Chest Pain when bending over: Causes and Treatments

Chest pain when bending over can be really annoying and frightful. Let us explore all the possible causes and treatments of it in this article.

Chest pain is one of the most important symptoms for which people seek the advice of a physician and sometimes the pain gets worse or initiates when the person bends.

There could be numerous reasons for chest pain, heart attack or angina is not always the reason for chest pain.

Causes of chest pain when bending over:

Some of the causes of chest pain include:

Angina:

This pain is associated with a feeling of pressure, fullness or tightness in the chest area. The pain associated also radiates towards the back, neck, jaw or shoulders. Angina pain usually starts with exercise, emotional stress, meals or smoking etc. and cause chest pain when bending over.

Pericarditis:

This is the inflammation of the tissue layers surrounding the heart. The pain experienced during Pericarditis is usually sharp. The pain often increases when you are breathing or lying flat, and the pain decreases while lying backwards.

Pleuritis:

Pleuritis is the inflammation of lungs and chest muscles. The pain usually worsens while breathing or coughing and is very sharp when bending over. This is also accompanied by chest pain when bending over.

Costochondritis:

This is the inflammation of the cartilages that join the upper ribs and the breastbone. The pain is specific to the region and worsens when the body is stretched towards front or back. Usually, the pains in most cases go in some days or weeks. It is the primary cause of chest pain when bending over.

Muscle pain:

Chest pain when bending over could also be associated with a muscle pull or a cramp as there are a lot of muscles that are joined with the chest wall or the back muscles which are attached to the chest muscles and are pulled when the person bends causing a chest pain when bending forward.

Pericarditis:

The pain in case of pericarditis worsens when the muscles of the outer covering (sac) rub against each other due to swelling. Pericarditis is divided into various categories depending on the fluid that accumulates around the heart:

Serous fluid: This is the deposition of pale yellow fluid around the heart

Purulent: This consists of white-yellow pus around the heart

Fibrinous: This includes of fibrin or leukocyte being deposited around the heart. Fibrin is one of the blood clotting agents while leukocyte is the constituent of WBCs

Caseous: This is the deposition of the material collected after cell death or necrosis.

Hemorrhagic: This is a blood-based fluid deposited on the heart

Symptoms of pericarditis:

• Sharp chest pain in the abdomen area, the chest pain when bending over may increase suddenly.
• Palpitations
• Shortness of breath
• Coughing
• Fever
• Pain in shoulders
• Swelling of legs or abdomen etc.

Causes of Pericarditis include:

In most of the cases, pericarditis occurs when there is an infection in the pericardium; this infection might lead to swelling. Mostly, the cause of the infection is a viral infection. Some of the viral infections that lead to pericardial pain include:

• Enteroviruses including common cold or meningitis
• HIV
• Herpes simplex
• Influenza
• Hepatitis C
• Cytomegalovirus
• Adenovirus causing pneumonia and bronchitis

Other causes of pericarditis include:

• Rheumatoid arthritis
• Kidney failure
• Radiotherapy
• Fungal infection
• Trauma
• Parasite
• Conditions such as AIDS, Cancer or tuberculosis etc.
• Medicines such as penicillin, warfarin also cause pericarditis

Treatment of Pericarditis:

Treatment of pericarditis using drugs includes:

OTC medicines – Medicines available without the prescription like aspirin and ibuprofen can help to soothe out the pain due to pericarditis to a large extent, providing relief from chest pain when bending over. If these medicines are not able to provide comfort, then the patient may shift to the drugs available on prescription after consulting a medical practitioner

Colchicine – Many people who are reluctant to recurrence due to pericardial pain are prescribed colchicine. It has anti-inflammatory property, but it should not be prescribed in case of people suffering from kidney or liver disease.

Corticosteroids- In case OTC medicines or colchicine are not useful for the treatment of pericardial pain, in those cases, corticosteroids are prescribed. The treatment of pericarditis is associated with the relapse of the pain and should be used as the last option. Side effects of this include weight gain, mood swings etc.

In case the medicinal treatment is not effective in curing pericardial pain, in that case, surgical treatment is done. Surgical treatment includes:

Pericardiocentesis:  This includes insertion of a small tube and draining the excess fluid out of the sac. The treatment might take several days for the removal of excess fluid.

Pericardiectomy: This is the last option used to treat pericarditis which involves the removal of the sac. This procedure is done when the sac has become hard and rigid. This is not the first line treatment due to a risk associated with the surgical procedure.

