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Suggest treatment for costochondritis

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Posted on Wed, 12 Apr 2017
Question: Dear Sir
For last two years I have unusual contraction in heart muscle mostly near the upper joint of mediastinum that happens infrequently ( sometimes once in a week or once in a month) and lasts less than a fraction of second. But for last 10 days it is happening more frequently even few times in a minute. When that happens i just get scary feeling and i feel my increased pulse intensity and it happens mostly in right side of my heart and above the thymus position. Apart from that it happens more frequently in a certain body posture such as: if I stay in exhaling position and bend low for few second then it happens and also sometimes neck movement from left to right.
I do not any CHEST PAIN and my blood pressure is 110/80 and Height is 172cm and weight is 61 kg. No visible palpitation apart from heart contraction. I have done ecg and attached my report. I was under stress while doing ecg.

My question is
1) What could be the possible cause of this?
2) While doing ECG I did not have episode of heart contraction. Is it symptom of heart attack?
3) My doctor told me it related to heart muscle fasciculation. Is it true?
Please Reply.

doctor
Answered by Dr. Sameer Maheshwari (38 minutes later)
Brief Answer:
Should be a muscle spasm

Detailed Answer:
Hi Mr XXXXXXX
This is Dr Sameer, cardiologist from Fortis Hospital.
The pain you are telling looks like muscular pain or costochondritis (inflammation of joint between muscle & bone of chest). Both are benign conditions & treated with pain killer.
Cardiac pain is non localized (it is diffused), it has no relation to respiration or change in position. It increase on exertion & decrease after rest.
So your pain does not look like a cardiac pain. If you still want your cardiac evaluation, I'll advice you for a test called Stress Echo, which is a wonderful test to rule out future risk of getting a cardiac disease. I'll also advice you for Chest X Ray to rule out any bony abnormality causing the above pain.

I also went through the ECG you have sent. Leads V1, V2 & V3 are missing. So please send them as they are most important to analyse a ECG. Rest of leads are normal.

Thanks & take care
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sameer Maheshwari (2 hours later)
Dear Sir
I DO NOT HAVE ANY PAIN only abnormal heart contraction/squeezing in the right side of heart and squeezing near thymus position where artery and veins are going through. When that squeezes I feel scary and increased pulse intensity. I do not have any shortness of breath. At certain body posture and movement, it happens frequently even at rest and feel like my heart is sinking.

Sometimes when I feel that squeezing is about to happen then I change my posture after that it does not happen.
I have attached my V1 V2 V3 ecg report.

1) Does the above condition seem any heart/lung diseases?
2) whether it is heart muscle twitching as my physician told me?
3) Does it feel like atrial fibrillation ?
I am worrying a lot. Please reply.
Thanks.


doctor
Answered by Dr. Sameer Maheshwari (44 minutes later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back.
I got the attached V1-V3 leads & the ECG shows Right Bundle Branch block which is normal in 90% of peoples. To rule out any abnormality, I'll recommend for a 2D Echo. If that is also normal than you don't have to worry.
ECG does not show Atrial Fibrillation & it is normal sinus tachycardia.
A sense of contraction, squeezing or twitching is definitely muscular. It must be the muscle fibres of inner chest wall causing all this. Cardiac pain does not decrease on change of posture, but muscle squeezing do (as you said that the squeezing go after you change position).
Sometimes their is some abnormal contractions coming from the normal parts of body which is called VPC's(Ventricular Premature Contraction) which can cause similar problems. In a normal heart, it can arise normally & you don't have to worry about that.
So get your cardiac evaluation done which should include 2D Echo, Stress test(like TMT or stress echo). As i advised you earlier too, get a Chest X Ray done to rule out any chest bone abnormality.
For such patients we generally give pain killer with a muscle relaxant(Like Tab Mobizox/ Diclovis MR/Myoril) twice daily. We Also start a anti acidity medication like Tab Pantoprazole 40mg once daily.

I hope the tests come out normal & you be fine very soon.
If you have any more question, I'll be happy to help.
Thanks & take care
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Sameer Maheshwari (29 minutes later)
Thank You for your reply.
Sir, I do not have any pain, only heart contraction and squeezing which forms extra beat as a consequence it increases increased pulse intensity. No pain at all. Only feeling of heart sinking and got scared. I have acidity too.
doctor
Answered by Dr. Sameer Maheshwari (14 minutes later)
Brief Answer:
Need evaluation

Detailed Answer:
Hi Mr XXXXXXX
I can understand you don't have the pain & just have contraction & squeezing.
As i told you earlier also these comes from muscle contractions or it could be VPC's (which your doctor referred to as flickering of heart).

Get a 2D Echo, stress test & Chest X Ray done & if they are normal than you are fine from cardiology side.
If these squeezing or contractions persist even after taking pain killer with muscle relaxant than you can go for another test which monitors the heart beat for 24 straight hours. This test is called holter monitoring.
So don't worry & you can relax after getting the above tests done.

I hope your query is answered. If you have any more question, I'll be happy to help or you can choose to close the discussion.

Thanks & take care
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sameer Maheshwari (2 hours later)
Thank You Sir
I will do the above test. It will take time.
Before that I want know your opinion that whether heart muscle twitching can cause all the things or any other serious problem.
Tell me frankly.
Thank You Sir.
doctor
Answered by Dr. Sameer Maheshwari (7 minutes later)
Brief Answer:
Heart muscle twitching is VPC's

Detailed Answer:
Hello Mr XXXXXXX
As i told you, heart muscle twitching is nothing else but VPC's.
In a normal heart it can be present normally & does not cause any problem except sense of missed beat & feelings you are having.
So if your echo & stress test are normal, than you don't have to worry.
So relax, and get these tests done as soon as you can. You can live your normal life as you want.
Follow up after the reports so that i can guide you further.
Thanks & take care
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Sameer Maheshwari

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Suggest treatment for costochondritis

Brief Answer: Should be a muscle spasm Detailed Answer: Hi Mr XXXXXXX This is Dr Sameer, cardiologist from Fortis Hospital. The pain you are telling looks like muscular pain or costochondritis (inflammation of joint between muscle & bone of chest). Both are benign conditions & treated with pain killer. Cardiac pain is non localized (it is diffused), it has no relation to respiration or change in position. It increase on exertion & decrease after rest. So your pain does not look like a cardiac pain. If you still want your cardiac evaluation, I'll advice you for a test called Stress Echo, which is a wonderful test to rule out future risk of getting a cardiac disease. I'll also advice you for Chest X Ray to rule out any bony abnormality causing the above pain. I also went through the ECG you have sent. Leads V1, V2 & V3 are missing. So please send them as they are most important to analyse a ECG. Rest of leads are normal. Thanks & take care