When chest pain is “just” costochondritis

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 often 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.

In New Zealand, physiotherapists like Steve August (see his detailed comments below) not only suffered himself for seven years with costochondritis after a serious climbing fall, but has been successfully treating the backs of his costochondritis patients manually for the past 30 years with non-drug, non-invasive physiotherapy, as he discusses in his video. Yes, you read that right: it is the back that is treated.

He sees costochondritis as often a straightforward musculoskeletal mechanical problem in which the costovertebral rib joints at the back are somehow jammed. This requires the anterior rib joints around the front to work excessively to compensate, leading to irritation, then to the inflammation that doctors call costochondritis.

Watch Steve’s second video in which he describes:

  • exercises and treatments recommended by New Zealand physiotherapists to unlock the rib hinges in the back to ease the symptoms of costochondritis
  • massage therapy for affected shoulder muscles
  • how to stretch tight, scarred muscles in between the ribs
  • gentle stretching exercises you can do at home to help open up the ribcage
  • use of anti-inflammatory gel to apply on the rib hinges at the front of your chest

If you are a physiotherapist or massage therapist, please watch this video and read this 2017 research paper from Zaruba and Wilson.

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.

Besides physiotherapy as New Zealand physiotherapists treat this condition, possible treatments include heat or ice, and medications like NSAIDs to relieve pain and reduce inflammation*

And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities. 

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*  CAUTION:  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. If you’re in this group, do NOT take NSAIDS before talking with your physician.

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NOTE FROM CAROLYN:   I wrote much more about diagnosis and misdiagnosis in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).

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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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199 thoughts on “When chest pain is “just” costochondritis

  1. There are a lot of questions when it comes to costochondritis. As a physical therapist I have dedicated the last 8 years to studying this elusive disorder. Recently I published a book on costochondritis that answers the three questions that most costochondritis patients ask:
    “What is it?’ “What causes it?” and “What gets rid of it?”
    In the book I introduce a NEW treatment technique for costochondritis that has proved to be very effective: The Breathing Assisted Recoil Technique.

    The title of the book is : ‘Costochondritis – A Forgotten Condition’

    If you have any questions you can contact me via the website: http://www.ribpainrelief.com

    Like

    1. Peter, most of the links on your website don’t work. This is neither helpful nor professional. And you don’t explain what your “Breathing Assisted Recoil Technique” is, or offer any published evidence that it works outside of your own clinic. Please let us know sources or publications.

      Like

  2. I was diagnosed with costochondritis in 2013 after a work I hurt to the chest area… it’s bothered me on/off since then … last week Tuesday at a different job I wound up twisting turning and having to lift a 100 lb propane tank because a grown man wouldn’t help get his stuff out of the cart under it …went to immediate care after suffering since then (a week later) and diagnosed again . I had pain last week like a stabbing pain for about 20 minutes then it subsided not completely and it comes and goes as a fuller ache now … when I move or push on the area it’s painful the Dr pushed and it was awful… so to say it can’t hurt into the shoulder and jaw is not correct talk to ppl that have it chronically 😞

    Like

  3. So glad I found this blog. Recently had a routine physical and annual mammogram. During my physical I complained to my pcp AGAIN about my weird chest, shoulder and back pain that comes and goes for no reason. She assured me EKG, EEG, and blood work looked good, and my lungs sounded fine after a recent bout with bronchitis where I nearly coughed my head off. I’m a bit top heavy so my mammograms are usually pretty tough to endure. Two days later I’m still lazing around with this pain that I’m now sure is costo.

    My pcp has referred me to a physical therapist suggesting that this is just old age, I’m 67 yo female, aches and pains.
    I’m back on my buspirone due to the anxiety this has caused but I hate not being able to function.

    Liked by 2 people

    1. Hi Denise – the clue in your story that just might point toward costochondritis is of course your description of coughing your head off with bronchitis. That severe cough can often be a common trigger for costo.

      I’m not a physician so cannot diagnose you, but please print and bring this 2017 research paper from Zaruba and Wilson with you to show to your physiotherapist (and to your PCP).

