Costochondritis: Chest Pain That Feels Like a Heart Attack

Although it is exceedingly rare for teens to have heart attacks, it is not uncommon for them to have chest pain. That can be really scary for you and your child. But when the cause of the sharp pain is costochondritis, you can rest easy knowing that your child does not have a dangerous condition.

What Is Costochondritis?

Costochondritis is an inflammation of the small disc of cartilage that connects each rib to the sternum, or breastbone. It can occur in only one rib but often occurs in multiple ribs, either on the same side of the sternum or on both sides. Costochondritis happens a little more often on the left than the right side of the chest. It is one of the most common causes of chest pain in teens, and it happens more often in girls than boys.

Symptoms of Costochondritis

The most frequent symptom of costochondritis is intermittent sharp, stabbing chest pain that usually gets worse when your child breathes deeply, coughs or moves the chest wall in other ways. These painful episodes vary in duration, frequency and intensity, and they generally come on randomly throughout the day.

Teens also often report feeling short of breath. However, when they are asked about breathing difficulties, most say they feel that they can’t take a deep breath because of the discomfort that occurs when they do.

Risks Factors of Costochondritis

There is no known cause of costochondritis, but some factors are suspected of increasing your child’s chances of developing this condition, including:

• A significant respiratory infection with prolonged or severe coughing
• Repetitive use of the chest wall in activities such as playing tennis, lifting weights or playing the violin
• Female teens with larger breasts because the tissue pulls on the muscles surrounding the chest wall, especially if bras are not well-fitted, do not provide enough support or are tight-fitting with underwire

Diagnosing and Treating Costochondritis

There is no specific test used to diagnose costochondritis. A physical exam along with your child’s history are enough to confirm the condition. However, many cardiologists will perform an electrocardiogram (EKG) on any patient who is complaining of chest pain to make sure their heart is performing normally.

In mild cases, the symptoms may resolve with just behavioral modifications and time. In more prolonged cases, the most common treatment is a course of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen along with chest wall rest. It is somewhat like treating a sprained ankle — but in this case your child can’t stop using their chest muscles entirely because they  have to continue to breathe! This leads to repeated microscopic re-injury, which can be tough to treat. For that reason, if a child comes in with significant symptoms, a longer course of medication that is taken routinely, regardless of symptoms, for several weeks is recommended. Teens with particularly stubborn areas of costochondritis may need to be referred to an orthopedic doctor for an injection of steroids into the cartilage, which can provide relief.

Other treatments focus on behavioral modifications to provide chest wall rest and avoiding activities that worsen the pain. Gentle stretching can help in some patients, especially after the acute pain has subsided. Ice packs or heat can help, too. Different patients respond to cold, heat or alternating the two. Heat therapy more frequently is recommended because costochondritis usually is a chronic condition rather than an acute injury, and this increases blood flow and decreases muscle spasms. Cold therapy generally helps inflammation and is useful in patients with visible swelling or who have acute onset of their symptoms.

If your child has anxiety, it sometimes is difficult to persuade them that costochondritis is not dangerous because so many people associate all chest pain with heart conditions. In truth, for kids, it is very rare for chest pain to be related to heart conditions. The vast majority of cases are musculoskeletal, psychologic (anxiety related), pulmonary / respiratory and gastrointestinal. Kids who have cardiac conditions present with different histories and exams.

The other good news is that even though costochondritis can be stubborn to treat, there are no long-term effects of having this condition.