What is costochondritis? How can doctors tell it’s not a heart problem? Get answers about the symptoms, causes, and treatment of this common chest pain condition.

Understanding Costochondritis: A Closer Look

Costochondritis is a condition characterized by inflammation of the cartilage that connects the ribs to the breastbone, known as the costosternal joints. This inflammation can lead to chest pain, tenderness, and discomfort, often mistaken for a heart-related problem. However, there are distinct differences between the symptoms of costochondritis and a heart attack that can help doctors make an accurate diagnosis.

Symptoms of Costochondritis

The primary symptom of costochondritis is chest pain that may feel sharp, dull, or gnawing. This pain is often exacerbated by deep breathing, coughing, or lying down. Patients may also experience tenderness and swelling in the affected area when the chest is pressed. In contrast, heart attack symptoms typically include an uncomfortable squeezing, tightness, or pressure in the center of the chest, along with other varied symptoms.

Causes of Costochondritis

There are several potential causes of costochondritis, including physical strain on the chest or arms, such as from heavy lifting or strenuous exercise, injuries to the chest area, and certain types of arthritis like rheumatoid arthritis or osteoarthritis. In many cases, the exact cause of costochondritis is unknown.

Diagnosing Costochondritis vs. Heart Problems

When a patient presents with chest pain, the primary concern is to rule out a heart attack or other serious cardiac condition. This typically involves an electrocardiogram (ECG) to check for signs of a heart attack, as well as blood tests to check for damage to the heart muscle. If these tests do not indicate a heart problem, the doctor may then consider a diagnosis of costochondritis based on the patient’s symptoms and medical history.

Treatment Options for Costochondritis

Costochondritis often resolves on its own without any specific treatment. However, in the meantime, patients may find relief from over-the-counter pain medications, such as acetaminophen or ibuprofen, or by applying pain-relieving creams or gels to the affected area. Gentle stretching exercises and the use of heating pads or ice packs may also help alleviate symptoms.

Preventing Recurrence of Costochondritis

To prevent the recurrence of costochondritis, it’s important to avoid activities that may have triggered the initial episode, such as heavy lifting or strenuous exercise. Maintaining good posture and engaging in low-impact exercises can also help reduce the risk of future episodes.

How can doctors be sure it’s not a heart problem?

Doctors can use several tests to rule out a heart problem and determine if the chest pain is due to costochondritis. The first step is typically an electrocardiogram (ECG) to check for signs of a heart attack or other cardiac issues. If the ECG is normal, doctors may then order blood tests to check for any damage to the heart muscle. If these tests do not indicate a heart problem, the doctor can then consider a diagnosis of costochondritis based on the patient’s symptoms and medical history.

What are the common causes of costochondritis?

The most common causes of costochondritis include physical strain on the chest or arms, such as from heavy lifting or strenuous exercise, injuries to the chest area, and certain types of arthritis like rheumatoid arthritis or osteoarthritis. In many cases, the exact cause of costochondritis is unknown.

How long does costochondritis usually last?

Costochondritis typically resolves on its own, without any specific treatment, although it can last for several months or even up to a year in some cases. During this time, patients may find relief from over-the-counter pain medications, pain-relieving creams or gels, and gentle stretching exercises.

Can costochondritis be prevented?

To prevent the recurrence of costochondritis, it’s important to avoid activities that may have triggered the initial episode, such as heavy lifting or strenuous exercise. Maintaining good posture and engaging in low-impact exercises can also help reduce the risk of future episodes.

How does costochondritis differ from a heart attack?

The main differences between costochondritis and a heart attack are the nature of the chest pain and other associated symptoms. Costochondritis typically causes a sharp, dull, or gnawing pain that worsens with deep breathing, coughing, or lying down, while heart attacks often cause an uncomfortable squeezing, tightness, or pressure in the center of the chest, along with other varied symptoms.

What are the treatment options for costochondritis?

The treatment for costochondritis is typically conservative and aimed at managing the symptoms. Over-the-counter pain medications, such as acetaminophen or ibuprofen, can help alleviate the pain. Applying pain-relieving creams or gels to the affected area, as well as using heating pads or ice packs, may also provide relief. Gentle stretching exercises can also help, while activities that may have triggered the condition should be avoided.

