# Sharp chest pain when breathing in along with dry cough



## Ivan AG (Sep 29, 2010)

I've been recovering from a flu in the past week or so and in the last few days I've started to experience a really sharp pain in my left rib cage, right below my heart when I'm breathing in.

I also have a dry cough throughout the whole day which isn't very productive and simply makes the pain worse.

I've read some pretty disturbing things online about this kind of pain, but I don't want to play doctor just yet.

The front rib area on the left hand side below the heart (I've circled it) is very tender to touch and it feels like it's bruised although I do not remember suffering any blow to that area of my ribs.


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## Ivan AG (Sep 29, 2010)

I think I might call my GP soon.

The pain feels like a wound of some sort and it's fairly bad.

The pain gets worse when I straighten out my posture . The only relief I get is when I bend over forward so my posture is slumped.


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## alte (Sep 4, 2010)

It sounds like pericarditis versus post influenza atypical pneumonia. 
http://en.wikipedia.org/wiki/Pericarditis
Treat pericarditis with NSAIDs. Very suspicious for this but good idea to see your GP.


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## Ivan AG (Sep 29, 2010)

Thanks for responding.

I'll try taking some painkillers and probably arrange a date to see my GP on Monday.

I hope I don't end up in surgery over some stupid flu.


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## alte (Sep 4, 2010)

Ivan AG said:


> I think I might call my GP soon.
> 
> The pain feels like a wound of some sort and it's fairly bad.
> 
> *The pain gets worse when I straighten out my posture . The only relief I get is when I bend over forward so my posture is slumped*.


This happens because the membranes surrounding the heart are inflammed in pericarditis. When a person leans forward, the heart moves slightly out of the pericadial cavity, away from the surrounding lungs which relieves the pain. Sitting upright forces it back in between the lungs, contact with which, produces pain. Contact with lungs also causes a friction rub, a characteristic sound you hear when listening with a stethoscope. Otherwise, it produces very characteristic EKG changes, your doc will likely do an EKG to look for these. An ultrasound may be done as well to evaluate for fluid around the heart, which if present, may have to be drained depending upon the size of the collection.

Here is a very good site for more information on this topic:
*http://www.uptodate.com/contents/patient-information-pericarditis*

The only thing from your story which makes pericarditis less likely is the fact that the overlying skin is painful to touch. This suggests trauma or injury (but I may be wrong and it may happen with pericarditis as well, I don't know).

In your case, the likely cause is flu.

For treatment

"_Treatment of pain - In most patients with acute pericarditis, treatment begins with aspirin or a nonsteroidal anti-inflammatory drug (NSAID). This helps to relieve pain. If pain does not improve within one week, further evaluation and treatment are necessary. Rest is also considered an important part of the treatment in the acute phase of the disease._

...."


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## Ivan AG (Sep 29, 2010)

Never suspected a flu could lead to such complications.

Thanks for clearing things up and I'll be seeing my doctor ASAP.

This sounds quite serious.


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## alte (Sep 4, 2010)

It maybe serious, but this really depends upon what your threshold is for seriousness. It is not as life threatening as a heart attack or cancer but obviously not as simple as a common cold either. It is not uncommon and routinely treated and cured.


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## Ivan AG (Sep 29, 2010)

It's just my natural tendency to be a raving hypochondriac that's acting up again.


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## KiwiGirl (Nov 13, 2011)

Yes I was thinking pericarditis. You really need to go see a doctor as it can be very dangerous. People have just dropped dead with pericarditis, most people can seem ok but your heart is inflamed. I would be going to a doctor asap. It could also either be that your back is out or you have a chest infection.


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## Ivan AG (Sep 29, 2010)

I'm not sure if this is relevant, but the location of the pain does not correspond to the location of the heart.

The sharp pain is just above the diaphragm on the left side of my chest. 

I'm pretty sure my heart is closer to the center of the sternum and it isn't located so close to my stomach.

I'm currently taking some Ibuprofen tablets to help relieve some of the pain, and it's having a considerable positive effect.


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## Ivan AG (Sep 29, 2010)

KiwiGirl said:


> Yes I was thinking pericarditis. You really need to go see a doctor as it can be very dangerous. People have just dropped dead with pericarditis, most people can seem ok but your heart is inflamed. I would be going to a doctor asap. It could also either be that your back is out or you have a chest infection.


It's too late to call my GP.

If I die in my sleep tonight, at least it's a painless death.


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## KiwiGirl (Nov 13, 2011)

The heart is usually more to the center to the chest and just a little to the left, but I'd still get it checked out though as soon as you can. You make just have a chest infection.


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## alte (Sep 4, 2010)

Ivan AG said:


> I'm not sure if this is relevant, but the location of the pain does not correspond to the location of the heart.
> 
> The sharp pain is just above the diaphragm on the left side of my chest.
> 
> ...