Pleuritis:

Pleuritis is the inflammation of the outer lining of the lungs or the chest. The inflammation occurs due to the deposition of the fluid between the outer layers of the lung. The inflammation of the tissue leads to chest pain when bending over.

Causes of Pleuritis include:

• Infections- Infection caused due to bacteria, fungi, virus or parasitic can lead inflammation of the outer layer of lungs
• Inhalation of toxic chemicals like ammonia also leads to pleuritis
• Vascular diseases associated with lupus or rheumatoid arthritis
• Cancer: This can be the cause of pleuritis, especially in case of lung or breast cancer when a tumour or the cancerous cells spread to the outer lining called as pleura.
• Pulmonary embolism- Sometimes there is a blood clot in the arteries supplying blood to the lungs. This can diminish the supply of oxygen to the lungs and leads to the cell or tissue death.
• Trauma – Fractures in the ribs or the irritation caused by the tubes that are used to drain out the fluid from the lungs can also lead to pleuritis
• Certain medicines can also lead to lupus formation or the pleuritis. These drugs include Hydralazine, Procan, and its combinations, Phenytoin etc.
• Abdominal processes such as pancreatitis, liver cirrhosis at after treatment also leads to pleuritic.

Many times the pain is associated with pain in the back and the pain aggravates while coughing or deep breathing. This also causes pain in the chest while bending over.

Treatment of Pleuritis include-

Providing support to the chest walls externally is essential. Pain medication like analgesics can help reduce the pain due to Pleuritis.

Sometimes Pleuritis is associated with heart, lungs and kidney Treatment of the actual cause linked with these organs can alleviate the symptoms of Pleuritis.

Drainage of the fluid from the pleural cavity also reduces the inflammation and removes symptoms like pain and shortness of breath. However, complete drainage of the fluid can worsen the situation. This can lead to rubbing of the lungs with the walls, causing increased difficulty while breathing.

Infection in the pleural cavity: Sometimes the cause is the infection in the pleural sac which can be treated using antibiotics or draining out the fluid using drainage pipe.

The drainage pipe involves drainage using a suction pipe to maintain a negative pressure in the lungs. In case there is excessive pus in the lungs, in that case, a process called ‘decortication’ is done which involves taking out of the pus under anaesthesia. This uses a pipe like an instrument to remove the pus and the debris from the lungs

Pleuritis can, however, be prevented by early detection of pneumonia or the disease associated with heart, lungs, and kidney.

Costochondritis:

The inflammation in the cartilages joining breastbone and upper ribs also cause chest pain when bending over. The condition is more often seen in females than males.

Causes of costochondritis include:

Injury –Injury to the chest caused because of an accident or a fall

Arthritis- In some patients, it is also associated with osteoarthritis, rheumatoid arthritis etc.

Strains – Stains due to excessive physical activity can also lead to costochondritis

Joint infections – viral infections also affect the rib joints and can be the cause of costochondritis leading to chest pain when bending over

Tumours – Cancer or a tumour can near the lungs or chest area can travel to the joints and affect them causing a lot of chest pain when bending over

Costochondritis is also a post-surgery symptom related to heart, kidney or lungs

Treatment options for Costochondritis –

Using a heat or ice pack can help elevate the pain and inflammation, providing relief from chest pain when bending over

Massage the chest area can also help reduce the pain due to costochondritis.

One should also try to identify the exercises or the sports activities that are aggravating the pain. One should modify these activities or altogether stop them for some time.

Medications like painkillers can help to reduce the pain associated with costochondritis. If the pain is persistent, Steroids are also an option in case the pain is severe and the above options are not providing relief.

NSAIDs are also effective for this treatment, but they should not be used in patients with a history of heart attack or heart-related problems

As in most of the pains associated with joints, rest can help the muscles relax and reduce the chest pain when bending over. One should lie down in a position that provides a comforting effect on the chest pain.

Apart from the above-listed causes, the chest pain when bending over could be a result of a muscle strain in the muscles supporting rib cage. A strained muscle may be tearing of a fibre. This can often occur during heavy weight lifting and becomes worse while breathing, bending or coughing.

Changing the lifestyle, taking rest, using painkillers and sprays can help reduce the chest pain when bending over gradually.

References:

1. https://www.medicalnewstoday.com/articles/193320.php
2. https://www.ncbi.nlm.nih.gov/books/NBK416/
3. http://chemocare.com/chemotherapy/side-effects/pericarditis.aspx
4. https://www.mayoclinic.org/diseases-conditions/pleurisy/symptoms-causes/syc-20351863
5. https://www.healthline.com/health/pleurisy
6. https://www.webmd.com/pain-management/costochondritis