      And if you haven’t done so already, go back and click the links to the two videos that New Zealand’s Steve August sent to me in this blog article. Best of luck to you…

      Like

      1. Many, many thanks for your response and again for all the info found herein. I have already watched the Steve August videos and after checking reviews and several testimonial videos re the ‘backpod’ I have ordered it. I will most assuredly be armed with the Zaruba and Wilson paper upon my visit to the physiotherapist, and follow-up visit with my PCP.

        I will keep you posted, and here’s to hope for a healthy and pain free 2019 for us all!!

        Liked by 1 person

        1. Thank you, Denise. I hope you will keep me posted – I’m very curious about why more non-New Zealanders seem to suffer for years with awful costo symptoms with nothing but drug prescriptions, while people who live in New Zealand are being treated with a non-drug, hands-on back treatment to “unlock the rib hinges in the back” as Steve suggests.

          Like

          1. Hi Carolyn. Happy New Year!

            Good question. I had no idea until I was deluged by queries after I put up the original YouTube video on how we’d view and treat costochondritis that most of the rest of the world didn’t also see it as a straightforward, readily fixable problem driven simply by rib cage tightness.

            I did luck in, because I had costo myself for seven years after a climbing fall. I fixed it after coming through physio school in New Zealand, so thereafter had a personal feel for the problem.

            I think the answer is probably egalitarianism. There is a core of good manual hands-on physio expertise in NZ and Australia, but also we talk to each other so ideas get around. I’m asked to lecture in this area at various NZ medical conferences, so there’s a two-way exchange of information between the docs’ and physio expertise. Everyone benefits.

            I don’t think this happens so much elsewhere, especially not in the UK and US. I’m a physio. One of my fishing mates is the Prof of Rheumatology in my city. I’m reliably informed by a GP (family doctor) friend from Oxford that this would not happen in England.

            So you get the docs elsewhere trying to solve costo using only the concepts and techniques in their doc toolbox, and failing, when all they have to do is look over the fence into the physio area for a much better fit.

            So I guess the non-wordy answer is – we are good, but we also talk to each other. How’s that for an aim for 2019?

            Best wishes, Steve August.

            Liked by 1 person

            1. Hello Steve and Happy New Year to you too.

              I’m neither a physician nor a physiotherapist – and I do not suffer with costochondrititis – but it seems clear to me that you are making a lot of sense when you write this:

              “…you get the docs elsewhere trying to solve costo using only the concepts and techniques in their doc toolbox, and failing, when all they have to do is look over the fence into the physio area for a much better fit.”

              It’s heartbreaking for me personally to read dozens and dozens of reader comments in response to this blog post over the years – about suffering that apparently continues because of what North American medicine continues to cling to in their “doc toolbox”.

              Here’s hoping that other healthcare professionals elsewhere will become open to “looking over the fence” in the pursuit of reducing suffering.

              Like

              1. I live in Eastern Canada and my sister who lives close has frequent bouts of costo! I know she only gets NSAIDS and rest from her Dr. here. I have frustration about why so many “fixes” are known in this world and so few Dr.s use them!!!

                Liked by 1 person

                1. It IS frustrating, Carol. It seems to be quite common for patients with costochondritis to suffer for a long time with very limited relief. I think, as New Zealand physiotherapist Steve August says (above) “…you get the docs trying to solve costo using only the concepts and techniques in their doc toolbox, and failing, when all they have to do is look over the fence into the physiotherapy area for a much better fit.”

                  Ask your sister to contact some local physiotherapists to ask if any are treating costo like New Zealand physios are doing (have her print and bring this 2017 research paper from Zaruba and Wilson to show them).

                  Like

          2. For several years, in the middle of the night, I’ll roll from my right side to my left and get a stabbing unbearable pain right where my heart is. Last night it lasted longer than usual. I am able to breathe through the “event” but not last night; I yelled!

            I have told my doctors about this and no one seems concerned. I am very fit, slim healthy diet and low blood pressure. It is scary.
            Thank you.

            Like

            1. Gay, this is not normal. We should be able to roll over in bed without yelling in “unbearable” pain. Something is causing this unusual symptom. Make an appointment to see a physiotherapist and go from there.

