness of breath, dyspnea and other symptoms. In addition, diaphragmatic paralysis, diaphragm distension, etc., may also cause chest tightness.
(4) Cardiovascular diseases: such as hypertension, tachyarrhythmias, heart valve disease, coronary heart disease, myocardial infarction, etc., which can lead to insufficient blood supply to the heart or hypoxia of the heart muscle, which in turn causes the chest net, often accompanied by palpitations, chest pain, dizziness and other symptoms. In addition, cardiac neurosis can also cause chest tightness.
(5) Other diseases: such as anemia, cervical spondylosis, biliary heart syndrome, metabolic acidosis, chest trauma, etc., may cause chest tightness.
2. Causes of traditional Chinese medicine
(1) Dampness and heat disturb the chest: feel the damp heat external evil, or the spleen and stomach are usually weak, gather dampness and dissolve heat, and dampness and heat disturb the chest, resulting in qi blockage in the chest, and then causing chest tightness.
(2) Phlegm and dampness internal obstruction: improper diet, overeating fat and sweet taste, dampness and phlegm, or weak spleen of the body, poor spleen movement, dampness and internal stagnation, dampness accumulates into phlegm, disturbing the chest septum, resulting in unfavorable qi, and then causing chest tightness.
(3) Insufficient heart qi: work and rest imbalance, damage to heart qi, or body yang deficiency, heart qi weakness, insufficient chest qi can cause chest tightness.
(4) Weak lung qi: Coughing for a long time, damaging lung qi, or weak body, insufficient lung qi, resulting in a decrease in qi in the chest, and then causing chest tightness.
Common diseases
Chronic obstructive pulmonary disease, emphysema, bronchitis, bronchial asthma, pneumothorax, hypertension, tachyarrhythmia, valvular heart disease, coronary heart disease, myocardial infarction, anemia, cervical spondylosis, biliary heart syndrome, metabolic acidosis, chest trauma
Medical treatment
Emergency (120) indications
1. Chest tightness and breathlessness suddenly worsen, resulting in inability to move normally or significantly affect daily life;
2. Chest tightness is accompanied by severe dyspnea, such as mouth breathing, sitting breathing, etc., and even cyanosis of the lips;
3. Chest tightness accompanied by severe chest pain;
4. Chest tightness accompanied by consciousness disorders;
5. Chest tightness after trauma;
6. Other critical situations occur.
All of the above need to go to the emergency department immediately or call the 120 emergency number.
Outpatient indications
1. Chest tightness persists or recurs;
2. Accompanied by palpitations, shortness of breath and other symptoms;
3. Accompanied by cough, sputum and other symptoms;
4. Accompanied by symptoms such as dizziness and fatigue;
5. Other severe, persistent or progressive symptoms and signs.
All of the above must be consulted in time.
Visit the department
1. If the symptoms are more severe, you need to go to the emergency department.
2. If it is suspected to be caused by respiratory diseases, you can go to the respiratory medicine department.
3. If it is suspected to be caused by cardiovascular disease, you can go to the cardiovascular department.
4. If the patient wants to adopt traditional Chinese medicine, he should go to the traditional Chinese medicine department.
Preparation for medical treatment
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor may examine the chest, preferably wearing loose clothing.
3. If you have recent medical experience, please bring relevant medical records, examination reports, etc.
4. If you have taken some medications to relieve symptoms recently, you can carry a medicine box.
5. Family members can be arranged to accompany them for medical treatment.
6. Patients can prepare a list of questions they want to consult in advance.
What questions doctors may ask patients
1. When did you start experiencing chest tightness? Is it persistent, or is it intermittent?
2. How do you feel chest tightness? Do you feel that it is difficult to breathe?
3. Have you felt that your symptoms have worsened or decreased since the onset of the disease? Is there any reason?
4. Do you have any other symptoms besides chest tightness, such as palpitations, chest pain, etc.?
5. Do you have cardiovascular or respiratory diseases?
6. How is your usual living environment?
7. How is your recent emotional state?
8. Do you have any other diseases?
9. Have you been treated at other medical institutions before visiting the doctor? How is it treated? What is the effect?
What questions can patients ask their doctor?
