Evidence. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. Ten causes of epigastric pain. The hiatal hernia may affect the chest and cause substernal pain. Required fields are marked *. Read the, immediately life-threatening causes of chest pain, Acute management checklist for aortic dissection, Acute management checklist for cardiac tamponade, Acute management checklist for acute pericarditis, Acute management checklist for heart failure exacerbation, Acute management checklist for Takotsubo cardiomyopathy, Acute management checklist for thoracic aortic aneurysm, Acute management checklist for pulmonary embolism, Acute management checklist for tension pneumothorax, Acute management checklist for spontaneous pneumothorax, Acute management checklist for asthma exacerbation, Acute management checklist for COPD exacerbation, Acute management checklist for pleural effusion, Acute management checklist for esophageal perforation, Acute management checklist for acute pancreatitis, Acute management checklist for esophageal hypermotility disorders, Acute management checklist for Mallory-Weiss syndrome, acute management checklist for herpes zoster, Rome IV criteria for functional chest pain, Differential diagnosis of increased troponin, Differential diagnosis of ST elevations on ECG, https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/diffuse-esophageal-spasm. Esophagitis is a potentially damaging inflammation of the esophagus. Julie has cared for people with similar injuries before. Whats Causing Pain in the Left Side of My Chest? Discuss substernal vs. retrosternal, retrosternal chest pain, and retrosternal thyroid surgery. The features that physicians rely on are associated symptoms that often accompany retrosternal chest pain and point to the particular underlying cause. Typical chest pain is retrosternal. Usually, these injuries occur during a large traumatic event, and the entire chest is usually imaged using CT scans or x-ray. A meta analysis of randomized clinical trials. An esophageal ulcer is often caused by erosion of tissue in the esophagus. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Serious cases may require surgery. A sternum fracture takes much longer to fully heal and can take up to six months to heal. Also known as pleuritis, pleurisy is caused by inflammation of the pleura the lining around the lungs. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. If the pain is described as atypical, musculoskeletal, or noncardiac with no further information on the underlying cause, then . Kearon C, Akl EA, Ornelas J, et al. Mayo Clinic Staff. Retrosternal (Substernal) Goitre Presentation. However, the common feature across all cases will be mild to severe chest pain. Kaman L. Management of Esophageal Perforation in Adults. [1] Up to 10% of substernal goiters are located in the posterior mediastinum, and 90% of . Non-cardiac chest pain (retrosternal, pseudoanginous) is defined as a constricting sensation localized in the middle of the breastbone (sternum), which is not caused by ischemic heart disease or other cardiac pathology. These pains can be cured with different medicines such as: Your email address will not be published. For this, sensors will be attached to the chest at different points to examine the heart problems. 2005-2023 Healthline Media a Red Ventures Company. Diagnosing & Treating Chest & Stomach Injuries, Solar Plexus Injury: Symptoms & Treatment, Psychological Research & Experimental Design, All Teacher Certification Test Prep Courses, Deep Vein Thrombosis: Theory and Treatment, Deep Vein Thrombosis: Practical Applications, Critical Care Nursing for Skin Conditions, Infections of the Blood & Respiratory System, Critical Care Nursing for the Liver & Kidneys, Thoracic Injury: Symptoms & Severity Score. If the pericarditis is chronic, colchicine (Colcrys) could be prescribed. for quality and safety during the production process. These are certain other significant causes of substernal pain, such as: Substernal pain has been reported as agonizing, crushing, and compressing in nature. Crockett et al. If you notice one or more of the signs below in yourself or someone else, call 911 or your local emergency number right away. . The young lady's name is Amanda, and she is alert and oriented but obviously shaken up from the accident. Pleura is the tissue sheet between the ribcage and lungs; inflammation in these sheets is known as pleurisy. Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease . Potential substernal chest pain causes include myocardial infarction (heart attack), pulmonary embolism, aortic stenosis, stable angina pectoris, acute coronary syndrome, atrial fibrillation, pneumonia, and severe anxiety and panic attacks, just to name a few. Acute Management of Esophageal Perforation. Viruses commonly cause acute bronchitis, while smoking may cause chronic bronchitis. It is concluded that in patients with single- and . Substernal chest pain can be symptomized by: Presence of a sour taste in the mouth or a sensation of regurgitation where that the swallowed food reenters the mouth Individual having problems with swallowing Presence of chest tenderness with deep palpation Individual having symptoms of heartburn with a burning sensation behind the breastbone. No statement herein is to be construed as a diagnosis, treatment, preventative, or cure for any disease, disorder or abnormal physical state. Typical treatment for pulmonary embolism includes anticoagulation medication like: Often referred to as AFib, atrial fibrillation is an irregular heart rate that can heighten your risk of stroke and heart disease. When the results were back, he told her she had a fractured sternum and sent her to have a CT scan. specifications following safe manufacturing practices. Additional tests for diagnosis include: Substernal chest pain treatment will first rely on correctly identifying the underlying cause. All our products are backed by a 100% satisfaction guarantee. Conditions such as acid reflux can lead to pain and are often confused with a heart problem. Their symptoms include cough, dizziness, sweating, sharp chest pain, and difficulty breathing. Moreover, pleurisy has been caused by bacterial infections like pneumonia or viral infections. Retrosternal means 'behind the sternum' and hematoma is a word used to describe a clotted pool of blood. The products released by Bel Marra Health. American Gastroenterological Association Institute Guideline onInitial Management of Acute Pancreatitis. Learn what retrosternal hematoma is, its causes, and treatment. Additionally, a code is needed to report the reason why the procedure was cancelled. Confirmed by: OGD showing inflamed mucosa. Learn what causes it, and what treatment options are available. If a bacterial infection is suspected, antibiotics will most likely be prescribed. In this article, the authors describe a simple, effective and minimally invasive technique for complex sternal closure using new titanium hooks applied parasternally and achieving adequate sternal stabilization. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. So, what's a sternum? The ingredients are tested by the manufacturer for. - Definition, Function & Location, Retrosternal Hematoma: Definition, Management & Treatment, Middle School Life Science: Tutoring Solution, NY Regents Exam - Earth Science: Test Prep & Practice, College Chemistry: Homework Help Resource, Study.com ACT® Test Prep: Help and Review, Study.com ACT® Test Prep: Tutoring Solution, Glencoe Chemistry - Matter And Change: Online Textbook Help, Retroperitoneal Injuries: Symptoms, Complications & Treatments, Sinus Infection (Sinusitis): Causes, Symptoms & Treatment, What Is a Cataract? Jun 09, 2022. substernal vs retrosternal chest pain . Symptoms could include new or unexplained chest pain coupled with shortness . As adjectives the difference between substernal and sternal is that substernal is (anatomy) situated under the sternum while sternal is of, relating to, or near the sternum. R07.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. Perform a 12-lead ECG for all patients with new or evolving chest pain as soon as possible, e.g., for timely identification of acute coronary syndrome. Tenderness when touching the area of the fracture. It is estimated that 44.9 percent of people visiting the emergency room for chest pain have acute coronary syndrome, a common cause of chest pain. In most cases, retrosternal chest pain falls into four primary areas: Retrosternal chest pain can be a symptom of many conditions affecting the upper stomach and esophagus. About 70% of patients who have sternal fractures are also diagnosed with retrosternal hematoma. uchicagomedicine.org/heart-and-vascular-articles/what-causes-chest-pain-and-when-to-consult-a-doctor, mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624, mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373, my.clevelandclinic.org/health/diseases/13792-mediastinal-tumor, ncbi.nlm.nih.gov/pubmedhealth/PMHT0021982/, mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894, my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism/treatment-options, heart.org/HEARTORG/Conditions/More/What-is-Pericarditis_UCM_444931_Article.jsp#.Wvr20tMvxTZ. (NSTEMI), or