Treatment is with nonsteroidal anti-inflammatory drugs (NSAIDs) and rest, and recovery is commonly spontaneous. (3)Дisease is usually self-limiting with occasional relapses. The upper costal cartilages at the costochondral or costosternal junctions are commonly noted to be tender. Presents with single or multiple areas of tenderness that reproduce the pain. Isolated musculoskeletal chest pain syndromes: i.Д¬ostosternal syndromes (costochondritis) (1) Instruct all of these patients to return if they experience any fever, palpitations, lightheadedness, shortness of breath, diaphoresis, change in the character of their pain, or radiation of pain to their arm, shoulder, or jaw. Direct the patient to seek follow-up with a primary care practitioner.Д®xquisite tenderness localized over the xiphoid cartilage may represent the rare condition of xiphoidalgia, which may be treated with a course of nonsteroidal anti-inflammatory drugs (NSAIDs) as described earlier. If the ECG and chest radiograph are normal and there is no evidence of other disease (the symptoms are purely musculoskeletal, there are no associated symptoms or significant risk factors, vital signs are normal, and the abnormal physical findings are limited to the chest wall tenderness that mimics their pain), prescribe anti-inflammatory analgesics, have the patient apply heat to ease discomfort, explain the pathophysiology, and reassure the patient that this discomfort usually subsides within 3 weeks.

If there is any suggestion of cardiac, aortic, or serious gastrointestinal or pulmonary disease if there are complaints of chest tightness or pressure or if there are significant cardiac risk factors or risk factors for PE, obtain appropriate consultation and strongly consider admission. When there is a reasonable possibility of one of these more serious clinical entities to be present, a more complete medical workup is required. The presence of costochondritis does not exclude the possibility of aortic dissection, myocardial infarction, pericarditis, esophageal or peptic ulcer perforation, PE, pneumomediastinum, pneumothorax, pneumonia, mediastinitis, or pleural effusion. If any abnormalities are discovered and there is any suspicion of a pulmonary, cardiac, vascular, or gastrointestinal disorder, begin the appropriate treatment and clinical investigation.

If there is concern for PE, but the patient is low risk, consider applying the PE rule-out criteria (PERC rule: age <50 years, pulse <100, SaO 2 в‰Ґ95%, no hemoptysis, no estrogen use, no surgery/trauma requiring hospitalization within 4 weeks, no prior venous thromboembolism, no unilateral leg swelling) to determine need for d-dimer testing to exclude PE. Carefully examine the abdomen using deep palpation under the costal margins, looking for signs of intraabdominal tenderness.ДЄt a minimum, obtain an electrocardiogram (ECG) and have a low threshold for chest radiograph or sonography. Inquire about any risk factors for pulmonary embolism (PE e.g., estrogen use, recent surgery, immobilization, malignancy, personal or family history of thromboembolic disease) or about a history of preexisting cardiac risk factors (e.g., family history of early-onset coronary artery disease, smoking, hypertension, diabetes mellitus, obesity, elevated cholesterol levels, or stimulant abuse).Д«e attentive to abnormal vital signs, pleural or pericardial rubs, new murmurs and dysrhythmias, single or paradoxic splitting of the second heart sound, new gallops, unilateral leg swelling, asymmetric pulses, and signs of congestive heart failure, which include rales, peripheral edema, and jugular venous distention. Pay special attention to the specific location and character of the pain (e.g., onset, severity, quality, radiation, duration, and whether it is related to strenuous activity, movement, deep breathing, and cough) and associated symptoms (e.g., sensation of a racing heart, palpitations, pallor, syncope or near-syncope, shortness of breath, nausea, vomiting, fever, weight loss, fatigue, diaphoresis, cough, or wheezing). Obtain a thorough history and perform a complete physical examination.

Upper chest discomfort nsaid