Dec 1, 2008 11:02 am US/Eastern
Dr. Mallika's Files: 'Am I Having A Heart Attack?'
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case: A 28-year old woman comes to clinic worried that she's having a heart attack. For the past two weeks she has been having sharp pain on the left side of her chest that comes and goes. The pain gets worse when she takes a deep breath, coughs, or bends forward. Her mother recently had a heart attack and she's terrified she's having one, too. Upon further questioning, she had a cold a few weeks ago which has completely resolved. She has had no fever, shortness of breath, nausea or vomiting. She does not smoke cigarettes and denies drug use. She is otherwise healthy and takes no medications.
On exam, she appears slightly anxious and is holding the left side of her chest with her right hand. Her lungs are clear and her heart exam is normal. When I push on her breastbone, she yells, "Ouch." An electrocardiogram is negative.
Discussion:
Other than a family history, this woman has few risk factors for heart disease. She is young and healthy and does not smoke. Therefore, it would be highly unusual for her to be having a heart attack… though not impossible. More likely, given this scenario, is a condition called Costochondritis.
Costochondritis is inflammation of the joint between your rib and your breastbone. It causes localized chest pain that is reproduced when you push on the chest wall. Costochondritis often mimics a heart attack, but it's a harmless condition that usually resolves on its own within a few weeks. We don't know exactly what causes it but it often occurs after a viral respiratory infection. Treatment usually involves taking anti-inflammatory medications like ibuprofen. A heating pad can also provide some relief.
Follow-up:
The woman took ibuprofen as prescribed, and her chest pain slowly resolved over the next few days.
A Word of Caution
Anyone who is experiencing new chest pain or discomfort should be evaluated by a doctor right away, even if you're young and healthy. A heart attack can strike anyone at anytime and should be ruled out before a diagnosis like costochondritis is made.
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