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What is heartache — BIOLOGICALLY?

Everyone has had “heartache.” When you feel really sad — from a relationship or the death of someone. Last night — I had this kind of pain. It’s right below my “breastbone” (xiphoid process) right in the center of the midline. The anatomical term is “epigastric” pain. I’m a doctor and know that most other docs would say it’s digestive problems or an ulcer. The heart is actually to the left and up higher from this point that always seems to hurt when I have “heartache.” I’ve done some research on hinduism and they actually place a “chakra” here where there is an “outpouring” of spiritual energy. In truth, I believe this is what doctors call “psychosomatic” pain in which the brain causes physical pain in the body that does not actually correspond to pain fibers firing in an organ or muscle. Any thoughts from some experts?


  1. Could be neurologically-mediated constriction of blood vessels supplying the heart. People with panic attack can have intense chest pain and get scared they’re going to die until they learn to recognize the attack and know they’ll be OK. So there are certainly precedents for a connection between mind and chest pain.

  2. Psychogenic pain is a potential possibility here. While you could get checked for epigastric pain (ideally with an upper GI; not the most tasty of tests, but fairly conclusive), odds favor PP if it is not constant or associated with a specific type of food/beverage consumption (ie, a jalapeno eating contest or large amounts of strong coffee on an empty stomach). Technically, the heart does not in and of itself register much pain (save during muscle death – myocardial infarct – a heart attack); the pericardium is more sensitive to this (as in pericarditis). If it turns out to be PP, the vagus nerve is probably the one to blame.


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