              Like

        2. Hi Denise. Pleased you thought I made sense. Well done on thinking for yourself. The odds are very good that (1) your costochondritis pain is just coming from rib joints on your breastbone overworking because the rib hinges round the back have become tight, and (2) your doc will not get this.

          There is a home test you can do for this rib tightness – it’s on the Costo page of the Backpod’s website http://www.backpod.co.nz

          Cheeringly, it’s usually not particularly difficult to sort out. Better check with your doc re osteoporosis first, but the Backpod’s only a graded stretch of the joints anyway; no jolting.

          I have noticed from my first year as a physio the tendency for patients to be pigeon-holed as old. Straightforward musculoskeletal problems that would be readily sorted out in a younger person often don’t get treated because the patient with them has been dumped in the too-old-that’s-all-you-can-expect box. Usually it’s simply not accurate. Get irritated.

          Try a sports massage or two as well, for the muscle between and overlying the tight rib cage, including the pecs.

          Best of luck.
          Cheers,
          Steve August

          Like

    2. I am with you, Denise! I had a routine mammogram with good results about six weeks AFTER having bronchitis. I have had pain in my upper right back, upper arm, right breast and back of my neck. My ribs are even sore to the touch.

      A PA told me yesterday that she thought it might be gallstones. I am scheduled for an ultrasound to rule it out. However, the more I read, the more I’m convinced it is costochondritis!

      Like

  4. Hello
    I’m Jackie,
    My GP has prescribed lasaprazole.

    He said my chest pain is acid reflux
    Causing me this horrible pain
    I’m so miserable .
    It’s present on the right breast . Then later this week it will be all over my chest .
    If I dare to sneeze I suffer severe crushing chest pain .
    Dread waking up tomorrow to suffer this again.

    Thanks for reading 🔮

    Like

    1. Hi Jackie – I’m not a physician so cannot comment specifically on your situation, except to say generally that “severe crushing chest pain” during a sneeze is not typically a symptoms of acid reflux. If your lasprazole is not effective at doing its only job (treating acid reflux), please report this back to your physician. Right now you simply don’t know what is causing these distressing symptoms. Try keeping a Symptom Journal (date/time of day/what were you doing/eating/feeling an hour or so before symptom starts?) Often doctors can see a pattern emerging that may help solve the mystery. Good luck to you…

      Like

  5. Hi Carolyn,

    I know you like good evidence, as do I. Here’s a link to a paper from Zaruba and Wilson in the US in 2017.

    Essentially they fixed all their cases of costochondritis by freeing up the tight rib and spinal joints around the back which cause the overuse strain and pain at the rib joints on the breastbone. This is exactly the New Zealand manual physiotherapy understanding and treatment approach I’ve been presenting.

    Now it’s only a case series of eight patients, but the point is this is the BEST evidence for how you fix costochondritis that exists. No one has ever done a clinical trial to see if anti-inflammatories or steroid shots into the rib joints on the sternum actually help. ALL the other bits of evidence are case studies of one or two patients. And that’s it.

    That means that every other approach to fixing costochondritis is pretty much guesswork, regardless of what you’ve been told. That’s where this “mysterious inflammation” nonsense comes from. Thanks for mentioning my YouTube video on fixing costo on your page.

    I am trying to get a little bit of validated common sense about costo out there.

    Best wishes,
    Steve August

    Liked by 1 person

    1. Steve, I am very happy to read this published paper. In fact, I am now considering re-writing much of this 2013 blog post to reflect more of what you and the study authors have been doing and less of the anti-inflammatories/heat/ice/steroid injections content that is widely relied upon here in North America.

      I see this as a two-pronged challenge, however:

      You have to 1. reach the family physicians who are usually the first diagnosers of costo, and then 2. you have to find out if other physiotherapists are as experienced as you in treating this as a musculoskeletal mechanical issue of the back.

      Thanks so much for sending this study on to me. I recall that my first response to your persistent early blog comments here (scroll waaaaaay down to August 2015, below) was to hope you would just quietly go away. 😉

      So thanks also for not going away… You have really helped me and my readers over the years in answering tricky questions (scoliosis, Vitamin D, coughing, etc etc) and understanding more about a tricky and painful diagnosis.

      regards,
      C.

