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IDENTIFYING CHEST PAIN

Q: I'm 55 years old and have been having pain on the right side of my chest for three weeks. I saw a cardiologist, who did a lot of tests and said that my heart is OK, and that I have a rib injury from a touch football game I played a few days before the pain started.

My father died of a heart attack when he was young, and I'm afraid that my doctor is missing something. What do you think?

-- C.A., Hampton, Va.
A: Chest pain can be very frightening. When the pain starts, you can't help but think you may be having an episode of angina or, worse, a heart attack. And, given your father's experience, you are understandably very concerned.

But chest pain can be caused by many factors. The fact that the pain you feel is on the right side greatly diminishes the chances that it's coming from the heart, but that's not a 100 percent assurance.

Often the key to the finding the cause is what you were doing just before or when the pain started. And for some problems, such as rib injuries, there may be a delay of a few hours to a few days before the onset of symptoms

In your case, even though you may not have realized it at the time, there's a good chance that you injured yourself during the football game. This points to physical trauma and damage to your musculoskeletal system in the area where the pain developed. So costochondritis is a likely cause of your pain.

Costochondritis pain is usually sharp and localized, and it can be prolonged. Movement of the chest wall in heavy breathing or coughing often brings on the pain or makes it worse. And, unlike almost all other causes of chest pain, pushing on the chest wall with your hand will cause the pain or make it much worse.

Pain from costochondritis is different than angina pain, which is usually diffuse and dull. Angina pain usually lasts a short time and can radiate out from the chest, often to the left shoulder and upper left arm. Angina pain may feel like a tightness or squeezing.

Costochondritis is inflammation of the costochondral joints. These joints are located where the ribs change from bone to cartilage along the side and front of the chest prior to meeting at the sternum (breastbone).

This condition is usually caused by injury to the costochondral joint, such as from trauma or surgery. Sometimes that trauma can be due to something that seems minor at the time, like a severe coughing episode.

Costochondritis can also be caused by an infection. Such infection can be due to post-operative or post-traumatic complications. The infection can also be caused by transmission of organisms in infected blood by needle-sharing heroin addicts.

Costochondritis can be diagnosed on the basis of symptoms and identified by CT imaging. The problem areas show up as soft-tissue swelling along with underlying fragmentation of cartilage and destruction of bone.

Treatment of costochondritis is straightforward but often difficult to follow closely. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin can be effective for the pain, and antibiotics may be recommended if an infection is suspected.

However, the key to healing is to limit joint movement until completely healed.

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