Costochondritis and heart palpitations: what to know

Costochondritis is irritation where a rib joins the breastbone. Pain may be localised, tender when pressed, and worse with movement, coughing, or a deep breath. Palpitations can feel like pounding, fluttering, skipped beats, or a racing heartbeat. Common triggers include stress, poor sleep, dehydration, fever, nicotine, caffeine, and some medicines. Palpitations can also occur with anaemia, iron deficiency anaemia, an overactive thyroid, low blood sugar, or an abnormal rhythm such as atrial fibrillation. Heart failure can cause breathlessness and a fast or irregular heartbeat, especially with reduced exercise tolerance.

The two sensations may happen at the same time without one causing the other. Pressing the painful area may support a chest-wall source, but it does not rule out a heart or lung problem.

Note when the palpitations begin, how long they last, whether the rhythm feels regular, and what you were doing. Record associated symptoms such as dizziness, breathlessness, faintness, fever, or chest pressure. Rest, drink fluids if you can, and avoid strenuous activity while symptoms are active. Do not stop prescribed medicines without advice. A clinician may check your pulse, blood pressure, heart rhythm, blood count, thyroid function, blood sugar, and hydration, with an electrocardiogram when appropriate.

Call emergency services if palpitations occur with severe or persistent chest pressure, fainting, marked breathlessness, blue or grey lips, confusion, or sudden weakness. Seek prompt medical advice for a new irregular heartbeat, repeated episodes, symptoms during exertion, or a personal history of heart disease. Chest tenderness that is severe, follows an injury, or is accompanied by fever also needs assessment.

Could the chest pain be coming from the rib joints, and what examination supports that? Do I need an electrocardiogram or blood tests? Could my medicines, caffeine, nicotine, thyroid, blood count, or hydration be contributing? Should I track my pulse during an episode?