      Like

      1. Thanks, Carolyn. Yep, I generally get shocked looks when I point out to doctors that the standard medical view of costochondritis and how you treat it is NOT evidence-based. I know – I’ve been back and actually looked at the research evidence.

        There’s another aspect of costo that is highly relevant to your own concerns. Up to 50% of thoracotomy and especially sternal open heart operations leave ongoing pain and/or costochondritis in their wake.

        This is an appallingly high proportion, but it isn’t surprising, as the stretch on the rib joints around the back and the muscles between the ribs is massive, let alone the scarring tethering afterwards. I’ve talked about this and what we do for it in the ‘Pain After Surgery‘ section of the Backpod website.

        And of course it’s distressing for the patient over and above the pain as every time they get a twinge, they think it’s the heart problem coming back.

        Cheers,
        Steve August.

        Like

  6. I suffer with costachondritis off & on for for yrs. Breast bone really all the time but this time something new. After taking the dog out, the dog pulling on the lead, when I got in I had a spasm on the chest, thought I was having a heart attack! I went to the doctor, he didn’t check me over he just said it was spasms! I went the hospital a week before the spasm. Had a full EKG etc, the dr said it was definitely the costochondritis, has any one else experienced the spasm? Plz could you give me some feedback?

    Liked by 1 person

    1. I’m sorry you’re suffering these new symptoms, Pamela. I am not a physician, but it sure sounds like there was a likely ’cause and effect’ impact of this incident (no spasm until the dog pulled hard on the lead, then a big spasm after that) which of course makes your doctors assume the link that makes the most sense. Please watch physiotherapist Steve August’s video all about condochostritis and see if any of it seems to apply to your own experience.

      Like

    2. I got a spasm cleaning out the washer this weekend. I have gotten them walking and running, lifting light weights. I have had costo so long that almost anything I do gives me spasms along the right side of my breastbone. What is scary is that I have aortic valve stenosis that is close to severe and a GERD problem as well so I never really know where that pain is originating from.

      When I mention this to doctors, they never seem to take me seriously…just say to rest and take ibruprofen. Anyone know if there are chiropractic solutions or treatment for costochondritis?

      Like

  7. Hi, I’m female 35 single from Iran. I have been suffering from pain in my sternum for a couple of weeks, now previous to that I had weird kind of palpitation and a weird sense all round my neck plus cracking sounds in neck and stiff neck, stiff itchy palm and fingers!

    I was diagnosed Vitamin D deficient by blood test (3 months ago, the vitamin D was 9 and last week 14). I am underweight and do not drink milk. Also due to long black covers we have to wear in my country I have been afflicted with this plague. Symptoms abound from severe yet chronic pain all around the neck especially the front part plus throbbing muscles around my neck and sense of burning in the palm etc…. You did not mention Vitamin D deficiency in your article so I thought it might be of some help to your readers. PS. just did the rheumatology blood work and the results were all negative. Also took the x-ray photos (cervical as well as breast) yet haven’t got the results out yet. Also bouts of breast and armpit pain – itchy feeling.

    Liked by 2 people

    1. Hello Sarah – I’m not a physician so can’t comment specifically on your experience, but your story made me wonder if Vitamin D deficiency is more common in countries/cultures where women whose bodies are covered don’t get the daily sun exposure that aids Vitamin D absorption. Turns out that Vitamin D deficiencies linked to full body coverage aren’t unique to women as this interesting Scientific American article suggests. Adults need 600 IU of Vitamin D daily, which is what’s in most multiple vitamin pills. It sounds like your Vitamin D deficiency is under control now, and I hope your other mysterious symptoms are being addressed, too.

      Liked by 1 person

  8. i’ve had costocondritis for years. What helps is a healthy green smoothie every night – kale, spinach, green apple, coconut water/water. If i do that the symptoms completely subside. Coffee can also make it worse. Dumbbell chest flys can aggravate it too.

