Sharp pain in the sternal wall chest while exercising can be unnerving. The location of the pain can be used to identify what organ system may be causing your pain. The heart lies directly behind the left side of the sternum. Most of the time, pain associated with the heart and exercise is called angina and is easily managed; however, it is important to make sure that this pain is not the sign of a heart attack, which can sometimes have similar symptoms to angina.
Angina
Angina is chest pain usually caused by exertion, heavy meals or emotional distress. Pain is gradual in onset and is usually described as heaviness, tightness or crushing. According to Dr. Heller, an Emergency Medicine physician in Seattle, pain occurs behind the breast bone or slightly to the left of it. This pain may radiate to the jaw, neck arms or shoulder. Most episodes usually resolve in 15 to 20 minutes and respond to rest and nitroglycerin.
Heart Attack
An acute heart attack can be severely painful or mildly discomforting, with pain usually exceeding more than 20 minutes in duration. Pain is retrosternal, but can also be epigastric. Pain can also radiate to the jaw, neck arms or shoulder. A tingling sensation may be experienced in the hand or fingers. When compared to angina, pain should be different in duration or severity or it may not respond to rest or nitroglycerin.
Evaluation
You physician may want to perform some laboratory tests and a complete physical examination, as well as evaluate your heart. Labs and studies usually consist of measuring concentrations of cardiac enzymes and obtaining a chest x-ray and an EKG. A chest x-ray allows your physician to take a general assessment of the outside of your heart, while an EKG allows for your physician to detect the electrical wave that passes through various parts of your heart and whether the wave signifies something of concern.
The doctor may perform an exercise stress if further diagnostic testing is needed. This test allows your physician to evaluate for evidence of ischemia while you are active. During the test, you walk or run on a treadmill while continuously being monitored via ECG. This study is done after acute chest pain has resolved and you are symptom-free.
Considerations
If you have sharp pain behind the left sternum during exercise, it is important that you have it evaluated by your physician. Your physician may prescribe you some medications that will help alleviate your symptoms; however, surgery or other invasive procedures may be needed if pain continues.
