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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 differences:
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
