Pain in the left breast in a child. The child has pain in the chest area. Causes and risk factors of the disease

week, May 28, 2017

Does your child complain that his chest hurts? What are the causes of chest pain in children aged 5 to 8 years, and how to help the child?

Fortunately, a heart attack is unlikely at this age! But there are a number of others possible reasons chest pain in children. Here are the most common ones:

Injury. Bones or muscles chest your child may be sick because he fell or was injured.

Stress or anxiety. If your child gets a dull chest pain when he is worried or upset (for example, before school or an upcoming dentist appointment), it may be directly related to stress.

Asthma. If asthma is the culprit, your child may also have a severe cough and difficulty breathing. Symptoms may worsen at night, in the early morning, and after running or crying.

Pneumonia. If the pain is associated with a persistent cough, your child may have pneumonia. Other symptoms of pneumonia include high fever, fast and difficult breathing, chills, decreased appetite, abdominal pain, vomiting, fussiness and headache.

Ingestion of a foreign body. Call " ambulance” if your child is having trouble breathing. If a child swallows a foreign object, such as a small part of a toy or a coin, he or she may feel chest pain from irritation in the esophagus as the object moves down. The child may also have a cough, wheezing, or drooling.

Gastroesophageal reflux disease (GERD). If your child complains of chest pain after eating, this may be the result of stomach acid flowing backwards into the esophagus. The child may also have a sore throat and a sour taste in the mouth or vomit.

Puberty. If your daughter is starting puberty, she may experience tenderness in her breasts as they begin to develop. Study shows girls show signs of puberty at older ages at a young age than ever before. If you notice a hard lump under your daughter's nipple - don't worry - it's completely normal sign breast development.

When should you see a doctor?

It depends on how sick your child seems. If your child is struggling to breathe, call 911. If your baby feels well except for chest pain, and the pain gradually goes away, you probably have nothing to worry about. If the pain continues for more than an hour (or keeps coming back), see your doctor.

Of course, you will also want to talk to your doctor if your child has other alarming symptoms- if you think he may have pneumonia, asthma or gastroesophageal reflux disease.

How do doctors diagnose and treat chest pain in children?

The doctor will first do a physical exam (pressing and feeling all around your baby's chest), then listen to breathing with a stethoscope. This way, the doctor can determine whether the pain is coming from the chest wall (ribs, muscles, or skin) or from organs inside the chest, such as the lungs or heart.

If the physical examination does not lead to a diagnosis, the doctor may take a chest x-ray to see if your child has swallowed a foreign body and will also check the x-ray for signs of pneumonia. In rare cases, the doctor may order an ECG to measure the electrical impulses in your baby's heart. Once your doctor diagnoses the cause of your chest pain, he may recommend that you suitable treatment. For example, if a child has pneumonia caused by bacteria, the doctor will prescribe an antibiotic.

What can you do at home to help your child?

If the pain only lasts a few minutes, your child may only need your reassurance. If the pain persists (for example, due to muscle soreness), you can give your child acetaminophen or ibuprofen to relieve the pain.

According to statistics, approximately every fifth person on the planet experiences pathological hair loss these days.
Photo courtesy of baldy200
Baldness is a process in which a person partially or completely loses the hair on his head. There are several types of baldness - androgenic, diffuse, focal and cicatricial. Review article in the magazine Medical Clinic Cleveland considers diffuse baldness. Here we present the main materials of this article, the full text (in English) can be found at link (1)

Normal hair growth cycle

Why does hair fall out?

• genetic predisposition;
• stress;
• surgical intervention;
• metabolic disorders;
• hormonal disorders;
• infectious diseases.

Physiological stress

In each specific case, the causes of baldness in men and women may be associated with additional unfavorable factors, including alcohol and drug abuse, smoking, temperature changes, and incorrectly selected hair care products.

If your hair falls out, what should you do?

• drug therapy;
• use of laser therapy;
• use of hormonal drugs;
• hair transplantation

What is "masked hypertension"?

Causes and risk factors of the disease

• men;
• patients with
  diabetes mellitus;
  kidney diseases;
  elevated blood pressure;
  high clinical blood pressure;
  high risk of cardiovascular diseases;
• people leading an unhealthy lifestyle (smoking, drinking alcohol, being overweight).

Diagnosis of masked hypertension

Why is masked hypertension dangerous?

Masked hypertension and risk of dementia

Sources
1. Masked hypertension, Definition, Meaning, Outcomes: A critical review. Papadopoulos, D. & Makris, T. Masked Hypertension Definition, Impact, Outcomes: A Critical Review. The Journal of Clinical Hypertension9 , (2007).
2. Disguised hypertension with knitted with on impairment of cognitive function tions. Masked Hypertension Linked to Cognitive Decline.

Eggs and the risk of diabetes

This prospective study included 2332 men aged 42 to 60 years. Their diet at baseline was assessed using a 4-day diet diary. The diagnosis of type 2 diabetes was assessed based on a questionnaire, followed by fasting blood and after 2 hours stress test after 4, 11 and 20 years from the start of the study, as well as by examining hospital discharge summaries and a diabetes reimbursement database.

Results comparing egg consumption and diabetes risk
Study participants were followed for an average of 19 years, during which time 432 men were diagnosed with diabetes. After adjusting for others possible factors risk was compared between individuals with the highest egg consumption and the lowest. This comparison showed that the risk of diabetes in the group with the highest egg consumption was on average 38% (range 18 to 53%) lower compared to the group with the lowest consumption. So much for cholesterol!

