Costochondritis is an inflammation of the cartilage that connects a rib to the sternum (Mayo Clinic, 2018). The pain from costochondritis may mimic those symptoms of a heart attack or similar heart conditions. This is common and occurs in about 28% of undifferentiated noncardiac patients that present with chest pain (Ferri, 2018). It occurs more in women than men and is more prevalent in people over the age of 40 (Ferri, 2018). The cause of costochondritis is largely unknown, however, it may be caused by a chest injury, hard exercise or heavy lifting, viral infections, strain from coughing, and infections occurring after surgery (U.S. National Library of Medicine, 2018).
Signs and symptoms may be pain and tenderness in the chest. The pain occurs mostly on the left side of the sternum (Mayo Clinic, 2018). The patient may present with complaints of sharp pain in the front of the chest wall, that may radiate to the arm or shoulder (Mayo Clinic, 2018). The pain may increase with a deep breath or cough and there may be tenderness when pressure is applied to the sternum where the ribs meet (U.S. National Library of Medicine, 2018). The pain may decrease when the patient is still and takes shallow breaths. A diagnosis is made after ruling out more serious conditions such as heart attack. A detailed history and physical exam are keys to diagnosing costochondritis. An electrocardiogram and chest x-ray should be done to rule out cardiopulmonary issues (Ferri, 2018). Treatment mainly focuses on relieving the pain as costochondritis typically goes away on its own. It may take as little as a few days or as long as a few months to go away.
Patients should be taught to apply hot and cold compresses, avoid activities that cause the pain to increase and to take nonsteroidal anti-inflammatory drugs, such as ibuprofen, as needed for pain (Mayo Clinic, 2018). The patient should be advised to return to the clinic or emergency room if they start to have difficulty breathing, have a high fever, are having any signs of infection such as pus, redness or swelling around the ribs, the pain is worsening even with pain medication, or they are having a sharp pain with every breath (Mayo Clinic, 2018).
References:
Ferri, F. (2018). 2018 Ferri’s Clinical Advisor. Philadelphia, PA: Elsevier.
Mayo Clinic. (2018). Costochondritis. Retrieved February 2018, from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175
U.S. National Library of Medicine. (2018). Costochondritis. Retrieved February 2018, from MedlinePlus: https://medlineplus.gov/ency/article/000164.htm