unstable angina. The word retrosternal means ''behind the sternum,'' and hematoma means ''a collection of blood outside of the blood vessels.'' Additionally, cognitive behavioral and psychological therapy may also be implemented. Non-cardiac chest pain (NCCP) is chest pain in patients who do not have heart disease. Medical treatments include the prescription of followings: Artery Relaxing Medications Cardiac Related Medications Medications to Dissolve Clots Blood Thinners Acid-suppressants Antidepressants On the other hand Substernal chest pain can be treated surgically by following methods: Balloons and stent placement Bypass surgery Dissection Lung reinflation. The normal thyroid gland resides in the neck, with both lobes wrapping gently around the trachea (breathing tube).When thyroids get enlarged (called a goiter), they can grow a number of different directions. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. If an individual experiences pain just below the sternal bone, then it is termed as Substernal Chest Pain. It has been a pretty slow day but dispatch just notified her that there has been a motor vehicle accident. Presence of chest tenderness with deep palpation. Follow-up imaging tests will be done to monitor the healing. Substernal chest pain might be abrupt or remain mild for several days before becoming severe. But they could also be a sign of something more serious, like pneumonia, bronchitis, or, Pain in the left side of your chest may be caused by an underlying heart, digestive, or lung condition, or it could be a symptom of an injury or panic, Does it hurt to breathe? On any matter relating to your health or well-being, please check with an appropriate health professional. Once life-threatening causes have been ruled out (either by patient history, examination, or rapid diagnostics), a more thorough history and examination should be performed to narrow the differential diagnosis and guide further diagnostic workup and therapy. Camargo CA, Rachelefsky G, Schatz M. Managing Asthma Exacerbations in the Emergency Department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations. A retrosternal hematoma occurs when the fractured sternum oozes blood that collects in the back of the sternum. This bone may also be referred to as the breastbone. 2014 AHA/ACC/HRS Guideline fortheManagement of Patients WithAtrial Fibrillation. 2013 ACCF/AHA Guideline for the Management of HeartFailure. Mazuski JE, Tessier JM, May AK, et al. Baumann MH, Strange C, Heffner JE, et al. It is often detected when a chest x-ray or CT scan is done for another reason. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo Cardiomyopathy. Chest pain can be divided into cardiac vs non-cardiac origin. However, the common feature across all cases is mild to severe chest pain. We avoid using tertiary references. Fig.1: Chest XRay of retrosternal goitre showing marked deviation of the trachea (windpipe) to left A retrosternal or substernal goitre occurs when the thyroid grows downwards from the neck into the chest. Retrosternal means behind the breastbone, or sternum. I feel like its a lifeline. Stark P. Imaging of pneumothorax. Commonly, it is because of acid reflux infection when stomach acid returns to your esophagus, which occurs especially at night. Chest pain can be associated with symptoms such as. Amsterdam EA, Wenger NK, Brindis RG, et al.. 2014 AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes. Cayley WE Jr. Sign up and get unlimited access. Moreover, CT (Computed tomography) scan gives detailed images of the heart, lungs, muscles, and bones and detects abnormalities. sternal wound infection, or nonunion should also be considered. If the retrosternal hematoma is large enough, it can compress the heart. Around 20% of western countries have been affected by acid reflux, which is most common in women. Salas M, Ward A, Caro J. Your email address will not be published. Enrolling in a course lets you earn progress by passing quizzes and exams. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2020 Report). Retrosternal chest pain is commonly described as stinging, agonizing, compressing, and/or crushing in nature. This space normally measures less than 2.5 cm in width. Substernal Chest Pain Symptoms. Please subscribe to our email newsletter: All brands, trademarks, service marks, logos, product labels and packing images displayed on this website, are registered to the respective owner. Heart attacks can cause substernal chest pain because the heart is deprived of oxygen, causing chest complications, as noted by Right Diagnosis. Sherwood MW, Kristin Newby L. HighSensitivity Troponin Assays: Evidence, Indications, and Reasonable Use. For this, cardiac pathology should be evaluated deeply to treat chest pain infection. Up to 20% of patients have breathing difficulties and pain coughing or sneezing. Localised pain which does not radiate. Linder H. (2018). Usually, they will grow within the neck as shown in the picture of the woman on our goiter page. However, it's best to treat this condition early; because as the disease progresses, the thyroid can put pressure on other body parts located in the neck and chest, such as the trachea, esophagus, lungs, or heart. copyright 2003-2023 Study.com. A myocardial infarction is a heart attack caused by damage to the heart muscle from a decrease or full stop of blood flow to part of the heart. A retrosternal goiter is always a consideration in people who have a mass sticking out of the neck. It is located in the middle of the chest and the ribs attach to it. Pulmonary embolism treatment options. With the help of a medical professional, you can find the reasons behind your particular case of substernal pain, helping you address potential harmful medical conditions as soon as possible. Only after we are satisfied with the products. If the cause is viral, your pleurisy will often clear up on its own. The pain may be caused by eating or drinking. When acid from your stomach moves up into your esophagus, it can cause a burning pain in your chest. Moreover, doctors can prescribe a combination of medicines like Pepcid, Prevacid, Nexium, Aciphex, or Protonix. Chronic lung diseases, including diseases of the pleura, the tissue that covers your lungs. Pneumonia. There is . Tsai TT, Nienaber CA, Eagle KA. Consider urgent specialty consult and critical care unit admission. Many treatment measures can be utilized for heart attacks, such as thrombolytic, blood thinners, aspirin, and nitroglycerine. To accurately assign an ICD-10-CM code for a Myocardial Infarction, coders will need to know both the wall and the artery involved in the Myocardial Infarction. This pain is most often experienced by people with ailments or injuries related to the heart, lungs, thyroid, or trachea. Symptoms of a fractured sternum include: Sudden onset of pain at the front of the chest after an impact or fall of some kind. There is a wide range of risk factors that can increase a patient's risk of experiencing chest pain. Learn how to tell the difference between a cyst and a tumor, as well as the cancer risk associated with each. He now advocates treating different medical conditions without the use of traditional drugs. It may feel like a heavy weight lying on the chest. Pleurisy treatment is based on the underlying cause of the inflammation. Chest pain comes in many varieties, ranging from a sharp stab to a dull ache. However, it does not substitutes a physician, hospital or medical care facility. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Moreover, acid reflux causes heartburn disease, bloating, burping, dry cough, nausea, or breathing issues. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. It is hard for you to swallow, as if you feel like it's all going to come right back up. Chest pain: Substernal, pressing, occasionally radiating to left arm. Fashner J, Gitu AC. Your mediastinum contains your heart, aorta, esophagus, thymus, thyroid, trachea, lymph nodes and nerves. Bruising may appear a few hours later. All These goiters can push and displace the breathing tube, swallowing tube and important blood vessels in the neck . If cancer is detected or the growth puts too much pressure on the trachea, lungs, or blood vessels, surgical removal is typically recommended. INTRODUCTION. Bel Marra products are produced Aortic Dissection Imaging. Are proton pump inhibitors the first choice for acute treatment of gastric ulcers? Moreover, sternum is the flat bone at the front of the chest that connects the ribs with the cartilage. 36 History and physical examination are only modestly useful for ruling in or out the condition; acute chest or . Oblique coronary CT angiogram shows occlusion of the distal right coronary artery with calcified and noncalcified plaque distal to occlusion. Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Patients presenting with substernal or left chest pain with radiation to the left arm had a less than 10% chance of having right coronary artery disease. This bone may also be referred to as the breastbone. Noncardiac Chest Pain. The symptoms of a heart attack may include chest pain, shortness of breathing, abnormal fatigue, nausea, or dizziness. The ingredients are tested by the manufacturer for. A bad . Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. During CPR, the sternum is compressed onto the heart to help it pump blood. Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review. laryngeal mask airway [LMA], i-Gel), orthopnoea and paroxysmal nocturnal dyspnoea (PND), Differential diagnosis for cyanosis (central), Differential diagnosis for right upper quadrant (ruq) abdominal pain, Differential diagnosis for large prostate, Differential diagnosis for urinary incontinence, Differential diagnosis for cough with pink frothy sputum. A fractured sternum is very painful because of the nature of the injury, and other internal injuries may also be associated with it. Its typically caused by acid reflux, infections, or allergies. These are certain other significant causes of substernal pain, such as: Pneumonia: It is a lung infection that inflames air sacs in the lungs. You have 30 days to try one bottle of the product. - Definition, Types & Symptoms, What Is Scabies? Since Amanda had undergone imaging tests, they had ruled out these other injuries. Type 1, Type 2, & Type 3, Ventriculostomy Procedure, Drainage, Catheter Placement, Nursing Care, Cleidocranial Dysostosis Meaning, Symptoms, Causes, Diagnosis, Treatment, Absolute immature granulocyte Test Normal, High & Low Ranges, Anterior talofibular ligament Function, Tear, Pain, Reapir Surgery, What is penoscrotal webbing (Turkey Neck) Surgery, Repair, Cost, Pupilloplasty Definition, Procedure, Recovery, Complications, Cost. Substernal goiter may involve one or both the lobes of the thyroid gland and may cause deviation and/or compression of the trachea, and less commonly esophagus or venous structures. Applicable to most patients with undifferentiated chest pain. A retrosternal goiter often causes no symptoms for years. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Once this has been achieved, proper treatment can ensue. Stress and rest image of the left ventricular myocardium using Tc-99m . Substernal hematoma is a medical synonym for retrosternal hematoma, but retrosternal hematoma is considered more correct. Ghadri J-R, Wittstein IS, Prasad A, et al. Everything You Need to Know About Acid Reflux and GERD. GTPAL System Format & Examples | What Does GTPAL Stand For? Once this has been achieved, proper treatment can ensue. A doctor prescribes medicines to stop clot formation in arteries. Risk factors for acute coronary syndrome can include a family history of cardiac disease, prior myocardial infarction, hypertension and/or hyperlipidemia, and diabetes. If lay down, bend over or go to any other position in which your stomach isn't straight the pain you feel increases. Free Special Report: The Secret Fixes for Your Sleep Problems, Get this report FREE when you opt in for our FREE Health eTalk daily The pre-hospital management of life-threatening chest injuries: A consensus statement from the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh. Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at . A 41-year-old woman presents with fever and retrosternal chest pain of 28 hours duration. The following are some causes of retrosternal chest pain. Classic angina presents with substernal chest pain that's described as "squeezing" or "pressure-like." It often radiates to the arms or jaw and is made worse by exertion or emotion and . It is a type of pain felt behind the sternum bone; a flat bone located in the middle of the chest. This is a complication experienced by about 70% of sternal fracture patients. esophageal spasms, to name a few. newsletter along with exclusive offers from, Bel Marra Health A full workup, including medical history and a physical exam, will be done to rule out potential cardiac causes. This is the American ICD-10-CM version of R07.2 - other international versions of ICD-10 R07.2 may differ. Doctor appointments are available near all your locations. caused by a yeast infection in the throat, hiatal hernias or It is an inflammation of the central airways of the lungs. It protects the heart and other organs and is compressed during CPR to help pump the heart due to its proximity to the organ. All While injury in this joint causes discomfort and pain in the upper sternum. It improves if the patient sits upright or leans forward. What Happens When the Wind is Knocked Out of You? A retrosternal hematoma occurs when clotted blood pools behind the sternum near the heart. Usually located substernal or in the left chest. The differential diagnosis is broad and includes cardiac (e.g., acute coronary syndrome, pericarditis), gastrointestinal (e.g., gastritis, peptic ulcer disease), pulmonary (e.g., pulmonary embolism, tension pneumothorax), musculoskeletal (e.g., costochondritis, rib contusion), and psychiatric (e.g., generalized anxiety disorder, panic disorder) etiologies. I would definitely recommend Study.com to my colleagues. This is one of those better safe than sorry situations. 