Analysis of other biochemical blood parameters in these two groups also showed more low level fasting glucose and C-reactive protein(CRP, C-reactive protein, used in medicine as a marker of the level of inflammation in the body) in the group with high egg consumption.
Photo courtesy of Samantha Evans

What is sciatica?

Causes of radiculitis

Other causes of back pain

Signs of radiculitis

Thoracic radiculitis

Cervical sciatica

Treatment of radiculitis

Chest pain is very common reason children visiting pediatricians, emergency departments, cardiologists and pulmonologists. The media quite rightly warn people that chest pain in adults is the first symptom of myocardial infarction and severe heart disease. However, this wariness extends to children, so chest pain is usually perceived by the child and his loved ones as something alarming and dangerous.

The child and his parents usually want to know whether these pains are related to the heart, whether they are dangerous and what consequences they may have. When dealing with chest pain, it is convenient to divide it into acute, severe, persistent pain and chronic, recurring, less severe pain. History taking and physical examination, as well as selection and information content additional methods studies in these situations will differ.

Acute chest pain

These children are usually anxious, seek emergency medical attention, and usually remain in pain during the examination. A history and physical examination are performed quickly to immediately determine whether the pain is related to the heart or not. When collecting anamnesis, you should pay attention, firstly, to the nature of the pain itself and accompanying complaints, and secondly, to concomitant diseases that may be the cause of chest pain. It is necessary to find out the time of onset of pain, its duration, nature, strength, localization and irradiation, as well as factors that intensify or alleviate pain. Pay attention to other complaints, such as fever, cough, vomiting, lightheadedness, fainting, palpitations, shortness of breath, sweating. Of the concomitant diseases, special mention should be made of congenital and acquired heart defects, diseases of the lungs and chest, and diseases of the abdominal organs. ECG, echocardiography and chest x-ray are most important for acute chest pain.

Cardiac causes of chest pain

Pericardial diseases

Inflammation and irritation of the pericardium (pericarditis) causes severe pain behind the breastbone, which the patient may describe as squeezing or pressing, so it is sometimes difficult to distinguish it from angina. The pain intensifies with movement, including breathing. The patient is trying to find comfortable position, usually leaning forward and refusing to lie on your back. Pain can be caused by pressing on the sternum. A pericardial friction rub is usually heard. With significant pericardial effusion, the friction noise may be absent, while heart sounds are muffled. It is very important not to miss the signs of tamponade.

Angina and myocardial infarction

This is the most terrible, but at the same time the rarest cause of chest pain in children. The pain is severe, located behind the sternum, patients describe it as burning, pressing or squeezing. It can radiate to the neck and left arm. It usually occurs during physical activity and goes away with rest. Physical examination may not reveal any abnormalities. During myocardial infarction, the ECG shows characteristic changes(elevation of the ST segment and changes in the T wave in the leads corresponding to the affected myocardium and reciprocal depression of the ST segment in the opposite leads). Find out if there is a history of hypertrophic cardiomyopathy or Kawasaki disease. In addition, especially if there is no indication of heart disease, you should find out if the child is using drugs, especially cocaine (crack). Cocaine causes spasm of the coronary arteries by increasing sympathetic tone, which can lead to myocardial ischemia and infarction. In this case, the pain is not associated with physical activity. EchoCG can detect abnormalities of the coronary arteries, their aneurysms (in Kawasaki disease), as well as hypertrophic cardiomyopathy.

Arrhythmias

Tachycardias, especially supraventricular ones, may be accompanied by acute chest pain. Typically, children, especially younger ones, simply complain of discomfort in the chest, but with a very high heart rate, coronary blood flow may be disrupted and ischemia may occur. The pain is usually not associated with physical activity and is often accompanied by lightheadedness, fainting and palpitations. Immediately after the arrhythmia stops, the pain goes away. During an attack, the diagnosis can be made using an ECG. Signs of ischemia on the ECG may remain for some time after the cessation of the arrhythmia.

Aortic dissection

The pain usually begins suddenly and is cutting or tearing in nature. The irradiation of pain depends on the part of the aorta: with dissection of the ascending aorta, the pain is localized in the anterior chest, with dissection of the aortic arch, the pain radiates upward (to the neck), and with dissection of the descending aorta - back (usually to the back). Dysmorphogenetic features of Marfan or Ehlers-Danlos syndrome are usually found. Delamination can begin for no apparent reason or after a seemingly trivial injury. Aortic dissection should be suspected in all patients with severe chest trauma or hemopericardium. Experienced specialist quickly make a diagnosis using transesophageal echocardiography. Emergency surgical treatment is indicated.

Non-cardiac causes of chest pain

Lung diseases

Spontaneous pneumothorax causes severe unilateral chest pain, which the patient often finds difficult to localize. Pain is usually followed by shortness of breath. The diagnosis is indicated by weakening of breathing on one side, as well as displacement of the trachea. Pay attention to bronchial asthma, cystic fibrosis, Marfan syndrome, as well as a history of trauma. Acute chest pain can be caused by pleurisy, which is characterized by pain on inspiration. Pleurisy most often occurs viral etiology, in particular with epidemic myalgia, which is characterized by fever and pleural friction noise. At high fever and intoxication, one should think of bacterial pneumonia. In children with sickle cell disease bacterial pneumonia very dangerous and requires emergency treatment. PE is very rare in children, but should be considered when coughing, shortness of breath, or hemoptysis is associated with acute pleuritic pain, especially if there is a history of leg injuries, or in girls taking oral contraceptives.

