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Have Severe Sternum Costochondritis. Have Frequent Rapid Heart Rate And Pain. Fatigued, Nauseous And Feel Unwell. What Can Be Done?
Question: I have pretty severe sternum costochondritis which prevents me from ever being able to take a deep breath. The pain can be pretty severe at times but what is really limiting my ability to function is very frequent rapid heart rate. I will wake up out of a sound sleep sometimes to find that my heart is beating as if I've just been running hard. If I try to use the crosstrainer (elliptical) at the gym without the arm movements, even going at just 2 mph at the lowest setting, within one minute my heart rate is in the mid 170s to 180s and no matter how slow I go I can never get below 165. At home I know my heart is speeding up any time I try to do daily tasks like wash dishes, hang laundry, sweep, etc. although I don't know how fast it gets in those situations. I feel very uncomfortable when this is happening and quickly become very fatigued, nauseous, and just generally feel unwell. Am I doing damage to my heart if I continue trying to exercise? Is this due to the costochondritis? I had an EKG and a heart catheter done over a year ago when this first started and everything was fine although the hospital did notice that my heart would suddenly speed up for no apparent reason at times.
Respected Ma'm
1. Treatment of costochondritis involves use of simple pain relievers, rest, avoiding movements which provoke pain, use of moist heat (application of towel wet with warm water) and rarely local injections of steroids.
2. It is normal and common to feel forceful heart beat with increased rate when you suddenly woke up from sleep. This is especially true for early or deep sleep.
3. I hope your cardiologist have ruled out that there is any condition in your baseline ECG which predisposes you to rhythm disorders.
3. Most important factor in treating your episodic increase in heart rate is knowing the rhythm at the time of increase in heart rate. The management can only be decided after ascertaining the rhythm. The methods to determine the rhythm are ECG (at the time of episode), 24 hours holter monitoring (if the episodes occur daily) or loop recording for longer intervals (e.g. 30 days or more). Second important investigation is to see the structure of heart by ECHO.
4.If there is some other rhythm disorder or there is a structural heart disease, the treatment will depend upon the condition.
5. If the rhythm is simply a quickening of normal rhythm mechanisms (sinus tachycardia) and there is no structural heart disease, we look for other predispositions. These involve use of tea/coffee/smoking/drug abuse/anti-asthma drugs/ anti cold drugs/ over-treated hypothyroidism/ anemia/ significant lung disease/ Significant systemic disease. A cardio-pulmonary testing which involves exercise under controlled conditions with monitoring of heart rate, rhythm, oxygen saturation will also help in understanding mechanism behind your problem.
6. This is not likely to be due to costochondritis.
7. If you are really damaging your heart by exercising or not, is not possible to answer with the information available. This definitely needs your examination/ further work-up.
With this insight, you can discuss the case with your local cardiologist and proceed accordingly.
Feel free to discuss further.
Sincerely
Sukhvinder
1. Treatment of costochondritis involves use of simple pain relievers, rest, avoiding movements which provoke pain, use of moist heat (application of towel wet with warm water) and rarely local injections of steroids.
2. It is normal and common to feel forceful heart beat with increased rate when you suddenly woke up from sleep. This is especially true for early or deep sleep.
3. I hope your cardiologist have ruled out that there is any condition in your baseline ECG which predisposes you to rhythm disorders.
3. Most important factor in treating your episodic increase in heart rate is knowing the rhythm at the time of increase in heart rate. The management can only be decided after ascertaining the rhythm. The methods to determine the rhythm are ECG (at the time of episode), 24 hours holter monitoring (if the episodes occur daily) or loop recording for longer intervals (e.g. 30 days or more). Second important investigation is to see the structure of heart by ECHO.
4.If there is some other rhythm disorder or there is a structural heart disease, the treatment will depend upon the condition.
5. If the rhythm is simply a quickening of normal rhythm mechanisms (sinus tachycardia) and there is no structural heart disease, we look for other predispositions. These involve use of tea/coffee/smoking/drug abuse/anti-asthma drugs/ anti cold drugs/ over-treated hypothyroidism/ anemia/ significant lung disease/ Significant systemic disease. A cardio-pulmonary testing which involves exercise under controlled conditions with monitoring of heart rate, rhythm, oxygen saturation will also help in understanding mechanism behind your problem.
6. This is not likely to be due to costochondritis.
7. If you are really damaging your heart by exercising or not, is not possible to answer with the information available. This definitely needs your examination/ further work-up.
With this insight, you can discuss the case with your local cardiologist and proceed accordingly.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My costochondritis is very severe and hasn't responded to any treatments including steroid injections. I am actually getting an SCS implant for it. During the implant trial I had no problems with my heart rate at all and was able to do everything I wanted to which is why I was wondering it was caused by the costochondritis. Once the trial ended, the problems began again. Unfortunately when I had the permanent implant installed, it wasn't in quite the right spot and am now awaiting revision surgery. Do you think it's okay to try to just ignore it and push on with whatever I'm doing or should I continue to stop and sit or lie down until it normalizes as I've been doing now?
Respected Ma'm
1. If the SCS or "spinal cord stimulator" has not been placed properly, it may produce some effects on your autonomic nervous system in the cord. Autonomic nervous system influences your heart rate too. But it will not produce abnormal fastening of heart rate with activity alone. This is something not expected out of a mal-placed SCS.
2. You should seek the opinion of your cardiologist about this rapid heart rate. It does not seem to be related to costochondritis. This must be evaluated to establish a proper diagnosis. Once we know the cause, approaches to definite management can be tried.
Sincerely
Sukhvinder Singh
1. If the SCS or "spinal cord stimulator" has not been placed properly, it may produce some effects on your autonomic nervous system in the cord. Autonomic nervous system influences your heart rate too. But it will not produce abnormal fastening of heart rate with activity alone. This is something not expected out of a mal-placed SCS.
2. You should seek the opinion of your cardiologist about this rapid heart rate. It does not seem to be related to costochondritis. This must be evaluated to establish a proper diagnosis. Once we know the cause, approaches to definite management can be tried.
Sincerely
Sukhvinder Singh
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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