1. Why do I have chest tightness?
2. Is the situation serious?
3. What tests do I need?
4. How should I treat it? Do I need to be hospitalized? How long does it take to get better?
5. If you take medicine for treatment, what are the dosage and precautions for the drug?
6. Do I have other diseases that will affect my treatment?
7. What should I pay attention to?
8. Do I need to review? How often?
examine
Expected inspection
The doctor will first conduct a physical examination or a four-diagnosis examination of traditional Chinese medicine to initially understand the lesion, and then may recommend blood routine, blood biochemistry, allergen testing, sputum culture, blood gas analysis, chest X-ray, echocardiography, chest CT, pulmonary function test, electrocardiogram, bronchoscopy, etc., to determine the cause.
physical examination
1. Western medicine examination
(1) Inspection: The doctor will observe the appearance of the chest, including the shape of the rib cage, whether it is symmetrical, whether there are abnormalities such as depression or protrusion.
(2) Palpation: The doctor will check the degree of thoracic expansion and whether there is tenderness by touching the patient’s chest.
(3) Percussion: The doctor will preliminarily determine whether there is fluid accumulation, pneumothorax and other abnormalities in the lungs by the acoustic changes produced by tapping the chest.
(4) Auscultation: Auscultation can help doctors determine whether the patient has abnormal changes in breath and heart sounds.
2. Traditional Chinese medicine examination
(1) Observation: mainly to observe the patient’s complexion, demeanor, lip color, tongue coating, etc.
(2) Smelling diagnosis: mainly to listen to the patient’s voice and breath to judge the reality of the symptoms and the possible causes.
(3) Consultation: including the duration of chest tightness, attack frequency, accompanying symptoms, personal life history, past history, etc.
(4) Cutting: The doctor will help determine the syndrome type by feeling the change in the pulse.
Laboratory tests
1. Blood routine
This examination can understand the levels of red blood cells, white blood cells, hemoglobin and other indicators, and then help determine whether the patient has infection, anemia, etc.
2. Blood biochemistry
This test can understand liver function, kidney function, blood lipids and electrolyte levels.
3. Allergen detection
该检查可以帮助确定患者是否存在可能引起胸闷的过敏性疾病，如过敏性哮喘等，以及对何种物质过敏。
4. Sputum culture
If pathogens are cultured, such as Streptococcus pneumoniae, Staphylococcus aureus, etc., the lung infection can be identified, and susceptibility testing can be performed to help doctors choose sensitive antibiotics for treatment.
5. Blood gas analysis
This examination can directly measure the pH of the blood, arterial blood oxygen partial pressure, arterial blood carbon dioxide partial pressure, and then calculate arterial blood oxygen saturation, standard bicarbonate, actual bicarbonate, buffer alkali and other relevant indicators through the formula, and then judge whether the patient has hypoxia and hypoxia, respiratory failure, acid-base balance disorder and other problems.
Imaging tests
1. Chest X-ray
This examination can show structures such as the lungs, heart, bones, etc., which can help evaluate and diagnose chest diseases such as pneumonia, tuberculosis, pneumothorax, etc., to determine the cause of chest tightness.
2. Echocardiography
This examination uses the physical characteristics of ultrasound to observe the morphological structure, functional state and hemodynamics of the heart and large blood vessels, and can help diagnose a variety of heart diseases that may cause chest tightness, such as coronary heart disease, heart valve disease, congenital heart disease, etc.
3. Chest CT
Compared with chest X-ray, chest CT can detect earlier and smaller lung lesions, such as early lung cancer, pulmonary interstitial disease, etc. For people with chest tightness, it helps to more accurately diagnose the type, extent, and severity of lung disease.
Other tests
1. Lung function test
By detecting the patient’s lung volume, ventilation function, ventilation function, respiratory dynamics and other indicators, this examination can evaluate the patient’s lung function, thereby helping to diagnose respiratory diseases that may cause chest tightness, and can judge the severity of the disease and evaluate the treatment effect.
2. Electrocardiogram
The examination uses an electrocardiogram machine to record the changes in electrical activity of the heart in each cardiac cycle from the body surface, forming a curve pattern, and then by observing the P-wave form and time, PR interval, QRS shape and time, etc., the conduction of the heart and whether there are ischemia problems in the myocardium, so as to preliminarily evaluate cardiac function and diagnose heart disease.