Diseases of the esophagus and stomach

With gastroesophageal reflux and reflux esophagitis, the pain is usually burning, mild and located behind the sternum, however, sometimes it can be compressive and resemble angina pectoris. The association of pain with eating and its intensification in the supine position indicates reflux esophagitis. Strong pain behind the sternum can occur with a foreign body in the esophagus. Esophageal spasm and rupture of the esophageal lining due to repeated vomiting can cause chest pain, but is rare in children.
When the diaphragm is irritated, the pain usually radiates to the shoulder and bottom part breasts; with fever and normal physical examination of the chest, lungs and heart, a subdiaphragmatic or hepatic abscess should be suspected. With splenic flexure syndrome, splenic infarction and splenomegaly during sequestration crisis, pain may be located in the left shoulder. Pancreatitis causes epigastric pain that can radiate to the back. In addition, pancreatitis may be accompanied by pleural effusion, making the correct diagnosis difficult.

Prolonged and recurring chest pain

These patients often come for a routine appointment with a doctor rather than coming to the emergency department. There is usually no chest pain during examination. Physical examination often shows no abnormalities; anamnesis plays the main role in diagnosis. As with acute chest pain, you should pay attention to the nature of the pain, other complaints and concomitant diseases. Since the pain may have been recurring for weeks, months, or even years before seeking medical attention, the history may be quite long. Pay attention to the events that preceded the onset of pain (family troubles, illness or death of loved ones), concern about pain in the family, the impact of pain on daily activities, including school performance and attendance, as well as the results of previous examinations and diagnoses. The child may understand that the adults around him do not believe in the presence or severity of pain or suspect self-interest behind his complaints.

When collecting anamnesis and examining the patient, you need to let him know that no one doubts the presence or severity of pain. Parents need to be explained that, although not always, the cause of the pain can usually be determined. They must understand that cardiac causes, as the most dangerous, will be excluded first. The differential diagnosis should then include less dangerous but more likely causes.

Chronic chest pain

It should be clearly explained that pain can occur in any part of the chest: chest wall and the structures adjacent to it, the lungs, the esophagus, the adjacent part of the stomach and the heart; however, the latter is the least likely cause of pain. We should not forget about psychogenic pain, however, they should be discussed last, after collecting anamnesis and physical examination.

Chest diseases

Pain in the muscles, bones and joints of the chest wall is the most common cause of chest pain among those cases where it can be found. The pain is usually localized, does not radiate, and can be reproduced. It usually intensifies with physical activity due to an increase in the frequency and depth of breathing, which may lead the patient to think about the cardiac origin of the pain. The entire chest should be inspected for bruising or skin rashes(for example, herpes zoster). In children of both sexes, the mammary glands are examined for the presence of nodules, mastitis, bruising or necrosis of fatty tissue. Myalgia often occurs due to injury and overwork, especially after sports competitions, intense training or a change in sport. Pain can sometimes be reproduced by palpation along the ribs and sternum.

There are several syndromes in which the ribs or sternum hurt; they are often confused and mixed up. Costochondritis is characterized by pain or tenderness of the anterior chest wall in the area of ​​the costosternal or costochondral joints. There is no swelling. The pain can range from mild to severe, is usually unilateral and is most often located in the area of ​​the 4th-6th costochondral joints. This syndrome occurs somewhat more often in girls and can occur after viral infections and intense physical activity. The diagnosis is made if the pain is reproduced on palpation.

Tietze syndrome is characterized by pain and thickening of the costochondral joints, while the skin is not changed; Most often, the cartilage of the second or third rib on one side is affected. The pain and thickening are usually intermittent but can persist for months or years, and boys and girls are affected equally often. A syndrome has been separately described in which a sharp cutting or shooting pain occurs at one point, usually in the area of ​​the apex of the heart, lasting from thirty seconds to several minutes. This pain can occur at rest or during light physical activity and can be repeated several times a day. The pain intensifies deep breath, so when it occurs, patients freeze and then begin to breathe shallowly. The etiology of this pain is unknown.

Slipped costal cartilage syndrome affects the anterior end of the 8th, 9th, or 10th rib. These ribs do not reach the sternum, and their ends are connected cartilage tissue. Damage to the latter can lead to the rib being displaced and superimposed on the one lying above. In this case, a sharp cutting, stabbing or dull pain occurs, which can last for several hours; soreness may remain for several days. The pain can be reproduced by placing your fingers under the edge of the costal arch and pulling it forward. With xyphoidalgia, pain is localized in the area of ​​the xiphoid process. It can occur both at rest and during physical activity. In children, pain at the site of attachment of the abdominal muscles to the xiphoid process may occur after prolonged running or gymnastics.

If chest wall pain can be reproduced, no further examination is necessary. Treatment begins with reassuring the child and his parents that the pain is not related to the heart and is not dangerous. Rest and mild painkillers (paracetamol or non-steroidal anti-inflammatory drugs) are usually sufficient. The patient should be warned that the pain may recur. For other diseases (mastitis, herpes zoster, etc.), appropriate treatment is carried out.