Yay! Ibuprofen is an NSAID so appropriate choice.

The majority of the heart is located to the left of the sternum above the diaphragm as seen here,

http://www.google.com/imgres?hl=en&...tart=0&ndsp=17&ved=1t:429,r:0,s:0&tx=52&ty=90

(The diaphragm is the fuzzy line running across the chest.)


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## KiwiGirl (Nov 13, 2011)

Do you have any other symptoms?...Mucus, shortness of breath?


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## KiwiGirl (Nov 13, 2011)

It could be PLEURISY which is an inflammation of the lining around the lung. Best to wait to see the doctor, let me know what happens ok


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## alte (Sep 4, 2010)

KiwiGirl said:


> Yes I was thinking pericarditis. You really need to go see a doctor as it can be very dangerous. *People have just dropped dead with pericarditis,* most people can seem ok but your heart is inflamed. I would be going to a doctor asap. It could also either be that your back is out or you have a chest infection.


Have you seen this happen? Pericarditis can be dangerous but I think the complication rate is rare (I don't know the numbers though). The most dangerous thing that can happen is pericarditis converting to tamponade where there is a bleed into the pericardial cavity. This can cause pressure on the heart which prevents it from beating effectively. There is reduced cardiac output which may cause someone to pass out. It is treated by placing a needle just below the xiphoid process of the sternum to remove the blood (technically called pericardiocentesis).
I think this is a rare complication though.


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## Ivan AG (Sep 29, 2010)

KiwiGirl said:


> Do you have any other symptoms?...Mucus, shortness of breath?


Hmm, I am experiencing some coughing with very little to no mucus, which is just leftovers from the recent flu I had.

Shortness of breath is a tricky one for me, since I have trouble distinguishing between psycho-somatic responses to anxiety and actual physiological symptoms that result from a real problem.

To be blunt, even if I did have shortness of breath I wouldn't know if it's caused by anxiety or pericarditis.


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## Ivan AG (Sep 29, 2010)

alte said:


> Yay! Ibuprofen is an NSAID so appropriate choice.
> 
> The majority of the heart is located to the left of the sternum above the diaphragm as seen here,
> 
> ...


In that case, it's just me having bad understanding of anatomy.

I did not realize the diaphragm was so close to the heart.

The actual pain I'm describing is coming from here (circled area). The bone itself feels sore to the touch as if it's been struck really hard.

I don't know if it's just the friction from the inflamed heart you describe that I'm feeling, but it's sure doing a great job at fooling me into believing it's the bone.


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## KiwiGirl (Nov 13, 2011)

alte said:


> Have you seen this happen? Pericarditis can be dangerous but I think the complication rate is rare (I don't know the numbers though). The most dangerous thing that can happen is pericarditis converting to tamponade where there is a bleed into the pericardial cavity. This can cause pressure on the heart which prevents it from beating effectively. There is reduced cardiac output which may cause someone to pass out. It is treated by placing a needle just below the xiphoid process of the sternum to remove the blood (technically called pericardiocentesis).
> I think this is a rare complication though.


Hi, Yes I know its rare, but it can happen. I'm no doctor. We had a young girl, she was about 18, just collapsed. She was a dancer. They said she had Pericarditis and than a few weeks after her it happened to a man in his forties. They both died, but I understand that it is rare.


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## alte (Sep 4, 2010)

Ivan AG said:


> In that case, it's just me having bad understanding of anatomy.
> 
> I did not realize the diaphragm was so close to the heart.
> 
> ...


This could be musculoskeletal pain or pleurisy as KiwiGirl said. For the former, ibuprofen is still a decent choice.

I am still fairly convinced (60/40) it will turn out to be pericarditis because the pain is positional, and the way you describe it as getting worse with sitting straight and improving by slumping forward, is dead-on classic for pericarditis.


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## KiwiGirl (Nov 13, 2011)

alte said:


> This could be musculoskeletal pain or pleurisy as KiwiGirl said. For the former, ibuprofen is still a decent choice.
> 
> I am still fairly convinced (60/40) it will turn out to be pericarditis because the pain is positional, and the way you describe it as getting worse with sitting straight and improving by slumping forward, is dead-on classic for pericarditis.


I agree too. Please let is know how you go and take care


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## Ivan AG (Sep 29, 2010)

Can't make appointments with my GP during the weekend since they're not working. 

.......

I don't know if my condition warrants a visit to the emergency room.


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## JaneSmith (Dec 13, 2011)

Hey if you die can I have your car? 
Just kidding. 
Wishing you a speedy recovery.


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## Ivan AG (Sep 29, 2010)

JaneSmith said:


> Hey if you die can I have your car?
> Just kidding.
> Wishing you a speedy recovery.


Meh, I don't have a car.

You can have my computer and tennis rackets though.