Chest pain from inflamed joints

Q.
My wife was having unusual chest pains and was diagnosed with costochondritis. But it’s lasted for weeks now, and I worry that she might have a heart problem. How can doctors be sure it’s not her heart?

A. Costochondritis is one of several conditions that are often mistaken for a heart-related problem. (Another is heartburn.) Costochondritis results from inflammation of the tough, flexible connective tissue (cartilage) between the ribs and the breastbone, called the costosternal joints (see illustration).

Possible causes of costochondritis include a blow to the chest, strenuous exercise, or heavy weight lifting. A respiratory or joint infection, severe coughing, and certain types of arthritis may also trigger the condition. But more often than not, the cause is unknown.

The main symptoms are pain and tenderness in the chest. The pain may feel sharp or dull and gnawing and often worsens when a person takes a deep breath, coughs, or lies down. The chest may feel tender and possibly swollen when pressed. Rest and quiet breathing tends to ease the pain somewhat.

In contrast, people often describe heart attacks as uncomfortable squeezing, tightness, or pressure in the center of the chest; other varied symptoms can also occur. Because heart attacks are common and potentially serious, it’s the first thing a doctor will rule out if a person shows up in any medical setting with chest pain. The testing includes an electrocardiogram, a brief, painless test that may reveal a distinct signature if a heart attack is occurring (or happened in the past). A blood test that checks for damage to the heart muscle is standard practice; other tests may be done as well.

Doctors always take a medical history, which may have helped pin down your wife’s diagnosis. There are no lab or imaging tests to confirm a diagnosis of costochondritis with certainty. The problem usually goes away on its own, without any treatment. But it can last several months and sometimes up to a year. In the meantime, people can take pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), or apply pain-relieving creams or gels to the affected area. These include over-the-counter creams that contain capsaicin or salicylates, or a 1% diclofenac gel (Voltaren). Exercises that might aggravate the problem, such as rowing or weight lifting, may need to be avoided. Gentle stretching exercises may help; so can putting either a heating pad or ice pack on the painful area a few times a day.

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Costochondritis is an inflammation in the chest where the upper ribs are joined to the sternum, or breast bone, by cartilage. It is a condition that is usually not life threatening and will often go away without treatment, but because of the symptoms, should not be ignored.

When children or adolescents feel chest pains, a common diagnosis is costochondritis, between 10 and 30 percent of cases, but a cause for it is usually not found.

Although the first thing that is thought of when adults have chest pain is a heart attack, they may also be diagnosed with this inflammatory condition. Tests will be completed in order to eliminate a heart attack before moving onto other possibilities as a diagnosis for the pain.

Costochondritis Causes

Often there is no definitive cause, but some of the causes include:

* Physical strain on the chest or arms – This will often happen with heavy lifting, a strenuous exercise routine, or overexerting during a physical activity.

* Injury to the chest area – This could be from an accident or fall that causes a blow to the chest.

* Arthritis – Arthritis is an inflammation of the joints. This inflammation can begin to inflame the cartilage of the chest. Types of arthritis include, rheumatoid arthritis and osteoarthritis.

* Tumors – Regardless of whether or not the tumor is cancerous, inflammation in the cartilage of the chest can occur depending on the location of the tumors.

* Viral infections – A viral infection can be a cause because of the inflammation that naturally comes along with the infection, along with strain that is felt in the chest from repetitive coughing.

* Fungal infections – In rare cases, a fungal infection can be the cause.

In addition to the other costochondritis causes, the cause on occasion is from a bacterial infection. It most commonly happens to those that use IV drugs and in those that have recently had surgery on their upper chest. The cartilage of the upper chest can be more prone to a bacterial infection after surgery because the blood flow to the area is reduced during surgery.

Symptoms of Costochondritis

There are a number of symptoms of costochondritis that may be seen. The first that is often noticed are chest pains. The pain that is felt may be a dull, aching pain, but is usually sharp and is on the front of the chest. It is more commonly felt on the left side in one confined location, but will sometimes spread and be felt in the back or stomach as well. Most of the time, the pain will start after exercising, an upper respiratory infection, or minor trauma to the chest area.