Lung diseases

Bronchial asthma due to physical exertion as a cause of chest pain in children is becoming more common. With bronchospasm, these children experience deep cutting retrosternal pain and tightness in the chest. It should be remembered that bronchospasm is most pronounced within 5-10 minutes after cessation of physical activity, and then gradually resolves over 20-30 minutes. Chest pain occurs at the height of physical activity or immediately after its cessation. Wiens et al. Using a specially designed stress test with a rapidly increasing incline on a treadmill, physical exertion bronchial asthma was identified in 72% of children referred to the cardiology clinic for long-term pain in the chest. Therefore, with chest pain associated with physical activity, you should always remember about bronchial asthma of physical effort.

In bronchial asthma, repeated chest pain can be associated not only with bronchospasm of physical effort, but also with muscle strain during constant cough. Bronchospasm of physical effort occurs in approximately 40% of children with bronchial asthma.

Chest pain due to pneumothorax was discussed above.

Children, especially those involved in sports, often have sharp pain in the right hypochondrium, which sometimes radiates to right shoulder or xiphoid process. The pain is cutting or cramping, occurs when walking or running and always goes away when you stop.

Gastrointestinal diseases

Reflux esophagitis is becoming more common in children, especially when chronic pain in the chest unknown etiology. The pain is located behind the sternum, in the heart area, or both. Increased pain after eating, with increased intra-abdominal pressure or in a lying position is a characteristic, but not obligatory symptom.

To confirm the diagnosis, esophageal manometry or esophagoscopy can be performed, but with a convincing history, a trial of H2-blocker treatment can be started immediately. To more rare reasons chest pains include foreign bodies esophagus, achalasia and diffuse esophagospasm.

Heart diseases

Actually, cardiac chest pain, that is, angina pectoris, occurs when there is a discrepancy between the myocardial need for oxygen and its delivery. This occurs when the coronary arteries are obstructed due to congenital anomalies or acquired diseases or with severe hypertrophy of the ventricular myocardium, when the increased myocardial oxygen demand is not satisfied despite normal coronary arteries. With angina pectoris, the pain is short-term, occurs during physical activity and goes away with rest. Patients usually describe it as pressing or squeezing, much less often as cutting or burning. The connection between chest pain and palpitations, lightheadedness or fainting is always alarming.

Congenital anomalies of the coronary arteries can cause myocardial ischemia in early childhood, but can only manifest themselves in adolescents. The most common of these anomalies is the origin of the left coronary artery from the pulmonary trunk. Complaints usually appear in infancy, but occasionally angina occurs only in adolescence. Sometimes there is an anomalous origin of the left coronary artery from the right coronary sinus of Valsalva or the right coronary artery from the left coronary sinus of Valsalva. In these children, the mouth of the coronary artery may be slit-like narrowed, or the artery may pass between the aorta and the pulmonary trunk; V the latter case expansion of the aorta and pulmonary trunk during physical activity leads to compression of the coronary artery. As a result, angina appears during physical activity. In coronary arteriovenous fistulas, ischemia can occur due to the steal phenomenon.

Kawasaki disease is the most common acquired coronary artery disease in children. Coronary artery aneurysms can lead to stenosis or thrombosis of the coronary arteries, resulting in ischemia. You should always check whether the child has Kawasaki disease; however, this disease is not always diagnosed.

Dyslipoproteinemia, including familial hypercholesterolemia, can lead to atherosclerosis of the coronary arteries in childhood. This diagnosis may be indicated by flat xanthomas on the skin, sometimes already at birth. Other metabolic disorders, such as mucopolysaccharidosis and homocystinuria, can also lead to stenosis and thrombosis of the coronary arteries.

With severe ventricular hypertrophy, an increase in myocardial oxygen demand, for example during physical activity, can lead to ischemia of its subendocardial layers and angina. Severe ventricular hypertrophy can develop in severe aortic stenosis or pulmonary valve stenosis, hypertrophic cardiomyopathy, severe arterial hypertension or pulmonary hypertension. Severe myocardial hypertrophy increases the risk of angina and sudden death.

It was thought that atypical chest pain may be due to mitral valve prolapse. However, in a study by Arfken et al. The prevalence of chest pain in children with and without mitral valve prolapse was similar. In addition, the prevalence of mitral valve prolapse among children with chest pain was no higher than among children in the general population. However, it turned out that children with mitral valve prolapse as a cause of chest pain are much more likely than others to have esophageal diseases.

Tachycardias, especially supraventricular ones, can cause angina. This should always be remembered when examining a child with chest pain, especially if the pain is accompanied by palpitations.

Psychogenic pain

For many children and adolescents, chest pain is psychogenic. The history often contains indications of mental trauma before the onset of pain, this could be death or coronary artery disease in relatives or friends, divorce, breakup of friendships, school failure, or serious disease. Other family members may have similar complaints. The pain is often very vague, and the child has difficulty localizing and describing it. The location and severity of pain may vary. Chest pain occurs with hyperventilation syndrome, depression and somatization disorder. There is often soreness at the apex of the heart.

Chest pain in children, like painful sensations in other parts of the body, can be triggered by a wide variety of factors. It’s one thing if a child’s chest hurts when he coughs, and quite another if his chest hurts after a fall or severe bruise. In order to correctly determine the treatment, exclude a fracture and prevent the development of the inflammatory process, urgently take the baby for examination to a medical facility or call a medical team at home.

