Q. What is the reason for chest pain that occurs with deep breath and pressing?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 02, 2018 and last reviewed on: Sep 04, 2018

Hello doctor,

I need an advice and an opinion about a chest pain I have been having for the past four days. About four days back, I was at the family farm doing some cleaning. It was dusty everywhere and so when I finished, I coughed and felt the dust went inside my chest. Since then, I have been having a chest pain, right above my right nipple, the pain is kind of in the bone. So, when I press on my chest bone beneath or above my right nipple, I feel some pain. The pain sometimes comes to my neck or my side, and today it came to the left side of my chest which got me worried. The pain usually happens when I take a deep breath. It is not continuous.

A month back, early morning while I was at work, it was a dusty day. Shortly after work started, I felt a pressure on my chest and a shortness of breath. So, I went to the ER, and they transferred me to the cardiology unit because my troponin was elevated. It was at 0.7. They did EKG, and it was normal. Later on that day, my troponin was elevated to 4.3. So, they did an ECO, and it was normal. The following day, my troponin was down to 3.4. They thought I had some kind of blockage and so they did a cardiac catheterization and found everything was normal. there was no blockage. I have no diabetes or blood pressure. I follow a low carbohydrate diet with intermittent fasting. My blood pressure and EKG during my stay at the hospital was normal. So, I was diagnosed with pericarditis, an inflammation of the outer part of the heart.



Welcome to

There are two possibilities in you, first is of musculoskeletal pain, which is originating from muscles and bones resulted due to coughing and stretch over the bones and muscles. And another possibility is of viral infection which commonly follows such exposures. This leads to inflammation of pleura and pericardium (lining of lungs) called as pleuritis or pericarditis. Both the pain will increase on deep breathing. I guess you do not have any fever, cough, rhinitis, etc., which may or may not be associated. Was there any history of heavy weight lifting or trauma to the chest?

This is unlikely to be caused by heart blockages and does not appear worrisome. But, considering the history of pericarditis in last month, you should get one hemogram with ESR (erythrocyte sedimentation rate), ECG, chest X-ray and troponin done especially if symptoms persist. Also, vitamin D levels, of which deficiency is very common and predispose to such musculoskeletal pain. We also need to rule out other infections of the lungs because such exposures frequently lead to infections and above investigations will help in deciding the cause.

You may use Diclofenac gel or spray for local application for symptoms relief. So, overall the first possibility is of musculoskeletal pain, which I guess should settle in another 3 to 4 days and does not appear worrisome, but should be evaluated. You may need vitamin D supplements after its testing.

Thank you doctor,

I have no history of weight lifting or trauma to the chest. I do have a follow-up appointment with cardiology unit next week in which I guess they will test the troponin again, along with other tests. I do not have any fever or fatigue with the current pain. just the pain. I guess I am very comforted by your answer. So, do you think waiting until my next appointment is fine?



Welcome back to

Yes, listening to your symptoms, I think you may wait until your next appointment. But, if you develop any new symptoms like shortness of breath or severe worsening of pain, leg swelling. etc., which is unlikely to develop in you (warning symptoms), then you should visit the ER. Overall, it does not appear anything serious at present. All the best.

Hello doctor,

So, I did go to my follow-up appointment with the cardiologist. I described the chest pain I have been having, and he did tell me that this has nothing to do with the heart. I asked him to take some tests to be sure, and he told me no need to because your latest tests show that your heart muscle is strong, and you had catheterization, and your arteries were normal. He advised me to use a special gel for the pain like you did, and it worked fine. I still do have little pain on my chest from time to time, but it is likely going away.

When I left the cardiologist office, he asked me to make a follow-up appointment after four months. At home, I opened my health chart on the hospital system; I found out that the cardiologist had ordered me three refills for aspirin 81 mg, and Omeprazole 20 mg capsule, for four more months. I was surprised because my treating cardiologist when I was discharged from the hospital, told me to use Aspirin only for a month, and now this different cardiologist asking me to continue for four more months on Aspirin. He didn't order a refill for the Colchicine. I have two main questions, please.1. Is it normal for a pericarditis diagnosed patient to continue Aspirin for six months? I hear there is a side effect of internal bleeding.2. I have been reading a lot about this disease, and I am honestly worried about this disease happening again. How fatal is this disease? And how likely it is going to happen again considering I have clear medical history apart from this incident? Please note that upon my discharge from the hospital, my treating cardiologist told me that I was diagnosed with pericarditis, but he told me that there is a possibility that it is myocarditis. I would appreciate receiving your feedback about my two concerns.



Welcome back to

Do you still have pains or are they settled?

Firstly, the episode which you had was likely a pleuroperimyocarditis, that is involving pleura, pericardium, and myocardium as well due to elevated troponin. It was likely due to a viral infection. So, infection occurred and settled, and left no residual damage. So nothing to worry about it at present.

Now, there may be a risk of reinfection, especially if you are exposed to a similar environment again. But chances are there; the body will clear it earlier next time and may not manifest similarly. So, you should not worry about it at present. However, take precautions like using a mask or some cloth to prevent dust exposure.

Now, since your angiogram was clear, there was no role of Aspirin in the first place. But, giving it for some period may be accepted. So, I do not think there is any need for aspirin now. If you have angiogram report, then review it and see if they have mentioned any minor plaquing in arteries or slow flow, etc.

However, considering the dose is lowest, bleeding risk is not much and further lower with Omeprazole so that you may continue it. But per se, I do not see any need unless there were any minor pathologies on the angiogram, which I guess not there.

So, overall, does not seem worrisome. I do not think the need for Aspirin but having it in this dose with Omeprazole is usually safe.

Hi doctor,

Right now I do not have pain, but about two days ago I had some pain. When I used the gel, it went away. I did have some pain this morning, but it was probably in the muscle because I do remember the exact pain I had before my diagnosis. It was a stabbing pain to the right of my chest, not the left, which was weird because the doctor told me it is supposed to be on the left.

By the way, I went last week to the doctor and did a vitamin D test as you suggested. The result was 21 ng/ml, and the doctor said there is a moderate deficiency. Today, I took vitamin D from the pharmacy but the doctor told me not to take it until a week later, and I do not know why he said that.

Thanks for your response about the Aspirin. I am going to continue on Aspirin along with Omeprazole for one more month, and then I am going to stop. Are you saying not to worry about the infection happening again as long as I take precautions during dusty weathers which is very frequent where I live?



Welcome back to

Please take Vitamin D supplements, maybe after a week as you are advised. And according to me, there is no role of extended Aspirin in you.

Also, regarding infections, the body also take care of it better than previous due to immune memory and may clear it without causing any manifestations. Although, please avoid exposures as much as possible. All the best.

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