Costochondritis or Heart Pain? How to Tell the Difference

You twist to lift the shopping out of the car boot, or you've been coughing for a week after a cold, and then a sharp stab catches you in the chest every time you breathe in deeply. The first thought is obvious: is this my heart? Often the cause is the chest wall itself, specifically inflammation of the cartilage joining the ribs to the breastbone, called costochondritis. It's painful and worrying but not dangerous, and it settles with time. The catch is that it can feel like heart pain, and you can't reliably tell them apart on your own. This guide explains the differences, when to call 911, and how to look after yourself once a doctor has confirmed the diagnosis.

Costochondritis vs heart attack: what's the difference?

The table below sums up the usual patterns. They are patterns, not rules: heart attacks can show up in unusual ways, especially in women, older people and people with diabetes.

For the full list of heart attack signs, including the less obvious ones, see heart attack warning signs. For a wider look at chest pain from the heart, lungs and stomach, see chest pain: when to go to the ER.

What are the symptoms of costochondritis?

Almost all the ribs are joined to the breastbone by cartilage, and when this cartilage becomes inflamed it causes pain at the front of the chest. Typical symptoms are:

• Sharp, stabbing or aching pain at the front or side of the chest, often beside the breastbone and on one side.
• Tenderness when you press where a rib meets the breastbone.
• Pain that's worse with deep breaths, coughing, sneezing, moving your upper body or lying down.
• Pain that sometimes spreads to the back or the stomach area.
• Pain that eases when you keep still and breathe quietly.

What is Tietze syndrome?

Tietze syndrome is a rarer cousin of costochondritis. The pain is in much the same place, but there is also swelling you can see or feel over the rib joint, usually at a single upper rib. Costochondritis normally causes no swelling. Neither is dangerous, but a doctor is the one to confirm which you have.

Does chest wall pain when pressing rule out the heart?

No. This is the most important point in this guide. Pain you can bring on by pressing one spot does point towards the chest wall, but it doesn't exclude the heart: you can have chest wall pain and a heart problem at the same time, and a spot can become sore simply because you keep prodding it to test it. So never self-diagnose costochondritis for a first episode. See a doctor if the pain is new and unexplained, or if you have any heart risk factors: high blood pressure, diabetes, high cholesterol, smoking, a family history of heart disease, or being roughly over 40.

When you're seen, the doctor will ask about the pain and examine your chest, and may request tests from the laboratory or a chest X-ray to rule out other causes. Once a doctor has confirmed the diagnosis, similar episodes later are easier to manage, as long as you get checked again if the pattern changes.

When should you go to the ER for chest pain?

Call 911 for

• Chest pain that feels like pressure, squeezing or heaviness, or a tight chest.
• Chest pain that spreads to your arm, jaw, neck or back.
• Chest pain with breathlessness, sweating, nausea, light-headedness or fainting.
• Chest pain with difficulty breathing and a fast heartbeat, or coughing up blood.
• Sudden, severe chest or back pain that feels like something tearing inside.

Don't drive yourself to the emergency department, and don't wait to see if the pain goes away.

Go to the ER now

• New, unexplained chest pain, even if it hurts when pressed, especially if you have heart risk factors.
• Chest pain after a fall, a car accident or a hard blow to the chest.
• Chest pain with a high fever and feeling generally unwell.
• Chest pain that comes on with exertion and eases with rest.

Urgent care or a doctor the same day

• Swelling, redness or warmth over the ribs or breastbone.
• Chest wall pain that's getting worse or isn't easing with painkillers.
• Sharp pain with every breath.
• Chest pain after days of coughing, with mild breathlessness.

Usually fine at home

• Chest wall pain a doctor has already diagnosed as costochondritis, and it feels like your previous episodes.
• Pain in one spot that's worse with movement, and you otherwise feel well.
• Pain that's slowly improving over the days, with none of the signs above.

What causes costochondritis, and can vaping or anxiety cause it?

Often no clear cause is found. Medical sources link it to a chest injury, hard exercise or heavy lifting, repetitive upper-body movements, a lot of coughing during colds, flu or chest infections, some types of arthritis and, rarely, infection.

Vaping: there's no strong evidence that vaping directly causes costochondritis. But if vaping leaves you coughing a lot, the coughing itself can strain and irritate the chest wall. Bear in mind that chest pain with breathlessness in someone who vapes may be coming from the lungs; see vaping lung warning signs.

Anxiety: anxiety doesn't inflame the cartilage itself, but it can cause chest tightness, tense chest muscles and fast breathing, and it makes you more aware of any pain. Because a panic attack can feel like a heart attack, read panic attack or heart attack? and don't assume the pain is anxiety the first time.

How long does costochondritis last, and how do you treat it at home?

Costochondritis usually settles by itself over days to weeks, though for some people it lasts a few months. Once a doctor has confirmed the diagnosis, these steps help:

• Rest from strain. For now, avoid heavy lifting, workouts and the movements that set the pain off, and build back up gradually as it eases.
• Heat on the sore area a few times a day may help; some people find a cold pack more soothing.
• Painkillers: ask a pharmacist. Anti-inflammatories such as ibuprofen are often used, but they aren't suitable for everyone, for example people with stomach ulcers, kidney or heart disease or high blood pressure. Stick to the dose on the label.
• Deal with the cough if that's the trigger, and get advice if it lasts more than three weeks.

If the pain drags on or keeps coming back with certain movements at work or in sport, physiotherapy can help with how you move and a gradual return to activity. The physiotherapy clinic at Emergency Plus runs 9:00–20:00 daily with no referral and isn't open 24 hours; new chest pain belongs in the emergency department, which is open 24/7.

Sources

• NHS — Costochondritis
• MedlinePlus — Costochondritis
• NHS — Chest pain
• NHS — Heart attack symptoms
• NHS — Pericarditis