Chest pain in children is observed much less frequently than headache or abdominal pain. It occurs with herpes zoster (shingles), rib fractures, pericarditis and other diseases.

Children complain of pain in the sternum, but describe their pain incompletely and inaccurately. Therefore, objective examination methods play a decisive role in diagnosis: examination, percussion, palpation, auscultation, x-ray examination, blood test.

Why does a child have pain in the chest area with shingles?

One of the reasons why a child has chest pain may be herpes zoster.

Herpes zoster ( herpes zoster; herpes zoster) is a chronic viral infection of humans that occurs with blistering rashes on the skin and mucous membranes. Infectious process controlled by components of the cellular immune system, a decrease in activity of which leads to dissemination of the pathogen with damage nervous system And internal organs. The causative agents are viruses of the herpesvirus family, which includes 8 types of viruses that are pathogenic for humans.

The concern is a sharp girdle pain, including in the chest area, accompanied by the appearance of vesicular rashes, usually one-sided, on the skin of the chest along the intercostal nerves. Most of the bubbles subsequently dry out with the formation of crusts, some open and erosions form in their place. Regional lymphadenopathy, nasopharyngitis, laryngitis, keratitis, conjunctivitis, iridocyclitis, chorioretinitis, uveitis, neuritis are observed optic nerve, encephalitis, meningoencephalitis, neuritis, hepatitis, pneumonia, esophagitis, enterocolitis, nephritis, urethritis.

For the treatment of herpes zoster in a child accompanied by chest pain, the following is prescribed: paracetamol - 10-15 mg/kg body weight 3 times a day, diclofenac - 2-3 mg/(kg day), B vitamins, acyclovir - 20 mg/(kg day) orally.

What else can be done if a child has chest pain due to herpes zoster, it is to treat it topically with solutions of aniline dyes (methylene blue, brilliant green), use ointments that have antiviral effect(tebrofen, oxolin, etc.), lotions with interferon.

A child complains of pain in the sternum: why does the chest hurt when a rib is fractured?

Often children complain of chest pain not because of a developing inflammatory process, but because of injuries. So, the cause of chest pain in a child may be a rib fracture.

A rib fracture usually occurs due to the direct action of mechanical force - a fall on a protruding object, a collision with a car, a train, or a car accident. Fractures can be open or closed, single or multiple.

With this pathology, the child complains of pain in the chest area: at rest the pain is dull, while inhaling it is sharp and cutting. The pain intensifies with deep breathing, cough. Movement of the chest on the affected side is limited. There is a connection with trauma; local pain in the rib area, limited swelling, sharp pain on palpation. The diagnosis is confirmed by X-ray examination.

In order to relieve chest pain in a child, analgesics are prescribed: paracetamol - 10-15 mg/kg 3 times a day, diclofenac - 2-3 mg/(kg day); elevated position; oxygen. A consultation with a surgeon is indicated.

For multiple rib fractures accompanied by shortness of breath, cyanosis, and signs of shock, hospitalization in the intensive care unit is indicated. If a child has pain in the chest area due to a fracture with compensated breathing, the victim is hospitalized in a trauma or thoracic department.

The child complains of pain in the chest area on the right and temperature: causes of pericarditis

The child may complain of chest pain on the right side due to pericarditis.

Pericarditis - acute or chronic inflammation pericardium. Distinguish acute pericarditis(less than 6 months) fibrinous and exudative (serous-fibrinous, hemorrhagic, purulent, putrefactive); chronic pericarditis (more than 6 months) exudative and constrictive, characterized by thickening and fusion of the pericardial layers, leading to compression of the heart chambers and limitation of their diastolic filling.

The clinical picture is determined by the underlying disease and the nature of the effusion, its quantity, rate of accumulation and age of the patient. The child's complaints: constant chest pain and fever, symptoms of circulatory failure (swelling, shortness of breath), attacks of severe weakness.

Pain in the heart is one of important symptoms inflammatory lesion of the pericardium. Children over 3 years old indicate the place where exactly they have pain in the sternum, and in infants this is evidenced by attacks of sudden anxiety, pallor, tachycardia and tachypnea. The pain in case of damage to the pericardium is dull, pressing, practically does not radiate to the left, more often it radiates to the right and to the abdominal cavity, which makes it considered abdominal. Malaise is noted.

Pericardial friction rub is often heard varying intensity and prevalence. The accumulation of exudate is accompanied by the disappearance of precordial pain and pericardial friction noise, the appearance of shortness of breath, cyanosis, swelling of the neck veins, weakening of the cardiac impulse, and expansion of cardiac dullness, however, with a moderate amount of effusion, heart failure is usually moderate. Due to a decrease in diastolic filling, the stroke volume of the heart decreases, heart sounds become muffled, the pulse is small and frequent, often paradoxical (a drop in filling and pulse tension during inspiration).

With constrictive (compressive) pericarditis as a result of deforming adhesions in the atria, atrial fibrillation or atrial flutter often occurs; a loud “pericardial tone” is heard at the beginning of diastole.

With the rapid accumulation of exudate, cardiac tamponade may develop with cyanosis, tachycardia, a drop in pulse, blood pressure, painful attacks of shortness of breath, sometimes with loss of consciousness, rapidly increasing venous stagnation. With constrictive pericarditis with progressive cicatricial compression of the heart, circulatory disturbances in the liver and system increase portal vein with high central venous pressure (CVP), portal hypertension, ascites (“Pick’s pseudocirrhosis”), peripheral edema appears.