    Liked by 1 person

    1. Thanks, Jeremy that makes a lot of sense. I was having a green smoothie every day then got busy and missed a couple of days and the pain that restarted was unbearable. Have restarted again today,

      Liked by 1 person

  9. I’m having the same symptoms right now. ..I’m told heart and lungs are clear. Will see a chiropractor in the morning to see if they can fix it. Hope you all are having or have had relief with your symptoms

    Like

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  12. I have been diagnosed with Costochondritis a month ago I have had symptoms off and on for 6 months. I think this is paired with anxiety my dr. is still trying to rule things out but several ekg’s and a stress test on my heart showed that it was fine.

    I am not reacting to any of the steroids they gave me for inflammation. My Dr just started me on an anti inflammatory for the next ten days. I have also noticed discomfort when breathing, in my back, and in my left arm. I also often check my pulse and it always seems normal. I notice that the pain in the chest moves around sometimes on the left or right and sometimes in the sternum. I notice more pain when I am bending over or leaning forward on my elbows. My dr. thinks this may also be due to large breasts.. Is this a possibility? I just want the pain to go away. The next step is to be treated for anxiety.

    Liked by 1 person

    1. I also have struggled with costochondritis since I was 22, I am now 52. It just shows up .. about three times a year .. when it gets where I can’t handle it anymore … I go for acupuncture… the only thing that has ever helped ….. and mine is both sides, front and back, top to bottom. Best of luck.

      Like

    2. Anxiety does not cause costochondritis, but the pain from costochondritis can cause anxiety. Physiotherapy sounds like the best solution. Personally, I would be suspicious of a speculation that large breasts may be a cause of costochondritis or similar (intense) pain.

      Like

  13. I have. I feel everything you just described. My cause is unknown. My flare ups are not as painful as they were but they do come every tinne with my menstrual and causes aches, tenderness & fatigue. I’ve tried pain medicine and non- pharmacological measures. I’m going to try acupuncture next.

    Liked by 1 person

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  15. I was diagnosed in 2013 with costochondritis after experiencing chest pain that just steadily got worse over a few hours time … the cardiologist on call looked at every test which was a complete cardiac work up all the tests I said my heart was fine he then asked what I did for a living I told him I pushed carts he pushed on my ribs …sternum it hurt …he diagnosed it as costochondritis 😞 Tonight I suddenly woke up with chest pain that went from front to back into my jaw…teeth and ear not sure what to make of it.

    Like

  16. I got taken to hospital straight from a doctor’s appointment when I went to ask about pain relief for a pulled muscle behind my right chest! It was affecting my breathing as I have functional neurological disorder (FND) conversion and my SATS were low! Doctor and paramedics thought I had a pulmonary embolism. I kept telling them I had pulled muscles. After medication, X-ray and scans they said it was due to rheumatoid arthritis FND and pulled muscle!

    This costochondritis sounds exactly like it! I no longer feel like a hypochondriac! Thank you x

    Like

  17. I’ve been diagnosed with Costochondritis today by the Dr. My ribs do not hurt to touch. I’m getting sharp pains on and off right around the heart area. Sometimes it feels like a trapped nerve which is excruciating. Other times it feels like great palpitations with pains. The pain is only in this area. Dr listened to lungs, abs said was all clear. Also used one of those things on my finger to check heart rate. Apparently all normal. I’m 9 weeks pregnant so all they could advise was take paracetamol for the pain and I’m to be reviewed in 2 weeks again. The pain scares me. I can’t sleep as I feel I’m going to have a heart attack or something. Are these normal symptoms of this? I used to get the pain few months back. Thought it could be my lungs so I quit smoking. Wasn’t a heavy smoker anyway maybe 3 a day. Was more a habit when driving. The pain stopped. Now it’s back again for last few days. Just scaring me now. But I’m reading so much into it. Maybe I’ve been misdiagnosed. How do I know until it’s too late? Maybe I’m just panicking.

    Like

    1. I hope you are feeling better by now. I understand the fear you describe I went through that for months before talking to my Dr. She was able to give me something to help my fears get under control short term. Then I just kept telling myself that it wouldn’t kill me because I had already lived through it many nights. I know you can’t take meds right now but maybe remembering that downsizing these attacks will help you to get through it a little easier. Good luck!

      Liked by 1 person

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