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Q. Why am I having sharp pain just left of sternum?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 09, 2018 and last reviewed on: Nov 23, 2022

Hello doctor,

Last night and today, I have been experiencing a sharp pain just left of the sternum, which is not deep, seemingly on top of the rib where it joins the sternum. It lasts a second or two but may repeat several times before stopping in five minutes or so. I went out in the garden today to dig a bit and wear my HR monitor (I have got health anxiety, anxiety disorder, well as depression). As I was digging, the pain started hurting with each heartbeat. I looked at my monitor, and it read 138 bpm. I am 70 years old and have been on medication (Benzodiazepines) for over 50 years for panic attacks and general anxiety. Two years ago, I felt similar pain but not to this extent. I went to ER, but nothing was found (the doctor said it could be costochondritis but definitely not my heart). I get bloodwork quarterly, and everything was fine except for the cholesterol, which was 235. I tried a statin, but the muscle pain was too great. In my EKG, I have RBBB or LAFB, which, 14 years back, after a stress test, I was told that I was probably born with it. I had gone to see the cardiologist then because of getting skipped beats and GERD he told me to ignore them. The last time I had an EKG was in the ER for six months when I had a weird pain in my back and side. They checked out the heart anyway and said it was fine. Probably just a colicky gallbladder. I have had stones for more than 20 years and have had no surgery. So I hesitate to go to the ER again. My local doctor just closed. HR is still 88 while lying down right now. Usually, my resting heart rate is under 67. Currently, I am on Lorazepam 2 mg, Prevacid 15 mg, and baby Aspirin.

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Hello,

Welcome to icliniq.com.

I have gone through your history, and it does not appear to be an ischemic pain. Ischemic pain will not be sharp and so short lasting. So the possibilities are costochondritis and pleuritic or pleuro-pericarditis. Do you get an increase in pain on the application of pressure at the same site? If yes it supports the diagnosis of costochondritis? Also, do you have any history of recent upper respiratory tract infections like a cough, rhinitis, fever, etc.? If yes, it points to pleuro-pericarditis, which is an infection of the lining of the lungs and heart which is usually viral and self-resolving.

The possibility is of gastritis and reflux disease. Do you also have upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water, and feeling in throat or chest burning? These are the other symptoms that may be associated.

An increase in heart rate is likely due to anxiety or pain or as a reflex to pain. So, get some more details of the symptoms, as I explained above. Meanwhile, you should get prescribed some NSAIDs (non-steroidal anti-inflammatory drugs) for this pain along with antacids like tablet Naproxen 250 mg two times a day or others like Ibuprofen along with tablet Pan DSR (Pantoprazole) or Esomeprazole Domperidone combination before breakfast once a day for five days.

So overall, it does not appear to be a matter of worry. However, it is better to get yourself examined by a local doctor.

Hi doctor,

Thank you for the reassurance that it is probably not cardiac pain. When frustrated, I tried walking up and down stairs while singing. I did get concerned about the third time down; I was getting short of breath but still sang slightly. I am out of shape for winter if working indoors (I am an artist). It just seems to take longer these days. Also, I never used to wear an HR monitor while gardening. I usually just rested (within two minutes, HR usually drops 30+ points). This health anxiety or depression is driving me nuts. I was never so lethargic as I am now. Fatigued for the last two years, my CBC and lipid panels are pretty good (except for cholesterol at 235, of course). I am hoping a few days on Advil will solve the problem.

#

Hi,

Welcome back to icliniq.com.

This should resolve with Advil (Ibuprofen) in a few days. You may also use Diclofenac gel for local application two times a day. For your anxiety part, you should also request Propranolol also (Ciplar LA 20 mg), which will help with anxiety and also keep the heart rate down. Avoid heavy activities till this is settled especially lifting heavy weights.

Try to remain engaged in some other activities and hobbies in order to reduce thinking about health and anxiety. So overall, as I mentioned, it does not appear to be an ischemic pain. Ischemic pain usually occurs with exertion and relieves with rest. This should continue for at least a few minutes, 5 to 10. Ischemic pain may occur at rest, but if one has got a heart attack and it is severe, it lasts for a longer time.

Pain for a few seconds may be due to costochondritis, pleuritic or esophageal spasm with acid reflux. Also, you should avoid fatty, oily, and spicy diets. Have some walks after having food instead of taking a rest. Have multiple small meals instead of heavy meals. Have regular sleep habits. Avoid smoking and alcohol, if any.


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