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## alte (Sep 4, 2010)

Ivan AG said:


> Can't make appointments with my GP during the weekend since they're not working.
> 
> .......
> 
> I don't know if my condition warrants a visit to the emergency room.


Depends.

Are you feeling any better?

Would you be able to pay for an ER visit?


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## JaneSmith (Dec 13, 2011)

Ivan AG said:


> Meh, I don't have a car.
> 
> You can have my computer and tennis rackets though.


Deal!!! I need some new tennis rackets!!! You can just put my name on them now just in case. ;-)


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## Ivan AG (Sep 29, 2010)

alte said:


> Depends.
> 
> Are you feeling any better?
> 
> Would you be able to pay for an ER visit?


I played a 2 hour tennis match this morning, so I can't complain.

The pain is still there, but it feels somewhat dulled and less piercing compared to yesterday.

I'm still going to the doctor, but there is definite improvement in my condition.


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## alte (Sep 4, 2010)

_"Treatment for specific causes of pericarditis is directed according to the underlying cause. For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy. These agents have a similar efficacy with relief of chest pain in about 85-90% of patients within days of treatment. Ibuprofen has the advantage of few adverse effects and increased coronary flow. Indomethacin has a poor adverse effect profile and reduces coronary flow.

*A full-dose NSAID should be used (aspirin, 2-4 g/d; ibuprofen 1200-1800 mg/d*; indomethacin 75-150 mg/d). *Treatment should last 7-14 days*. A full-dose NSAID should be maintained until normalization of the C-reactive protein (CRP) followed by gradual tapering of the drug for another 1-2 weeks to prevent early reoccurrence"_

http://emedicine.medscape.com/article/156951-medication

You probably don't want to simply stop taking the medication. I am not sure whether you have this condition or not but bolded above is the recommended treatment for it. just an fyi.


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## Ivan AG (Sep 29, 2010)

I've read about the increased risk of peptic ulcers when taking NSAIDs.

There was some mention about taking proton-pump inhibitors while undergoing NSAID treatment for this condition. 

What's your take on this?


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## alte (Sep 4, 2010)

That's a good thought. Do you have a history of ulcers? Do you smoke or drink alcohol? If no, then the risk of developing ulcers is low especially because you will need only a couple days and not months and months of treatment.. regardless it wouldn't hurt to take a PPI simultaneously, just to be safe.


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## Ivan AG (Sep 29, 2010)

No history of ulcers, no smoking, and I drink about once a week on the weekend. 

I probably don't need PPIs for this treatment.


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## Blawnka (Dec 12, 2011)

I've been getting this occasionally for 4 months straight, I'm not sure what's going on either.


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## Ivan AG (Sep 29, 2010)

Very, very interesting.

My pain seems to be flaring up again as soon as I entered the evening hours, quite similar to my flu symptoms when I was sick.

I felt cured around 3-4 hours ago. Barely felt any pain and could stand up straight.


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## JaneSmith (Dec 13, 2011)

You can break a rib from coughing. just sayin.


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## Famous (Sep 6, 2011)

or you can bring on fibrousitis from coughing, causing muscle spasm,.


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## alte (Sep 4, 2010)

Ivan AG said:


> Very, very interesting.
> 
> My pain seems to be flaring up again as soon as I entered the evening hours, quite similar to my flu symptoms when I was sick.
> 
> I felt cured around 3-4 hours ago. Barely felt any pain and could stand up straight.


That is weird. Has it been awhile since you last took ibuprofen? Ibuprofen lasts 4 to 8 hours.


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## Ivan AG (Sep 29, 2010)

alte said:


> That is weird. Has it been awhile since you last took ibuprofen? Ibuprofen lasts 4 to 8 hours.


Yeah, I took Ibuprofen recently.

I'm feeling great right now and I'm contemplating whether a doctor's visit is worth it.

I'll take the decision in the morning depending on how I feel.


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## Ivan AG (Sep 29, 2010)

I'm back from the doctor's office. 

He used a stethoscope to try and detect any abnormalities, but came up with nothing.

He advised me to keep taking Ibuprofen and said to visit him again if the pain does not improve in a few days.


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## alte (Sep 4, 2010)

How is the pain today? Any better?


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## Ivan AG (Sep 29, 2010)

I'm practically cured.

The pain has subsided and I can comfortably stretch my back.

There is still a bit of pain but it's quite dull and nothing compared to Saturday night.

Thanks for all your help, alte.


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## KiwiGirl (Nov 13, 2011)

Glad you are feeling better and everything is good.


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## alte (Sep 4, 2010)

Ivan AG said:


> I'm practically cured.
> 
> The pain has subsided and I can comfortably stretch my back.
> 
> ...


no problem friend. glad you are doing better.


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## Ivan AG (Sep 29, 2010)

KiwiGirl said:


> Glad you are feeling better and everything is good.


Thanks, Kiwi.


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## alte (Sep 4, 2010)

How are things now?


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