Mr Q's history is suggestive of
costochondritis – a fairly painful condition which may easily be confused with
pain of cardiac origin (like a heart attack). There are, however, a number of
1. With costochondritis the pain is mostly localised
(specific to a certain area)
2. The pain is usually not sudden in onset and
can come along over a couple of days
3. The patient is usually able to pinpoint
exactly where the pain is situated
4. The pain does not usually radiate (spread
to other areas).
Costochondritis, in most cases, does not have a clear
cause, but can follow a respiratory tract infection or repetitive strain on rib
cage (like injury or coughing). It is important to make sure the pain is not
cardiac in origin and therefore your doctor will do a couple of tests to exclude
heart problems as the cause of pain.
Shortness of breath, sweating
and severe discomfort
Pain with a cardiac cause will, in most cases, be a
central, dull, persistent, sudden onset pain which may also radiate to the
jaw, neck and arm. It is also accompanied with shortness of breath, sweating
and severe discomfort.
The most common site for costochondritis is on the left
side (which may make one suspect a heart condition) over ribs 4,5 and 6. The pain is often worsened by breathing in (when
the chest cage expands) and can be reproduced when pressing on the
cartilage-bone junction of the ribs.
Special investigations are important in differentiating
between cardiac pain and costochondritis. An ECG and cardiac markers can show
possible cardiac changes. It is important to remember that, early in ischaemic
heart conditions, an ecg and blood tests can be normal.
People suffering from costochondritis are usually not
admitted to hospital and treatment is focused on clearing up the inflammation.
Anti-inflammatory medication is therefore key in managing the condition.
Depending on the cause, conservative management with medication and rest is
usually sufficient. If a clear infectious cause is found (bacterial),
intravenous antibiotics may be considered.
Costochondritis can be a very painful condition. All
chest pain should be examined by a doctor.
NOTE: Health24's on-site GP Dr Owen Wiese reveals
new cases on Thursdays. The answer is posted with the story on Mondays,
or you can get it in our Daily Tip – sign up here.
Previously on What's Your Diagnosis?
What's your diagnosis - Case 1: vomiting and weight loss
What's your diagnosis - Case 2: eye pain
What's your diagnosis - Case 3: strange behaviour and a bullet in the back
What's your diagnosis - Case 4: seeing odd things
What's your diagnosis - Case 5: mysterious lungs
What's your diagnosis - Case 6: runner with seizures
What's your diagnosis - Case 7: swollen knee
What's your diagnosis - Case 8: bloody semen
What's your diagnosis - Case 9: confusing neurological signs
What's your diagnosis - Case 10: diabetic teenager with unusual signs and symptoms
What's your diagnosis - Case 11:bruising with no apparent cause
What's your diagnosis - Case 12: severe tummy pain
What's your diagnosis - Case 13: severe sore throat
What's your diagnosis - Case 14:abdominal pain and swelling
What's your diagnosis - Case 15: the world is spinning
What's your diagnosis? – Case 16: numbness in forearm
What's your diagnosis? - Case 17: burning urine
What's your diagnosis? – Case 18: boy with persistent fever
What's your diagnosis? – Case 19: lady who can't lose weight
Image: Chest pain from Shutterstock
Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.