Pectoralgia - myofascial pain in left chest area

Pectoralgia pain in left chest area

A 67-year-old woman. Complaints of severe pain in left chest area, pectoralgia with irradiation into the arm (along the inner edge). This pain occurred 1.5-2 years ago. A few months before that, the patient had suffered intramural myocardial infarction. At the time of observation, ECG and other investigations were made - only residual changes were present. No cardiac pathology, which could explain the symptoms, was found. Atypical angina pectoris was diagnosed. Pain does not respond to nitroglycerin, but can be reduced by changing body position.

Objective examination. The greater pectoral muscle is examined first. Very severe painfulness on palpation, thickened bands and nodules, which when provoked cause classical referred pain (clavicle part into the shoulder, sternum part - deep around and into the arm, rib part down and to the center) were revealed, the same muscle strongly restricts movement in the shoulder. On the right side there is much less soreness, no reflected pain.

Diagnosis: pectoralgia, chest myofascial pain syndrome of the large pectoral muscle.

Treatment: progressive pressure technique + PINS (progressive inhibition of neuromusculoskeletal structures), myofascial release (direct method), postisometric relaxation.

As a result, complete disappearance of daily pain, decrease of frequency and intensity of exacerbations. The patient was given recommendations for self-treatment (PIR, self-massage).

Myofascial pain syndrome chest. Conclusions.

A very memorable case, which occurred at the beginning of my practice. At that time, I was actively and purposefully studying the most frequent immediate cause of pain and the underlying problem - Myofascial Pain Syndrome. If I were to examine this patient now, I'm sure I would find a bunch of other dysfunctions (ribs, cervical and thoracic spine, diaphragm, fascial restriction, and more). But even these local methods proved sufficient.
What this case is particularly memorable for was the large blue-brown bruises in the heart area, which the patient made to herself by massaging this area incorrectly. The question, "Why?" was answered, "It reduce and sometimes totally relieved my pain." Unfortunately, no one who examined the patient paid any attention to this.

P.S.

What I have noticed is that myofascial pain in the pectoralis muscle in left chest area is very common in people who have had a heart attack. It can be explained by tension and irritation of the muscle as a result of very severe pain, which can then simulate heart pain and develop into a full-fledged pectoralgia syndrome.