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Costochondritis-The Heart Attack That Wasn't

          For many years I've seen the scenario repeat itself. The patient comes in with a panicked look on his/her face and says, "I think I may be having a heart attack."

          The electrocardiogram is normal and the answers to my questions don't add up to heart problems. Less than thirty seconds on the exam table, however, yields the diagnosis-costochondritis.
What is this strange sounding ailment? Costochondritis is an inflammation in the cartilages where the ribs join the breastbone. Since we have to take breaths in and out of our lungs, there cannot be a direct rigid attachment of the ribs to the breastbone.

          Instead, the ribs join the breastbone (known medically as the sternum) through flexible cartilages known as costal cartilages. But just like any cartilage, these costal cartilages in the chest wall can get inflamed. This is costochondritis, which literally means inflammation of the cartilage.

          The key symptom is pain-not in the center portion of the chest under the breastbone, which is more typical of heart related pain-but rather pain along the edges of the breastbone. Many patients, and even doctors, can occasionally be thrown off as the pain can radiate into the arms, shoulders, or across the entire chest.

          Another tip-off that this is cartilage inflammation rather than a more serious heart ailment is the fact that the pain increases with twisting movements of the upper body-reaching for something (especially overhead), taking in a very deep breath, coughing, or sneezing.

          The physical examination performed by a doctor shows tenderness over the anterior chest wall area along the breastbone where the rib joins the sternum. There may be some degree of redness over the skin and the pain is more often than not on the left side of the chest area.

          The biggest problem in diagnosing costochondritis is differentiating it from blockage in the coronary arteries that lead to the heart. Usually, heart related pain involves a squeezing, crushing feeling. It radiates from the middle of the chest to the shoulder or arm (usually left arm), and worsens with stress, exertion, or even following a large meal. Costochondritis, on the other hand, is more associated with movement of the chest wall and tenderness along the junction of the ribs with the breastbone.

          Once a patient knows the diagnosis, his/her facial expression has a way of changing immediately. The ailment usually disappears as mysteriously as it came on, but often a low dose of Naprosyn or another over-the-counter, anti-inflammatory will stop the pain, along with warm, moist heat. Rare cases, such as an infection into the cartilage, require more aggressive measures, but this is unusual.

          I emphasize one point, however, about costochondritis. If you have any doubt whatsoever about your chest pain, and even if you feel it is simply a cartilage inflammation, get a confirmation from a doctor.

          Costochondritis occasionally stumps even doctors, but, most of the time, it is easy to diagnose based on the above symptoms. The truth truly does set you free.