COSTOCHONDRITIS VS. HEART ATTACK: KNOWING THE DIFFERENCE
Medically Reviewed and Updated by Dr. Sony Sherpa (MBBS) - October 14, 2024
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 condition is seen in people between 40 and 50 years of age, with a slight predominance in women.[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
- Pain when twisting the torso
- Pain when vomiting
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 strain 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 vs. 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, may be felt on both sides of the chest, and is accompanied by other symptoms such as shortness of breath, nausea, or dizziness.[9]
Costochondritis is chest wall pain due to inflammation of the cartilage that connects the ribs to the sternum. It is generally sharp, localized, and reproducible by pressing on a specific area.
Angina, on the other hand, is chest pain due to reduced blood flow to the heart. It usually presents as a squeezing or pressure-like pain that may radiate to other parts of the body, such as the arms, neck, or jaw. Unlike costochondritis, angina pain is not reproducible by touch and typically worsens with exertion or stress.
Costochondritis vs. Heart Attack: Comparison Table
|
Criteria |
Costochondritis (Chest Wall Inflammation) |
Heart Attack (Blood Flow Blockage) |
|---|---|---|
|
Symptoms |
Sharp, localized pain that worsens with movement, coughing, or deep breathing. It is often reproducible, meaning a specific spot can be identified when pressed. |
Pressure, tightness, or a squeezing sensation in the chest, often radiating to the arms, neck, jaw, or back. |
|
Location of Pain |
Typically localized to one side of the chest, often around the sternum. |
Mainly center or left side of the chest, may radiate to other areas such as arms, back, or jaw. |
|
Aggravating Factors |
Pain worsens with physical activity involving chest movement, deep breaths, coughing, or pressing on the chest area. |
Pain often worsens with physical exertion or emotional stress, but may occur at rest. |
|
Shortness of Breath |
Usually absent, but may occur due to pain and discomfort. |
Common, often accompanied by other symptoms such as sweating, dizziness, or nausea. |
If you are suffering from a similar type of chest pain, medical attention to receive appropriate treatment is essential.
Who Is at Risk?
Individuals at higher risk of developing costochondritis include:
- Athletes in contact sports: Those who frequently experience chest impacts, like in football or wrestling.
- Physically demanding jobs: People who perform heavy lifting or repetitive activities may strain their chest wall.
- Hispanic people: There may be a higher prevalence of costochondritis in certain populations.
- Women: More often affected by costochondritis than men.
- Children and teenagers: They are more prone to costochondritis than adults.
When to See a Doctor
You should see a doctor for costochondritis if:
- You are unsure about your chest pain and want a proper diagnosis
- The pain is severe or worsens over time
- The pain presents with shortness of breath, dizziness, or other concerning symptoms
- You have a pre-existing medical condition that may increase the risk of complications
- The pain persists for an extended period of time despite self-care measures
- You are experiencing recurrent episodes of chest pain
- Your daily activities are significantly affected by the pain
- If you experience heart palpitations along with chest pain, this could indicate a more serious condition that requires prompt treatment.
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 evaluate 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
- Stretches and physical therapy exercises to improve posture and strengthen the affected area[10]
- Anti-seizure medications may sometimes be prescribed to manage chronic pain in severe cases of costochondritis. These medications can help reduce nerve-related pain, providing relief when standard treatments are insufficient.
- 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
Costochondritis Self-Care
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.
Costochondritis Stretches and Exercises
Purpose of Stretches and Exercises
Incorporating stretches and exercises can help alleviate discomfort associated with costochondritis by improving flexibility, reducing muscle tension, and promoting overall chest wall mobility.[13] These exercises should be performed gently and without pain.[14]
- Chest Stretch
- How to Do It: Stand in a doorway, placing your forearms on the door frame. Step forward gently until you feel a stretch across your chest. Hold for 15-30 seconds.
- Benefits: Opens up the chest and relieves tightness in the pectoral muscles.
- Neck Stretch
- How to Do It: Sit or stand comfortably. Tilt your head sideways, bringing your ear towards your shoulder. Use your hand to gently pull your head further into the stretch. Hold for 15-30 seconds and switch sides.
- Benefits: Reduces tension in the neck, which can help relieve referred pain to the chest.
- Torso Twist
- How to Do It: Sit on a chair with your back straight. Place your right hand on the back of the chair and twist your torso to the right. Hold for 15-30 seconds and repeat on the left side.
- Benefits: Increases mobility in the thoracic spine and relieves tension in the ribcage.
- Side Stretch
- How to Do It: Stand tall and reach your right arm overhead, leaning gently to the left. Hold for 15-30 seconds, feeling the stretch along your side. Repeat on the other side.
- Benefits: Stretches the intercostal muscles located between the ribs, enhancing flexibility.
Recommended Strengthening Exercises
- Wall Push-Ups
- How to Do It: Stand an arm's length away from a wall. Place your hands at shoulder height and perform push-ups against the wall, ensuring your body remains straight.
- Benefits: Strengthens the muscles around the chest without putting too much strain on the ribcage.
- Seated Row with Resistance Band
- How to Do It: Begin seated on the floor with your legs extended. Now loop a resistance band around your feet, holding the ends. Pull the band towards your torso, making your shoulder blades squeeze together. Repeat for 10-15 repetitions.
- Benefits: Strengthens the upper back muscles, which helps maintain proper posture.
How Long Can Costochondritis Last?
The prognosis for costochondritis is generally favorable. Most cases are mild and tend to resolve within a few weeks, with 90% of individuals experiencing no pain after three weeks. In almost all cases, the condition disappears within a year. Reocurrence is possible but rare. If chest pain persists beyond this time, another medical condition may be the cause and should be investigated promptly.
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
Foods to Avoid With Costochondritis
Managing inflammation through diet can help ease costochondritis symptoms. Here are some foods to avoid:
- Processed Foods: High in unhealthy fats and preservatives that worsen inflammation.
- Sugary Foods & Drinks: Promote inflammation and weight gain.
- Fried Foods: Contain trans fats that can increase inflammation[15].
- Red & Processed Meats: Linked to higher levels of inflammation.
- Dairy Products: May aggravate inflammation in some individuals.
- Refined Carbs: Cause blood sugar spikes and contribute to inflammation.
- Excess Salt: Leads to fluid retention and more strain on the body.
- Alcohol: Causes inflammation and slows healing.
Choosing anti-inflammatory foods like leafy greens and omega-3-rich options can support better health and pain management.
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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