Q: My sister went to the emergency room because she thought she was having a heart attack, but she ended up being diagnosed with costochondritis. What is that?

A: Costochondritis refers to inflammation of the costosternal joints, the cartilage between the ribs and the breastbone (sternum). It’s one of the most common causes of chest pain and is frequently mistaken for a heart attack.

Possible causes include physical strain (such as heavy lifting or strenuous exercise) or trauma (such as a blow to the chest). Even severe coughing may cause costochondritis. The condition may be related to an underlying musculoskeletal condition such as arthritis or a joint infection. But in most cases, the underlying cause remains a mystery.

With costochondritis, the chest pain may be sharp and stabbing or dull and gnawing, and it often gets worse if the person takes a deep breath or coughs. The chest may also feel tender when pressed and may possibly be swollen. In contrast, people in the throes of a heart attack are more likely to say they feel chest discomfort rather than pain or tenderness. They often describe sensations such as squeezing, tightness, pressure, or feeling like “an elephant is sitting on my chest.”

But often it’s not easy to tell the difference, which is why your sister was smart to go to the emergency room. Heart attacks are common and potentially very serious, so it’s always a good idea to rule out the possibility. Doctors advise people to call 911, since traveling via ambulance is faster and safer than going by car. If you say you have chest pain, the dispatcher will typically send paramedics who are trained to perform electrocardiography (ECG). This quick, painless test can often reveal if a person is having a heart attack. If you show up to the emergency room on your own and mention any symptoms that sound like a possible heart attack, you should have an ECG within about 10 minutes of your arrival. You’ll also get a blood test that checks for damage to the heart muscle.

However, there are no lab or imaging tests to confirm a diagnosis of costochondritis with certainty. This condition usually goes away on its own, without any treatment. But it can last up to several weeks and sometimes longer.

In the meantime, using a heating pad or applying pain-relieving creams or gels on the painful area can help. These include over-the-counter creams that contain capsaicin or salicylates, or a 1% diclofenac gel (Voltaren). Pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) are also options. Some people also find relief by doing gentle stretching exercises.

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