3. Bronchoscopy
When respiratory diseases are suspected and other tests cannot be clarified, the internal condition of the respiratory tract can be directly observed through bronchoscopy, providing an important basis for clinical diagnosis and treatment.
diagnosis
Diagnostic principles
Generally, according to the medical history consultation, the patient has symptoms such as chest blockage, chest pain, palpitations, shortness of breath, dyspnea, etc., and combined with physical examination, observation, hearing, cutting, blood routine, blood biochemistry, allergen detection, sputum culture, blood gas analysis, chest X-ray, echocardiography, chest CT, pulmonary function test, electrocardiogram, bronchoscopy and other examination results, the diagnosis can be confirmed. During the diagnosis process, doctors usually need to differentiate several common diseases that cause chest tightness, such as chronic obstructive pulmonary disease, coronary heart disease, and anemia.
differential diagnosis
1. Chronic obstructive pulmonary disease
COPD, or COPD for short, is a chronic airway disease characterized by persistent airflow restriction and corresponding respiratory symptoms. In addition to chest tightness, patients mainly present with dyspnea, chronic cough, sputum production, wheezing, chest pain and fatigue. Physical examination can reveal changes such as barrel-shaped chest, weakened bilateral speech tremor, excessive lung voice, and weakened breath sounds in both lungs. Pulmonary ventilation function test is an objective indicator for judging airflow restriction and the “gold standard” for the diagnosis of COPD.
2. Coronary heart disease
Coronary heart disease, also known as coronary atherosclerotic heart disease, refers to heart disease caused by atherosclerosis of the coronary arteries (coronary arteries) causing lumen stenosis or occlusion, resulting in myocardial ischemia, hypoxia or necrosis. Chest tightness in patients is usually associated with exercise, heavy physical labor, emotional agitation, etc., and is generally short-lasting and can be relieved after a few minutes of rest. The pain is mainly behind the sternum, often radiating to the left shoulder, the inside of the left arm to the ring finger and little finger, or to the neck, pharynx, and jaw. In addition, patients may also be accompanied by palpitations, fatigue, dizziness, sweating, nausea and other symptoms.
3. Anemia
Anemia is a clinical syndrome caused by a decrease in the volume of red blood cells in the peripheral blood of the body, which is below the lower limit of the normal range, and cannot transport enough oxygen to the tissues. In addition to chest tightness, patients may also experience symptoms such as dizziness, fatigue, memory loss, insomnia, and paleness. The diagnosis can be confirmed by blood routine, peripheral blood smear, and other examinations.
treat
Anticipated treatment
For patients with chest tightness, they can first try to reduce symptoms by resting properly, improving environmental ventilation, and adjusting their mood. If the above measures are ineffective or accompanied by other discomforts, you should seek medical attention in time to clarify the cause, and then take targeted measures, such as oxygen inhalation, medication, surgical treatment, etc., to alleviate symptoms as much as possible.
Treat the cause
1. Chronic obstructive pulmonary disease
Treatment in the stable period is mainly medication, commonly used include bronchodilators (such as albuterol, terbutaline), inhaled glucocorticoids (such as budesonide, fluticasone furoate), expectorants (such as carboxymestein, fodostane) and phosphodiesterase inhibitors (such as roflumilast), etc.; In addition, patients should also take some non-pharmacological treatments under the guidance of a doctor, including smoking cessation, vaccination, nasal catheter oxygen, etc. Patients in the acute exacerbation stage should return to their pre-acute exacerbation state as soon as possible under the guidance of a doctor, through the application of bronchodilators and other drugs, Venturi mask oxygen inhalation, etc., and learn self-monitoring and management, so as to identify and reduce the risk of future exacerbations early.
2. Coronary heart disease
Patients should take appropriate treatment according to the type of disease, the severity of the disease, and the individual’s health status under the guidance of a doctor, such as immediate rest, sublingual nitroglycerin, oral antiplatelet drugs (such as aspirin, clopidogrel) and myocardial ischemic improvement drugs (such as metoprolol, verapamil), percutaneous coronary intervention, coronary artery bypass grafting, etc.
3. Anemia
Patients with anemia should be guided by a doctor to develop a treatment plan based on the severity and cause of symptoms, including blood transfusion, hemostasis, medication and surgery. For example, patients with severe anemia should correct anemia as soon as possible by transfusing red blood cells; Patients with anemia and bleeding should take different hemostatic treatments according to different bleeding mechanisms; Patients with iron deficiency anemia should try to remove the cause of iron deficiency, and at the same time take oral ferrous sulfate, ferrous gluconate and other therapeutic iron agents according to the doctor’s advice; Patients with hematopoietic stem cell dysfunctional anemia may need hematopoietic stem cell transplantation.
General treatment
1. Stop ongoing activities, rest properly, try to keep your body in a relaxed state, and avoid strenuous exercise or overexertion in a short period of time.