X-ray examination reveals an increase in the diameter of the heart, and a trapezoidal configuration of the cardiac shadow with a weakening of the pulsation of the cardiac circuit; low wave voltage on the ECG.

If a child has chest pain due to pericarditis, treatment can be conservative and surgical. Etiotropic therapy: antibiotics for infectious pericarditis, hemodialysis for uremia, anti-inflammatory therapy for Dressler's syndrome and connective tissue diseases; discontinuation of medications that cause pericarditis. To evacuate fluid during acute exudative pericarditis complicated by tamponade, therapeutic pericardiocentesis is performed.

Indications for surgical treatment: chronic exudative pericarditis, relapses of tamponade in acute exudative pericarditis, purulent pericarditis.

If a child has chest pain due to pericarditis, NSAIDs are prescribed: indomethacin - 2-3 mg/(kg day), diclofenac - 2-3 mg/(kg day), ibuprofen - 10-15 mg/(kg day). It is possible to prescribe glucocorticoids, for example, prednisolone at a dose of 0.7-1.0 mg/(kg day) for 5-7 days, followed by a gradual decrease. The use of prednisolone ensures fairly rapid resorption of effusion. Treatment of the underlying disease.

When a child coughs, the chest hurts: chest pain with pleurisy

Another reason why a child has chest pain may be damage to the parietal pleura.

Pleurisy is inflammatory disease pleura with the formation of fibrinous plaque on its surface or effusion in its cavity. This secondary process is a syndrome or complication of many diseases, but at a certain period it can become more pronounced. clinical picture to the fore, masking the underlying disease.

Pleurisy infectious nature can be caused by specific pathogens (mycobacterium tuberculosis, treponema pallidum) and nonspecific (pneumococci, streptococci, staphylococci, coli, viruses, fungi, etc.) infections that penetrate the pleura by contact, lymphogenous, hematogenous.

A common cause of pleurisy is systemic diseases connective tissue (acute rheumatic fever, SLE, etc.), neoplasms (pleural mesothelioma, etc.), thromboembolism and thrombosis in the pulmonary system.

According to the nature of the damage to the pleura, the following are distinguished: dry (fibrinous) pleurisy, characterized by the deposition of fibrin on the surface of the pleura with a small amount of exudate; adhesive (adhesive, productive, fibrous) pleurisy, occurring with the formation of fibrous adhesions between the layers of the pleura; armored (pachypleuritis) - indurative pleurisy, characterized by the appearance of foci of ossification or calcification in the pleura; effusion (exudative) pleurisy, occurring with the accumulation of exudate in the pleural cavity.

krasota9999:
Majority colds accompanied by a cough. Cough is reflex reaction, aimed at eliminating any obstruction in the respiratory tract. It occurs when special receptors are irritated in the mucous membrane of the pharynx, larynx, trachea, bronchi and pleura (a thin membrane covering the lungs and chest on the inside).

The most common causes of cough:

* foreign body ingestion (most often food, small toys and their parts, dust)
* irritation of the mucous membrane respiratory tract in pairs chemical compounds or excessively dry air
* allergic diseases(primarily bronchial asthma)
* infectious and inflammatory diseases of the respiratory system (acute respiratory infections, pneumonia, measles, whooping cough and others)

When coughing, a sharp sensation is created in the chest and respiratory tract. high blood pressure air, the jet of which removes dust particles, small foreign bodies, bacteria and viruses along with sputum, etc.

Thus, a cough is not only a sign of trouble in the body, but also an ally in the fight against the causes of this trouble. The cough can be dry and wet (doctors say: unproductive and productive) depending on whether phlegm comes out when coughing.

A dry cough accompanies such forms of acute respiratory infections as laryngitis, or inflammation of the larynx, while the voice becomes hoarse, “sits down,” pharyngitis (inflammation of the pharynx) and tracheitis (inflammation of the trachea). A dry cough also occurs with inflammation of the bronchi, both infectious (ARVI) and allergic in nature (bronchial asthma, asthmatic bronchitis, obstructive bronchitis). At the same time, the transition of a dry cough to a wet one indicates improvement and speedy recovery. Causes of “allergic” cough: physical activity, dry air, allergens (plant pollen, animal dander, house dust). A dry cough is characteristic of whooping cough - a childhood infection, which in some cases is very severe, and the cough has the character of attacks that last up to half an hour and often end with vomiting. Whooping cough can be avoided by doing DTP vaccination or similar imported vaccines.

A wet cough accompanies respiratory tract infections. When you have a runny nose (including allergies), the mucus that forms in the nose along the walls of the pharynx flows into the larynx, causing a cough. Thus, the infection does not enter the underlying trachea and bronchi. With pneumonia and bronchitis, sputum is formed in the bronchi in response to inflammation. It removes dead mucous membrane cells and microbes.

It is important to remember that a normally healthy child has the right to cough several times a day. This clears the airways.