4. If this were to occur, Amanda would become pale and have low blood pressure and heart rate. A thymoma is a growth on the thymus. Pain, numbness, pinching, prickling, or . Only a dr. can tell you which one What diagnosis does the nurse expect? Substernal and retrosternal mean the same thing,: its an adjective describing the anatomical area below, beneath or behind the breast bone. However, other less serious conditions can also cause chest pain. ​What causes chest pain and when to consult a doctor. The CT scan showed that she also had a retrosternal hematoma. Location, Pain, Abscess | Gluteal fold vs Gluteal cleft, Medial Longitudinal Fasciculus Functions, Location, Lesion, Damage, Saturday Night Palsy Meaning, Definition, Symptoms, Recovery, Treatment, What is Jefferson fracture? Antidepressants and mood relaxers can be prescribed to treat panic attacks and anxiety. On EKG there will be evidence of ST elevation or depression, Q waves, or inverted T waves. Importantly, the retrosternal chest pain from ACS typically lasts longer than 30 minutes, is exacerbated by activity, and is relieved by rest/nitroglycerin. You could be dealing with GERD. Buildup of infected pus in the back of the throat. liver disease. Healthline Media does not provide medical advice, diagnosis, or treatment. Oftentimes, there are no symptoms of retrosternal goiter and it is diagnosed when chest imaging is done for another reason. 3. Find out what causes this pain and how to, When you have chest pain, your first thought may be that it's a heart attack. Infrasternal is another term meaning . This report is about a large substernal goiter, which was resected via a transcervical and full sternotomy approach. Related: Chest pain update: Retrosternal chest pain, chest pain that comes and goes, anxiety chest pain. Conditions such as hemothorax (blood between the chest wall and the lung), pneumothorax (air between the chest wall and lung), pneumonia, and pleuritis are all possible causes of retrosternal chest pain. The pain can be felt behind the breast bone. There are various factors which lead to Substernal Chest Pain, some of which can be extremely serious to include Pulmonary Embolism, Aortic Stenosis, Stable Angina Pectoris, Acute Coronary Syndrome, Myocardial Infarction, Atrial Fibrillation and the like. Severe or prolonged substernal or precordial chest pain usually indicates myocardial ischemia. Heart attacks are often treated with angioplasty or a coronary artery bypass graft (CABG) and medications such as: Pericarditis is inflammation of the pericardium, or tissue that surrounds the heart. Interested in the newest medical research, distilled to just one minute? Cardiac enzymes such as troponin and CK-MB will typically increase within 3-12 hours after onset of chest pain if the pt is having . The retrosternal airspace is seen as a normal lucency between the posterior aspect of the sternum and anterior aspect of the ascending aorta on lateral chest radiographs. Chey WD, Leontiadis GI, Howden CW, Moss SF. Your email address will not be published. Substernal pain may also occur on the left side of the chest, and while typical pain is normally constant, a creeping discomfort can grow severe for a few minutes. During his active practice he served as the head of the Dept. The features that physicians rely on to diagnose it are the associated symptoms that accompany . March 3, 2022 by which of the vamps should you date Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Khalaf M, Chowdhary S, Elias PS, Castell D. Distal Esophageal Spasm: A Review. Create your account, 26 chapters | Gyawali CP, Fass R. Management of Gastroesophageal Reflux Disease. ). In addition, air sacs fill with pus, causing chest pain, fever, severe coughing, sweating, confusion, breathing issues, and nausea. Treatment often includes OTC medications such as Pepcid but your doctor might prescribe: Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as: Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to the heart.