2. Keep the indoor air fresh and well ventilated so that enough oxygen can be inhaled.
3. You can relieve tension and reduce psychological pressure through deep breathing, meditation, yoga, etc.
drug therapy
For details, see causal treatment and traditional Chinese medicine treatment.
Related drugs
Albuterol, terbutaline, budesonideside, fluticasone furoate, carboxymestein, fodostane, roflumilast, nitroglycerin, aspirin, clopidogrel, metoprolol, verapamil, ferrous sulfate, ferrous gluconate, Shuxiang granules (such as Jiangzhong Shuxiang granules), Chuanbei Loquat Capsules (Yang Jisheng)
Surgical treatment
If chest tightness is caused by organic lesions, such as valvular heart disease, thoracic aortic aneurysm, or lung cancer, conservative treatment is ineffective, and the body is assessed to be able to tolerate surgery, surgical treatment needs to be considered.
Traditional Chinese medicine treatment
1. Syndrome differentiation and medication
(1) Dampness and heat disturbance chest syndrome: treatment should be to clear heat and dampness, aroma and relax, and the main prescription should be Huopu Xia Ling Decoction. If the heat is worse than the damp evil, chest tightness and irritability, vomiting, abdominal distension, and red urine, you can choose manna disinfection pill. Commonly used traditional Chinese medicines include Huoxiang, magnolia, pinellia, talc, scutellaria, calamus, red ring, almonds, coix seeds, white cardamom kernels, pig ling, zexia, light tempeh, etc.
(2) Phlegm and dampness internal obstruction syndrome: The treatment should be to dissolve dampness and expectoration, and the main prescription should be Erchen Decoction. If the phlegm is blocked in the lungs, the chest is unfavorable, the chest is full and stuffy, and there is a lot of cough and wheezing, it can be combined with Sanzi Yangqin Decoction to dispel phlegm and benefit the lungs; If the phlegm is blocked and the blood circulation is not smooth, resulting in phlegm and stasis stagnation, severe chest tightness, or chest pain, purple and dark tongue, and astringent pulse, you can use the new Gua Lou Xianbai Decoction to dissolve phlegm and open depression, activate blood and remove blood stasis. Commonly used Chinese medicines include pinellia, orange red, white poria, perilla seeds, white mustard seeds, radish seeds, melon seeds, garlic white, atractylodes, etc.
(3) Heart Qi deficiency syndrome: The treatment should nourish the heart qi, and the main prescription should be supplemented with heart decoction. Supplementing the heart decoction (author’s prescription). Commonly used traditional Chinese medicines include fried codonopsis, roasted licorice, garlic white, roasted cinnamon twig, Panax notoginseng, and Zhiyuanzhi.
(4) Lung Qi weakness syndrome: The treatment should nourish the lung qi, and the main prescription should use Lung Supplement Decoction. If the condition improves after treatment, Qiwei pills can be used to replenish the lungs and control qi, thereby consolidating the curative effect. Commonly used Chinese medicines include ginseng, astragalus, cooked ground, schisandra, aster, mulberry bark, etc.
2. Proprietary Chinese medicine
(1) Chest relief granules (such as Jiangzhong Chest Relief Granules): It has the effect of activating blood circulation and dissolving blood stasis, clearing circulation and relieving pain, and is suitable for chest paralysis caused by blood stasis blockage, with symptoms such as chest tightness and precordial tingling; Coronary heart disease and angina pectoris are seen in the above symptoms.
(2) Chuanbei loquat capsule (Yang Jisheng): clears heat and clears the lungs, dissolves phlegm and relieves cough, is used for cough and phlegm yellow or unpleasant spitting caused by wind and heat invading the lungs, internal stagnation and fire, throat swelling and pain, chest tightness and pain, cold cough and chronic bronchitis see the above symptoms.
3. Acupuncture therapy
Commonly used acupuncture points include Qizhong, Qimen, Zhongfu, etc., which should be selected and operated under the guidance of a doctor.
4. Moxibustion therapy
Commonly used acupuncture points include Shenmen, Daling, Neiguan, Zhongnai, etc., which should be selected and operated under the guidance of a doctor.
It should be reminded that for patients who need traditional Chinese medicine treatment, they should first be treated in a regular traditional Chinese medicine hospital, and a prescription of traditional Chinese medicine should be issued after the differentiation of a professional traditional Chinese medicine doctor.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and constitution, and may vary from person to person.
Estimated cost of treatment
The cost of treatment may vary significantly from person to person, depending on the hospital chosen, treatment plan, and medical insurance policy.