F.A. KHABIROV^1,2, E.F. RAKHMATULLINA¹, O.S. KOCHERGINA¹

¹Kazan State Medical Academy – Branch Campus of RMACPE MH Russia, Kazan

²Republican Clinical Neurology Center of the MH of RT, Kazan

Khabirov F.A. ― MD, Professor, Head of the Department of Neurology, Chief Physician of Republican Clinical Neurology Center

Address: 13 Vatutin Str., 420021, Kazan, Russian Federation, tel.: (843) 278-23-17, e-mail: [email protected]

 The article summarizes the data of literature review and authors’ observations on the issue of diagnosing the reasons for pain in the heart zone and front chest wall, initially interpreted as the result of cardiovascular or psychovegetative disorders. The most frequent clinical miofascial and vertebral syndromes are described, which have mainly vertebrogenic etiology: pectalgia syndrome, major and minor pectoral muscles syndrome, anterior scalene muscle syndrome, facet syndrome, and some others. The anatomic-physiological features of the musculoskeletal structure in the neck and chest zone are presented, which promote myofascial or tunnel syndromes. The zones of myofascial trigger points are described, irritation of which causes the pain pattern characteristic for cardialgia and toracalgia. The key diagnostic criteria for identifying an extracardial source of pain are presented. The main therapeutic approaches to curing this pathology are briefly listed.

Key words: miofascial syndrome, cardialgia, toracalgia, vertebral pathology.

(For citation: Khabirov F.A., Rakhmatullina E.F., Kochergina O.S. Vertebroneurological causes of cardialgia. Practical medicine. 2020. Vol. 18, №1, P. 43-49)

