Chest Pain

Substernal chest pain

Substernal chest pain

Substernal chest pain is quite painful that usually feels below or behind the sternum bone. Moreover, sternum is the flat bone at the front of the chest that connects the ribs with the cartilage. The sternum consists of three parts; manubrium, body, and xiphoid process. 


Mainly, substernal chest pain has been caused by problems with bones and muscles close to the sternum and sternum itself. These are certain other significant causes of substernal pain, such as:

  • Pneumonia: It is a lung infection that inflames air sacs in the lungs. In addition, air sacs fill with pus, causing chest pain, fever, severe coughing, sweating, confusion, breathing issues, and nausea.
  • Bronchitis: It is an inflammation of the central airways of the lungs. Bronchitis may cause severe cough, chest pain, breathing problems, wheezing or sore throat. Viruses commonly cause acute bronchitis, while smoking may cause chronic bronchitis. 
  • Myocardial infarction: Myocardial infarction is often called a heart attack caused by the blockage of blood flow from arteries to the heart. The symptoms of a heart attack may include chest pain, shortness of breathing, abnormal fatigue, nausea, or dizziness. 
  • Sternum fracture: Sternum fracture causes severe pain during coughing and inhaling. It occurs due to trauma like a sports injury or car accident. People with sternum fractures may face difficulty breathing and swelling in the sternum. 
  • Pulmonary embolism: Pulmonary embolism is an obstruction of blood clumps in pulmonary arteries that supply blood into the lungs. Resultantly, it causes the prevention of oxygen in the lungs, which could be life-threatening. Their symptoms include cough, dizziness, sweating, sharp chest pain, and difficulty breathing.
  • Costochondritis: It is chest pain that is mainly caused by the inflammation of the cartilage that connects ribs to the sternum. Costochondritis can also occur due to injury, infection, severe coughing, physical strains, or trauma. Moreover, other problems are also seen in costochondritis, such as pain in the ribs, difficulty in deep breathing, or coughing. 
  • Injury in the sternoclavicular joint: Sternoclavicular joint attaches the upper sternum to the collarbone. While injury in this joint causes discomfort and pain in the upper sternum. Joint injury symptoms include swelling or mild pain in the upper chest and difficulty in shoulder movement.
  • Hiatal hernia: The hiatal hernia may affect the chest and cause substernal pain. There are different symptoms of hiatal hernia, such as heartburn, frequent burping, problems in swallowing, dry cough, blood vomiting, and loss of appetite. 
  • Acid reflux (GERD): Acid reflux is commonly known as Gastroesophageal reflux disease. It occurs when stomach acid returns to the esophagus. Around 20% of western countries have been affected by acid reflux, which is most common in women. There are different signs of acid reflux, such as a burning sensation in the chest, difficulty swallowing food, chronic cough, laryngitis, chest pain, and disruptive sleep. 
  • Muscular strain: Several muscles have been connected to ribs and sternum. Trauma or injuries have resulted in bruising or swelling, causing pain in these muscles. 
  • Pleurisy: Pleura is the tissue sheet between the ribcage and lungs; inflammation in these sheets is known as pleurisy. Pleurisy may cause severe chest pain when a person is breathing, sneezing, coughing, or moving. The other symptoms are dry cough and shortness of breathing. Moreover, pleurisy has been caused by bacterial infections like pneumonia or viral infections.

Symptoms of substernal chest pain

Substernal pain has been reported as agonizing, crushing, and compressing in nature. The following are different symptoms depending on the causes of substernal pain;

  • Feeling sour taste
  • Pain in the ribs 
  • Difficulty in breathing
  • Heartburn
  • Collarbone trauma like swelling or bruising
  • Mild pain and swelling in the upper chest
  • Difficulty in swallowing food
  • Frequent belching
  • Vomiting
  • Loss of appetite
  • Perspiration
  • Dizziness
  • Feeling sour taste: Commonly, it is because of acid reflux infection when stomach acid returns to your esophagus, which occurs especially at night. Moreover, acid reflux causes heartburn disease, bloating, burping, dry cough, nausea, or breathing issues. 
  • Pain during breathing, coughing, and fever: These all are the symptoms of respiratory disease that causes substernal pain throughout normal breathing. 

Diagnosis of substernal chest pain

The diagnosis can be initiated by taking the patient’s medical history and physical tests. This is the initial step among all chest pain infections to sort out cardiac causes. Blood tests will be done to check cardiac enzymes within the blood. Electrocardiogram (ECG) is another test that can be used to prevent electrical signals and the heart’s rhythm. For this, sensors will be attached to the chest at different points to examine the heart problems.

Furthermore, an echocardiogram can be used to measure other cardiac abnormalities by using sound waves. These sound waves can create real-time images of the blood vessels and heart muscles. Chest X-Ray can also be used to estimate lungs and heart size. Moreover, CT (Computed tomography) scan gives detailed images of the heart, lungs, muscles, and bones and detects abnormalities. In addition, it helps measure the leading causes of substernal pain, such as aortic dissection or pulmonary embolism. 


The treatment of substernal chest pain initially relies on the patient’s cardiac causes and symptoms. For this, cardiac pathology should be evaluated deeply to treat chest pain infection. These pains can be cured with different medicines such as:

    • Artery relaxing medicines: These medicines are used to relax arteries and permit them to work efficiently. Nitroglycerin and hypertensive can be utilized for artery relaxation.
    • Acid suppressants: These medicines can prevent the amount of stomach acid produced in acid reflux patients. Moreover, doctors can prescribe a combination of medicines like Pepcid, Prevacid, Nexium, Aciphex, or Protonix. 
    • Antidepressants: Substernal chest pain is found in anxiety patients. Antidepressants and mood relaxers can be prescribed to treat panic attacks and anxiety. Furthermore, psychological therapy and cognitive behavior are also effective.
  • Blood thinners: A doctor prescribes medicines to stop clot formation in arteries. Many treatment measures can be utilized for heart attacks, such as thrombolytic, blood thinners, aspirin, and nitroglycerine. 




Leave a Reply

Your email address will not be published. Required fields are marked *