What should parents be wary of if their child coughs?
Combination of cough with the following symptoms suspicious for pneumonia:

* shortness of breath (increased breathing rate per minute) more than 60 in a child under two months of age, more than 50 - from 2 to 12 months and more than 40 - in children over 1 year
* the temperature does not drop below 38 degrees continuously for three days
* the child completely refuses to eat
* chest pain

A persistent cough that lasts for weeks or months requires special attention. This should definitely force parents to see a doctor for an examination, since in this way various chronic diseases: bronchial asthma (typical night cough, cough after exercise), chronic pneumonia, tuberculosis, etc. Naturally, in all these cases, cough is only a harmless symptom, and the disease itself that causes it must be treated.

A dry, obsessive, debilitating cough for a child that prevents him from falling asleep (pharyngitis, laryngitis, tracheitis) is treated with drugs that suppress the cough reflex. These medications should be prescribed by a doctor after making sure that the child does not have a serious pathology. They are taken for several days while the body fights the viral infection that causes these diseases. In these cases, various cough lozenges and lozenges sold in pharmacies may be useful, as well as steam inhalations(which must be carried out with great caution, since in some children steam can cause increased swelling of the mucous membranes).

Cough with bronchitis and moist cough requires the use of expectorants, which thin out thick mucus and enhance its removal from the bronchi. Some of them are sold in pharmacies without a doctor's prescription (cough mixture, marshmallow root, licorice root, Doctor Mom, etc.). They are made on the basis medicinal plants and for the most part are absolutely harmless for children, provided that the age-specific dosages that are given in the instructions for the drugs are observed.

However, it is important for parents to remember that the cough itself needs to be treated in rare cases; first, the doctor must determine its cause. Therefore, treatment should ultimately be determined by a doctor.

Olgatz:
The child is coughing(

Coughing is a spasmodic movement of the respiratory tract aimed at removing an irritating element. According to medicine, many processes in this part of the body can cause coughing. Judge for yourself, respiratory system The human organ is huge and includes a variety of structures: mouth, nose, throat, larynx, trachea, bronchi, their branches and lungs. Why does my child cough? Experts in family medicine talk about this in detail in this article.

The most common cause of cough is upper respiratory tract infection. Let's start from the beginning: air enters the lungs through the nose and mouth. Diseases such as rhinitis, sore throat, sinusitis and even adenoids can cause a child to cough. It will not be the main symptom. But in a lying position, when discharge from the nose and throat flows into the larynx and trachea, the baby reflexively develops a cough. In this case, the cough often bothers you at night or early in the morning, when mucous discharge from the upper inflamed sections accumulates in the nasopharynx.

Much more severe cough occurs in children with laryngitis - inflammation of the larynx. Laryngitis occurs with particular severity in children under 7 years of age. It is caused by various viral infections of the upper respiratory tract. Pathological process It begins with a common runny nose, fever, and mild cough. But literally within a few hours the child develops a rough barking cough with a whistling sound when inhaling.

Often the baby has a feeling of lack of air, which causes nervousness and motor agitation. In other children, such a cough may appear against a background of complete calm. In some cases, hypoxia (lack of oxygen) may actually develop, which manifests itself as bluish lips. cough, causes and symptomsCough with laryngitis becomes more strong at night, and in the morning the sick child’s condition improves.

At the first signs of the disease, you need to take measures to alleviate the patient’s condition: steam inhalation, frequent stays with the child in the bathroom, in which you need to open the tap with hot water. In the case of such laryngitis, the more humidity in the environment where the child is. all the better. Use air humidifiers, hang a damp towel over the radiator, etc.

Only in particular severe cases You will need medications different from those usually used for catarrh: sometimes drugs that relieve laryngeal spasm and corticosteroids are prescribed by injection (intravenously or intramuscularly).

With infections of the lower respiratory tract - bronchi and lungs, the cough will be different. With bronchitis, the walls of the bronchi become inflamed. They swell and thicken, which makes it difficult for air to pass through them, so the baby's breathing rate increases. Shortness of breath may occur. Dear readers, if you are not reading this article on the website of the Embassy of Medicine, then it was borrowed there illegally.

When you inhale and exhale, the mucous discharge of the bronchi (sputum) “sounds”: gurgling and wheezing occurs, which can be heard at a distance even without a phonendoscope. An adult removes phlegm, which he coughs up, expectorates and spits it out. The child does not know how to do this, so he swallows the sputum. This often causes vomiting in young children, triggered by a coughing fit.cough, causes and symptoms

Bronchitis requires vigorous medical intervention family medicine and prescription of antibiotics. In addition, the child’s condition is alleviated by medications that make the sputum more liquid - mucolytics. The best and natural mucolytic is water. A baby with bronchitis needs plenty of fluids (water, hot milk and soda) and moist air in the room.

In young children, a cough often appears during feeding. In this case, family medicine specialists advise feeding them less. This is perfectly acceptable for a few days. It’s worse if a child chokes: pneumonia may develop.

Pneumonia in children is characterized by the appearance of high temperature and its fluctuations during the day - from low to 40-41. cough, causes and signs. The cough with pneumonia is very strong - dry or with a small amount of sputum. Older children may complain of chest pain when breathing and coughing. In some cases, the development of pneumonia is combined with the appearance of herpes (“fever”) on the lips.

To establish final diagnosis For pneumonia, a chest x-ray is necessary.

Pneumonia small child- This is a very dangerous and formidable disease. Be sure to contact your family medicine doctor and pediatrician for advice at the slightest suspicion of pneumonia.

Olgatz:
Why are they coughing?

