When chest pain is “just” costochondritis

26 Dec

Costochondritis-7by Carolyn Thomas

Many female heart patients become familiar with the word “costochondritis” only while being misdiagnosed with the condition during an actual cardiac event, as in:

  • “My MD said it was just costochondritis and a  pinched nerve, because my ribs were sore.” (LH, age 51, New York: heart attack)
  • “At first, we looked at musculoskeletal causes. It had to be costochondritis; my chest wall seemed tender to touch, so I even had steroid injections in my chest wall.” (ZM, age 59, Arizona: heart attack, 12 stents, triple bypass surgery)
  • “Pains in chest radiating down arm and up to my chin. My GP reluctantly sent me to a cardiologist who was dismissive, said that my age was a big factor and that it was 99% likely to be just costochondritis as I also have fibromyalgia” (BT, age 42, U.K: heart attack, 90% blocked LAD coronary artery, two stents)  

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can often reproduce by pushing on the cartilage in the front of your ribcage.

Costochondritis can be extremely painful yet, mercifully, it’s relatively benign. Much of the medical literature suggests that it will usually go away on its own within a few days, but some patients report symptoms that can linger for weeks or even months. It can also be a recurring condition that appears to have little or no warning of onset. Pneumonia can be misdiagnosed as costochondritis. Many patients living with fibromyalgia or chronic fatigue syndrome complain of chest wall pain and restriction of movement, often identified by their health care providers as costochondritis.

Chest pain in adults is considered by most doctors to be a potentially serious sign of a heart problem until proven otherwise. Reporting chest pain usually leads to a battery of medical tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor may diagnose costochondritis as the culprit. It may, however, be difficult to distinguish between the two without specific testing. 

Never assume chest pain is “just costochondritis”.

Here’s an example: Emergency physician Dr. Seth Trueger described this study as one that “might be the coolest chest pain study ever done.”

The study found that when rheumatologists using the American College of Rheumatology criteria for diagnosing costochondritis evaluated patients in the E.R. complaining of chest pain:

“Six per cent of the patients the doctors diagnosed with costochondritis actually had an acute myocardiardial infarction (heart attack).”

(What rheumatologists were doing in the E.R. was not explained . . . )

Most (real) cases of costochondritis seem to have no clear cause. Occasionally, however, the diagnosis might be correlated with:

  • Injury. A blow to the chest
  • Physical strain. Heavy lifting and/or strenuous exercise
  • Arthritis. In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection. The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours. Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.

Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.  Sometimes patients with a severe cough can develop this as a result of continued coughing and rapid expansion/contraction of the rib cage.

This condition affects females more than males (70% versus 30%).

Kelly Young is a patient advocate, blogger, and president of the Rheumatoid Patient Foundation. She described costochondritis like this in her blog RA Warrior:

“As early as 1964, the journal ‘Radiology’ published a study explaining that the effects of Rheumatoid Arthritis on the rib joints “have not been adequately described in the literature.”[1] Mayo Clinic’s description of costochondritis makes it clear the word describes a symptom, pain or inflammation of the rib joints that can be caused by various illnesses.[2,3]

“The term is also confusing because there can be varying diagnoses with similar symptoms.”

But Kelly says that she has also read some skeptical articles about costochondritis symptoms, considered by some physicians as the garbage can diagnosis of hypochondriacs.

Costochondritis is not associated with swelling, as opposed to Tietze’s syndrome, where swelling is characteristic.  Tietze’s syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling around the joint, the ribs or cartilage near the breastbone. Redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding, although even swelling can be variable from patient to patient. The pain  can cause difficulty with sleeping, and even rolling over in bed is sometimes painful.

Possible treatments include heat or ice, and medications to reduce the inflammation (ibuprofen or naproxen are commonly used for this).  And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities.

And as Kelly Young sums up about her own bouts with costochondritis:

“Like other joint inflammation, costochondritis is eased by rest, NSAIDs, ice or heat, and prednisone. Pain medications can help manage severe costochondritis. And if it is persistent, steroid injections can be used.

“Usually, as with other joints, the inflammation subsides to a more manageable level in a few days.

“I’m counting on that because the only other solution I can think of is to not breathe. It hurts too much!”

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1  Alpert M, Feldman F. The rib lesions of rheumatoid arthritis. Radiology. 1964 May 82: 872-875
2  Mayo Clinic. Costochondritis. 2012 May 6.
3  HealthHype.com. Severe costochondritis – causes, symptoms, treatment. 2010 May 9.
4  Flowers LK. Medscape. Costochondritis. 2012 Apr 13.

Q:  Have you ever experienced costochondritis?

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8 Responses to “When chest pain is “just” costochondritis”

  1. qualityhealthcareplease December 30, 2013 at 10:12 am #

    When I went to medical school 35 years ago, the teaching was to be very careful with the diagnosis of costochondritis. Because 50% of the time, chest pains are actually something else. This should be an expected piece of knowledge in any health care providers’ brain.

    On the other hand, I have seen many patients who have undergone extensive (and unnecessary) cardiac evaluations without the slightest consideration of something besides heart problems. Two cardiac caths before the diagnosis of costochondritis is inexcusable. This problem cuts both ways.

    Like

    • Carolyn Thomas December 30, 2013 at 12:35 pm #

      Good point, Dr. B: in either case, non-cardiac issues can cause chest pain – and cardiac issues can have no associated chest symptoms at all.

      Like

  2. Anne December 26, 2013 at 7:22 am #

    Good article. Heart patients need to check in with their cardiologist before using NSAIDs as they raise the risk of coronary damage.

    Like

    • Carolyn Thomas December 26, 2013 at 7:38 am #

      Thanks for this reminder, Anne. Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them.

      Like

      • Magda December 26, 2013 at 8:33 am #

        Good article. In addition to heart disease, I also have this from a car accident where I was injured by the seatbelt. I often have swelling and pain, but no doctor has diagnosed it. I had to learn to tell the difference since doctors often dismiss it and tell me to take an anti-inflammatory. I usually suffer through or use ice, since I don’t want to take risks with the NSAIDs.

        Like

        • Carolyn Thomas December 26, 2013 at 9:26 am #

          Thanks Magda – I hope your symptoms improve over time.

          Like

          • Dr. Barbara Keddy December 26, 2013 at 7:13 pm #

            I have both – heart disease and chronic costochondritis. I have lived with the latter for many decades because of fibromyalgia. Because this can mimic a heart attack it causes me great anxiety. My HA presented as the classic chest pain and it was a few minutes before I realized this was different than what I had been living with for many years.

            However, flare-ups are anxiety provoking! Almost a year now and the constant pain in my chest, neck, jaw stirs up the same questions: is it fibro? costochondritis? another HA? I’ve come to the conclusion I have to live with the uncertainty- the challenges of daily living! :-(

            Like

            • Carolyn Thomas December 26, 2013 at 7:42 pm #

              Hello Barbara and thanks so much for sharing your unique personal experience. When I was writing this post, I was so surprised to learn that 60% to 70% of those with fibromyalgia may also have symptoms of costochondritis, too. One report suggests that such people might find themselves “with an ice pack on your chest and a heating pad on your back at the same time.”

              Like

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