REFERENCES

1. Alliluev I.G., Makolkin V.I., Abbakumov S.A. Boli v oblasti serdtsa [Pain in the heart]. Moscow: Meditsina, 1985.
2. Khabirov F.A. Rukovodstvo po klinicheskoy nevrologii pozvonochnika [Guidelines for clinical neurology of the spine]. Kazan: Meditsina, 2006. 520 p.
3. Toropina G.G. Kardialgii v strukture psikhovegetativnogo sindroma (kliniko-psikhofiziologicheskoe issledovanie): avtoref. … dis. kand. med. nauk [Cardialgia in the structure of the psycho-vegetative syndrome (clinical and psychophysiological study). Synopsis of dis. PhD med. sciences]. Moscow, 1992.
4. Anzai A.K., Merkin T.E. Adolescent chest pain. Am Fam Physician, 1996, Apr; 53(5):1682-90.
5. Baldi F., Ferrarini F. Non-cardiac chest pain: a real clinical problem. Eur J Gastroenterol Hepatol., 1995; 7 (12):1136-40.
6. Ho K. Noncardiac chest pain and abdominal pain. Ann Emerg Med,1996; 27(4):457-60.
7. Yaroshevskiy A.A., Morozova O.G. Musculoskeletal pain in the chest area as an interdisciplinary problem. Novosti meditsiny i farmatsii, 2012, no. 405, pp. 34-40 (in Russ.).
8. Karlson B.W., Herlitz J., Pettersson P., Ekvall H.E., Hjalmarson A. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med, 1991; 230 (3):251-8.
9. Beitman B.D., Mukerji V., Lamberti J.W., Schmid L., DeRosear L., Kushner M., Flaker G., Basha I. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol, 1989; 63 (18): 1399-403.
10. Katon W.J. Chest pain, cardiac disease, and panic disorder. J Clin Psychiatry, 1990, May; 51 Suppl: 27-30.
11. Popelyanskiy Ya.Yu. Ortopedicheskaya nevrologiya. Vertebronevrologiya. Ruk-vo dlya vrachey [Orthopedic neurology. Vertebroneurology]. Kazan, 1997. Vol. 1. 554 p.
12. Khabirov F.A., Khabirova Yu.F. Klinicheskaya vertebronevrologiya [Clinical Vertebroneurology]. Kazan: Meditsina, 2018. 596 p.
13. Khabirov F.A., Khabirova Yu.F. Bol’ v shee i spine: Rukovodstvo dlya vrachey [Pain in the neck and back: A guide for doctors]. Kazan: Meditsina, 2014. 504 p.
14. Veselovskiy V.P. Prakticheskaya vertebronevrologiya [Practical Vertebroneurology]. Riga, 1991. 221 p.
15. Zaslavskiy E.S. Bolevye myshechnye sindromy v oblasti plechevogo poyasa, ruki i grudnoy kletki [Painful muscle syndromes in the shoulder girdle, arm and chest]. Novokuznetsk, 1982. 71 p.
16. Shesternya P.A., Vasil’eva A.O., Shkil’ L.M. et al. Titz syndrome — an interdisciplinary clinical case. Sibirskoe meditsinskoe obozrenie, 2017, no. 2, p. 112 (in Russ.).
17. Podchufarova E.V. Musculoskeletal pain in the chest. Consilium medicum, 2006, vol. 8, no. 8 (in Russ.).
18. Brummett C.M., Cohen S.P. Facet joint pain in Benzon: Raj’s Practical Management of pain, 4th ed. Mosby, 2008.
19. Giles L.G.F. Innervation of spinal structures. Clinical anatomy and management of low back pain. Ed. Giles L.G.F. Oxford: Butterworth-Heinemann, 1997. Pp. 219-231.
20. Lange M. Die Wirbelgelenke. Stuttgart, 1936. 341 p.
21. Mooney V., Robertson J. The facet syndrome. Clin.Orthop. Relat. Res. 1976, vol. 115, pp.149-156.
22. Weishaupt D., Zanetti M., Hodler J. et al. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiol, 1988, vol. 209, pp. 661-666.
23. Gongal’skiy V.V. The mechanism of the acute phase of painful facet syndrome on the example of the thoracic spine. Ukrainskiy nevrologicheskiy zhurnal, 2014, no. 2, pp. 87-92 (in Russ.).
24. Gerwin R.D., Shannon S., Hong C.Z. et al. Interrater reliability in myofascial trigger point ekhamination. Pain, 69:65-73, 1997.
25. Simons D.G., Trevell Zh.G., Simons L.S. Miofastsial’nye boli i disfunktsii: rukovodstvo po triggernym tochkam [Myofascial pain and dysfunction: A guide to trigger points]. Moscow: Meditsina, 2005. 1192 p.
26. Travell J., Rinzler S.H. The myofascial genesis of pain. Postgrad Med 11, 1952. Pp. 425-434.
27. Travell J., Bigelow N.H. Role of somatic trigger areas in the patterns of hysteria. Psychosom Med, 9, 1947, pp. 353-363.
28. Travell J. Reffered pain from skeletal muscle: the pectoralis major syndrome of breast pain and soreness, and the sternomastoid syndrome of headache and dizziness. NY State J Med, 55, 1955, pp. 331-339.
29. Travell J. Office Hours: Day and Night. The World Publishing Company. New York, 1968. Pp. 261-264.
30. Mendlowitz M. Strain of the pectoralis minor, an important cause of precordial pain in soldiers. Am Heart J, 30, 1945, pp. 123-125.
31. Travell J. Pain mechanisms in connective tissue. In: Connective Tissues, Transactions of the Second Conference. Edited by Ragan C. Josiach Macy, Jr. Foundation, 1952. New York. Pp. 86-125.
32. Travell J., Rinzler S.H. The myofascial genesis of pain. Postgrad Med 11. Pp. 425-434. 1952.
33. Zohn D.A. Musculosceletal Pain: Diagnosis and Physical Treatment. Ed.2. Little, BrownCompany. Boston, 1988. P. 212.
34. Podchufarova E.V., Yakhno N.N. Boli v spine i konechnostyakh. V kn.: Bolezni nervnoy sistemy: ruk-vo dlya vrachey [Pain in the back and limbs. In: Diseases of the Nervous System: Manual for Doctors]. Moscow, 2005. Vol. 2. Pp. 306-331.
35. Barulin A.E., Kalinchenko B.M., Puchkov A.E. et al. Kinesiotherapy in the treatment of pain syndromes. Volgogradskiy nauchno-meditsinskiy zhurnal, 2015, no. 4, pp. 29-31 (in Russ.).