Contributors: Michael Yu and Dr. Emran of Simple Health Radio
On this episode of Simple Health Radio, Dr. Emran recalls a case involving a young man named “Zack”.
Zack is a healthy 26-year-old African American male who showed up at the ER with a 1-week history of severe chest pain.
Zack works as a high school gym teacher and lives an active lifestyle. His family had no history of heart problems and he himself had no medical issues. Zack could not recall any injuries that may have caused the chest pain and did not experience any physical trauma, such as a car accident.
Despite all this, the chest pain was bothering Zack so much that he could not sleep, go to work, or even get dressed in the morning. Zack told Dr. Emran that the pain got worse with sneezing and described it as “sharp” and “shooting”.
Zack’s initial physical examinations didn’t produce any alarming results: his lungs were clear, he had no fever or a cough, and he was able to talk in a full sentence. However, Dr. Emran did note that Zack’s chest was tender over certain areas.
Dr. Emran continued with a chest x-ray, only to find that Zack’s chest seemed completely healthy; there were no signs of broken ribs or infections. An EKG (electrocardiogram) was then used to look at Zack’s heart rhythm, which was also completely normal. After a few more rounds of tests on Zack’s electrolytes, blood sugar, and immune function, there was still no cause that could be identified.
Dr. Emran took another look at Zack’s chest and found that his pain was reproducible, meaning that physically pressing on his chest would cause the pain to become worse.
With this information, Dr. Emran concluded that Zack had costochondritis.
The chest and ribcage are an important part of the body. Humans have 12 ribs on each side. Some ribs are complete, meaning they go from the spine and wrap around to the sternum. The sternum is the breastbone in the middle of the chest which is made of cartilage and is the most flexible part of the chest.
Costochondritis occurs whenever the ribs connecting to the sternum become inflamed as a result of physical exertion, infection, or injury. Dr. Emran explains that Zack’s costochondritis may have been caused by a change in his physical routine or a mild infection.
Every year in the U.S., more than 600,000 cases of costochondritis are diagnosed, especially among healthy adults and teenagers. Dr. Emran tells us that most people who have chest pain often avoid visiting the ER. Instead, they take over-the-counter medications such as Tylenol and Advil to wait out the pain. Sometimes, the chest pain goes away, but in Zack’s case, the pain simply became worse.
Dr. Emran decided to treat Zack with a combination of medications. Zack was offered prescription NSAIDs, steroids, and a short course of Tylenol with Codeine. NSAIDs are medicines that help reduce swelling and inflammation without causing drowsiness. The steroids also help reduce inflammation, but with a stronger effect. Before the inflammation is reduced, the Tylenol and Codeine would help Zack sleep more soundly.
The prescriptions worked and after several days, Zack was almost pain-free. He was advised to follow-up with his doctor and do some additional testing, just to be on the safe side.
Costochondritis is a common cause of chest pain. If you or your family experience costochondritis, please reach out to us and provide feedback so we can educate others about this condition.
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If you think you may have a medical emergency, call 911 immediately. Dr. Emran and Simple Health Radio do not recommend or endorse any specific tests, physicians, products, procedures, opinions, consults, or any other information that may be mentioned on this website or radio podcast.
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