Pain may also be felt when a person coughs or takes in a deep breath. The chest pains are typically felt in the fourth, fifth, and sixth ribs. As a person takes in deep breaths or move the upper body, the pain will likely increase and will decrease when the body is not moving or more shallow breaths are taken.

Tenderness of the rib cage will also be noticed when pressure is applied. Applying pressure and checking for tenderness is something a physician will do in order to give a diagnosis.

When an infection from surgery is the cause, there will be redness, pus discharge, or swelling in the location of the surgery.

*** If you believe that you may have costochondritis, seek contact a medical professional immediately.

How to diagnose Tietze’s syndrome – Rheumatology services

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How to Diagnose Tietze’s Syndrome (Cos-cartilage Syndrome, Costal Chondritis) : Costo-cartilaginous syndrome is a disease from the group of chondropathy, accompanied by aseptic inflammation of one or more upper costal cartilages in the area of ​​their articulation with the sternum. The initial diagnosis of Tietze’s syndrome will require an X-ray or CT scan of the ribs and a subsequent consultation with a rheumatologist.

Which doctor treats costochondral syndrome: With symptoms of Tietze’s syndrome, you should first consult a rheumatologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with an orthopedist.

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Tietze’s syndrome is a rare condition that causes chest pain in the upper ribs. It is a benign disease that mainly affects patients under the age of 40. The exact cause of its occurrence is unknown.

Symptoms of costochondral syndrome

The main symptom of Tietze’s syndrome is chest pain. In this condition, pain is felt around one or more of the 4 upper ribs, especially where the ribs attach to the sternum. In 70-80% of cases, the pain is localized around one rib. Usually only one side of the chest is affected. Inflammation of the cartilage of the affected rib causes pain and swelling. The area may hurt, look swollen, or red. Tietze syndrome pain can:

• come on suddenly or gradually
• be sharp, stabbing, blunt or painful
• vary from weak to strong
• extend to arm, neck and shoulders
• aggravated by exertion, coughing or sneezing.

Causes of Tietze’s syndrome

The exact cause of Tietze’s syndrome is unknown. However, researchers believe that it may be the result of a minor injury to the ribs. Injuries caused by:

• severe cough
• severe vomiting
• upper respiratory infections, including sinusitis or laryngitis
• strenuous or repetitive physical activity
• injuries or wounds.

Risk factors

The biggest risk factors for Tietze syndrome are age and possibly season. Tietze’s syndrome mainly affects children and patients under the age of 40. The number of cases is higher in winter and spring. The syndrome develops most often in women, but can also affect men.

How Tietze’s syndrome differs from costochondritis

Tietze’s syndrome and costochondritis cause chest pain around the ribs, but there are important differences:

Diagnosis of Costochondral Syndrome

Tietze’s syndrome is difficult to diagnose, especially when it is necessary to distinguish it from the more common costochondritis. During your initial appointment, your doctor will perform an orthopedic examination and ask you about your symptoms. He will prescribe certain tests to rule out other causes and make the correct diagnosis. These include:

• blood test to check for signs of a heart attack or other illness
• Ultrasound to check ribs for cartilage inflammation
• X-ray of the ribs to detect diseases associated with organs, bones and tissues
• Chest MRI to look more closely at cartilage thickening or inflammation
• CT ribs
• electrocardiogram.

Treatment

General treatment regimen for Tietze’s syndrome:

• rest
• avoidance of strenuous activity
• applying heat to the affected area.

In some cases, the pain resolves on its own without treatment. For relief, the doctor will recommend painkillers. Other possible treatments for ongoing pain and inflammation include steroid injections to reduce swelling, or injections of lidocaine into the affected area to relieve pain. Tietze’s syndrome pain usually improves within a few months. Sometimes the condition improves and then resume. In extreme cases where conservative treatments fail to reduce pain and swelling, surgery is required to remove excess cartilage from the affected ribs.

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Author: Viktor Evgenievich Tolnikov

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2. Atakhanov P.K. Surgical correction of congenital pectus excavatum using multidisciplinary bone xenofixators: Diss. . cand. honey. Sciences. Frunze, 1989. -150 p.
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