COSTOCHONDRITIS VS. HEART ATTACK: KNOWING THE DIFFERENCE

Costochondritis is a leading cause of chest pain that affects millions of people annually. This inflammation can result in sharp or dull pain in the chest that can seem like an infection, heart attack, or other severe conditions.

This article reviews what costochondritis is, the risk factors and causes of chest pain, other symptoms, diagnosis, and treatment options for costochondritis.

What is Costochondritis?

Costochondritis denotes inflammation of the cartilage (chondritis) that connects the ribs to the breastbone, known as the costochondral joint or junction.^[1]

Other names for costochondritis include chest wall pain and costochondral syndrome.

The costochondral joints connect the ribs to the chest wall. They comprise cartilage, and ten pairs of these joints connect the first ten ribs to their costal cartilages. These joints do not move, providing structure to the ribcage and sternum.^[2]

The pain is mostly experienced around the 4th, 5th, and 6th ribs.^[3]

The underlying inflammation can result in sharp pain in the chest, which is easy to mistake for a heart attack or other severe conditions.

The prevalence of costochondritis is likely more common than seen in current reports. About 1 in 5 patients experiencing chest pain and seeking medical attention have muscular or rib-related causes.

The Mayo Clinic suggests it affects women over 40 more often^[4]. Women may experience pain in different areas than men, including the upper ribs and breastbone. They may also experience more severe pain and tenderness in the affected area.

Costochondritis affects children and teenagers more than adults as a symptom of Tietze syndrome.^[5]

Symptoms of Costochondritis

The defining feature of costochondritis is chest pain, which ranges from mild to severe. The pain manifests as sharp or dull and on the left side of the chest. Rarely, the pain may also radiate to the shoulder or arm.

Other symptoms of costochondritis may include:

• Pain when taking deep breaths or coughing
• Tenderness in the affected area
• Pain that deepens with physical activity or movement
• Pain that improves with rest
• Difficulty breathing
• Pain that intensifies at night
• Increased discomfort when lying down, lifting heavy objects, or applying pressure to the affected area

Factors exacerbating pain include stress, poor posture, deep breaths, physical activity, and heavy lifting.

Any other symptoms are uncommon to costochondritis and may indicate another health condition.

If other symptoms are present, such as shortness of breath, dizziness, fever, a constant cough, nausea, muscle spasms, or any other symptoms, it is crucial to get evaluated by a medical practitioner.^[6]

Causes of Costochondritis

Costochondritis arises from inflammation of the cartilage in the costochondral joints. Physical strain or chest injuries are frequent causes. It can also result from inflammation from a respiratory infection or a pre-existing condition such as arthritis.

Some risk factors for developing costochondritis include:

• Chest strain or injury
• Repetitive movements or activities that put strain on the chest
• Respiratory infections
• Pre-existing inflammatory and autoimmune conditions such as arthritis, lupus or fibromyalgia
• Poor posture
• Stress or anxiety

Athletes and those in physically demanding jobs are at a higher risk for developing costochondritis.

Other Reasons for Rib Pain

Many conditions can resemble costochondritis.

Tietze Syndrome is a distinct condition in which costochondritis is a symptom. You can tell the difference between the two as Tietze syndrome causes sudden chest pain that spreads to the arms or shoulder, lasting for weeks, and swelling at the painful rib-breastbone junction.^[7]

Other reasons for chest pain can include:

• Rib fractures
• Chest wounds
• Acute coronary syndrome
• Pulmonary embolism
• Pneumonia
• GERD (chronic acid reflux)
• COVID-19
• Fibromyalgia
• Lupus
• Bornholm disease^[8]
• Heart attack

As several conditions that mimic costochondritis can result in fatality, it is vital to get your symptoms checked by a qualified healthcare professional.

Costochondritis vs. Heart Attack

Chest pain can be due to various causes, such as costochondritis or a heart attack. Distinguishing between the two is crucial since a heart attack needs urgent medical care.

Heart attack pain is a squeezing sensation or pressure that can radiate to other body areas. It also may not improve with rest, can be felt on both sides of the chest, and is accompanied by other symptoms such as shortness of breath, nausea, or dizziness.^[9]

If you are suffering from a similar type of chest pain, medical attention to receive appropriate treatment is essential.

When to See a Doctor

You should see a doctor for costochondritis if:

1. You are unsure about your chest pain and want a proper diagnosis
2. The pain is severe or worsens over time
3. The pain presents with shortness of breath, dizziness, or other concerning symptoms
4. You have a pre-existing medical condition that may increase the risk of complications
5. The pain persists for an extended period despite self-care measures
6. You are experiencing recurrent episodes of chest pain
7. Your daily activities are significantly affected by the pain

Diagnosis of Costochondritis

A healthcare practitioner will complete a physical evaluation and may order further tests to diagnose costochondritis. The physical examination can ascertain what tests a proper diagnosis requires.

These tests may include:

• X-rays to rule out other conditions, such as a rib fracture or lung infection
• Blood tests to check for signs of disease, inflammation, or infection
• An electrocardiogram (ECG) to rule out heart problems
• A chest CT scan or MRI to get a more detailed image of the chest area

These diagnostic procedures will help your doctor to ensure an appropriate treatment.

Costochondritis Treatment and Management

Treatment concentrates on pain relief and lowering inflammation. Treatment options may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Speak to your doctor about safer options for children and teens with Tietze syndrome
• Physical therapy exercises and stretches to improve posture and strengthen the affected area^[10]
• In severe cases, corticosteroid injections can reduce inflammation and pain
• A specialist might also offer transcutaneous electrical nerve stimulation, or TENS, which uses an electrical current to stimulate an area, providing pain relief^[11]
• Infrequently, surgery may remove the affected cartilage

In addition to medical treatment, self-care tips can help alleviate the pain and discomfort of costochondritis. These include:

• Utilizing heat or ice packs on the affected area several times a day^[12]
• Maintaining proper posture to diminish strain on the chest area
• Recovering properly and avoiding activities that aggravate the pain
• Using a chest brace or wrap for support
• Getting enough rest and avoiding strenuous activities
• Employing relaxation tactics like deep breathing to lessen stress and anxiety

The prognosis for costochondritis is typically favorable. Most costochondritis cases are mild and tend to resolve relatively quickly, with or without minimal medication.

About 90% of individuals with costochondritis experience no pain after three weeks. In almost all instances, the condition disappears within a year.

While recurrence of costochondritis is possible, it is rather unlikely. If the chest pain does not improve, it is likely another medical condition requiring prompt diagnosis.

How to Prevent Costochondritis

You can lower your costochondritis risk by strengthening your posture. Here are some tips to help:

• Perform daily stretches and core muscle-building exercises to develop a good posture. This can lower strain on the chest area
• Minimize activities that strain the chest, such as heavy lifting or repetitive movements
• Take breaks and stretch during activities that require repetitive movements
• Pay attention to your body and avoid anything that triggers pain
• Keep within a healthy weight range to relieve pressure on the chest
• Manage stress and anxiety through relaxation techniques
• Seek medical attention for respiratory infections or other conditions that may lead to costochondritis

Conclusion

Costochondritis is a typical cause of chest pain that can be mistaken for more severe conditions. It is essential to seek medical attention if you experience chest pain to determine the cause and receive appropriate treatment. Treatment options for costochondritis include pain relievers, physical therapy, and home remedies.

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