Most often, bronchitis in children is a complication of acute respiratory viral infection. At first glance, ARVIs themselves are not dangerous. The child, of course, will have a fever, cough, and sneeze, but in five days he will be healthy. However, the virus is very insidious: when it enters the human body, it leaves “marks” that, like a magnet, attract harmful bacteria. The child's immune system, weakened by the disease, cannot resist this onslaught. As a result, complications begin. The mucous membrane of the bronchi is covered with microvilli, which are involved in cleansing important body from germs, sputum, dust, allergens. And special glands produce mucus, which covers this membrane with a thin layer. Mucus contains antibodies that protect the bronchi from invading bacteria and viruses. But if the immune system fails to cope with its task, develops inflammatory process. Phases of the disease: 1. When harmful bacteria enter the bronchial mucosa, it swells, swells, and thickens. The child coughs and complains of difficulty breathing and shortness of breath. 2. The patient develops sputum. This is mucus containing immune cells and dead germs that turns into pus. Sputum is released during coughing. It is necessary to explain to the child that it should not be swallowed. Pus entering the intestines poisons the entire microflora. And 80% of our immunity depends on the condition gastrointestinal tract. Therefore, by swallowing mucus, the patient further reduces protective forces of your body. By the way, the sputum must be taken to the laboratory and cultured. Experts will determine which microbes need to be combated. Be sure to tell your child that you cannot cough too much or frequently, otherwise a bronchial trap will occur. When a person coughs heavily, the flow of air irritates the already inflamed lining of the bronchi, the swelling intensifies, and some of the air along with phlegm is retained in the lower sections bronchi and alveoli - blockage of the lumens of the bronchioles occurs, which leads to shortness of breath and even suffocation. You need to cough rarely and effectively, that is, only if a sufficient amount of sputum has accumulated. The doctor should prescribe medications to the child that thin the mucus and promote its better separation, or dissolve it altogether. There are other drugs, they are mucous glands - mucus enters the lumen of the bronchi and begins to liquefy phlegm. If the cough is dry and tearing, you need medications that block the cough reflex. But they must be taken very carefully, as they contain strong substances that affect the brain. Recovery stage. At this stage, despite the improved state of health, the child cannot yet be sent to school, since residual effects remain - cough, runny nose, weakness. The bronchial mucosa has not yet had time to restore its epithelial cover, damaged by bacteria and viruses, and is very vulnerable to new infection. If you don’t take care now, the disease may become chronic. Chronic bronchitis is when a person gets sick three times a year for three years. But this is not the last stage of the disease. The next stage will be the transition to asthma. I tell all my patients chronic bronchitis I say: you are potential asthmatics, you are one step away from asthma. Treatment Most often, bronchitis has to be treated with antibiotics, but you cannot buy them at your own discretion or on the advice of a pharmacy consultant. It is necessary to contact a pulmonologist. He will select medications that are suitable for your child. Perhaps the matter will be limited only to herbal medicines. Be carefull! Today it is “fashionable” to make a diagnosis - allergic bronchitis. In fact, there is no such disease. A simple example. Imagine that you have a wound on your hand. She hurts. Now imagine that you hit this sore hand on the table or poured salt on the wound. Hurt! But this does not mean that you are allergic to the table or to salt. The same goes for allergens. When there is an infection in the bronchi, it causes an inflammatory process, and the allergen, getting on the irritated tissue, causes an exacerbation of this process. With such an “allergy” you should definitely contact a pulmonologist. Another problem of our people is the passion for self-medication. The English say: “He who heals himself heals a fool.” Today, parents perceive a schoolchild’s runny nose and cough as normal and are in no hurry to turn to specialists. Medicines without a prescription can be bought at any pharmacy, and busy adults cannot always find time to go to the doctor with their children. In addition, many mothers at work are not given sick leave to care for their children. Therefore, as soon as the child’s fever subsides, the parents give him some pill at their discretion and send him to school. Pediatricians also often discharge children with “residual effects” - cough, runny nose, weakness. It is not surprising that illnesses among schoolchildren become chronic. The child spends energy on walking, studying and communicating, and the body does not have the strength to fight the infection. In addition, at the stage of “residual effects” the patient becomes dangerous for other children. In the first days of illness, the virus sits deep in the tissues. The child coughs, but germs do not come to the surface. And when a small patient begins to recover and cough up sputum, there is a danger of infecting other people. Therefore, if a child continues to have a cough, it is too early to send him to childcare facility. Tips for parents 1. Adults often consider a child's cough nervous tic. Indeed, it happens that coughing hides disorders of the nervous system. But such cases are extremely rare. How to distinguish a tic from bronchitis? If a child gets his feet wet and the tic gets worse, it means it’s not a tic! 2. Don't be afraid to do it x-rays. The doctor needs them to diagnose correct diagnosis. He can't always hear what he sees in the picture. 3. If your child suffers from a rare dry cough, be careful. The student must be examined. The causative agent can be not only staphylococci and streptococci, but also chlamydia and mycoplasma. These infections are not only sexually transmitted, but also pulmonary. Also, the cause of the disease can be pneumocystis - these are the eggs that are laid by lice beetles that live in pillows and blankets. They settle on the mucous membrane of the bronchi, trachea and lungs and irritate them. And you definitely need to be tested for tuberculosis. Today, cases of tuberculosis are very common. 4. Everyone healthy man should do fluorography once a year. A child who has had problems with the bronchi needs to be seen by a pulmonologist once every six months.