Differentiating Between Costochondritis and Heart Issues
Hello, I'm a 23-year-old male, standing at 6'2" and weighing approximately 190 pounds. I realize the title might seem alarming, but I'm not great at coming up with names. For the last four days or so, I've been experiencing a mild discomfort in the vicinity of my heart, or perhaps just beneath it. This sensation comes and goes unexpectedly, lasting for varying periods. The discomfort has always been slight, never escalating to what I would label as a "squeezing" feeling. It hasn't radiated elsewhere, though at times I feel a more peculiar sensation, like a tingle, in my left elbow. Occasionally, this tingle extends to my palm, but these sensations typically dissipate quickly and don’t always coincide with the chest discomfort. Additionally, I've noted a minor pain located in the center of my chest, near my sternum. This feeling is somewhat strange—possibly reminiscent of pressure—but it’s hard to precisely describe. I haven't experienced any fatigue nor difficulty breathing. I've even attempted some light exercises (I'm mostly inactive and not in great shape), and my heart rate increased as expected; however, I felt fine throughout those activities—nothing seemed off. I would prefer to consult my doctor, but the clinic informed me that the earliest appointment available is on April 16th. Given my circumstances, visiting urgent care isn't an option for me, and I'm reluctant to go to the hospital, as I don't wish to appear overly dramatic or a waste of resources. Living with my grandparents, I mentioned my situation to my grandma. She offered me an aspirin, which appeared to alleviate the discomfort yesterday. Today, she provided another dose, and although I still experience the sensations, they are considerably milder and less frequent than before.
Answers (1)
3/27/2025, 10:50:39 PM
OpenHealth AI
It’s understandable to be concerned about chest discomfort, especially given your age and the uncertainties surrounding it. While the symptoms you describe could relate to costochondritis (inflammation of the cartilage in the rib cage), they can also evoke worries about heart-related issues, which is common. Let's clarify this situation and consider some next steps.
Key Points
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Nature of the Discomfort: The mild and intermittent nature of your discomfort, along with the absence of severe symptoms like difficulty breathing or fatigue, leans more towards musculoskeletal causes rather than cardiac concerns.
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Symptoms and Possible Causes:
- Costochondritis: Often presents as localized chest pain, especially near the sternum, which can sometimes resemble the pressure you described. It commonly improves with rest or over-the-counter anti-inflammatory medications like aspirin.
- Heart Issues: Chest pain from the heart is typically more severe and may be accompanied by additional symptoms such as shortness of breath, radiating pain, or severe pressure.
What to Do Next
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Monitor Symptoms: Keep a daily log of your discomfort, noting its intensity, duration, and any activities that exacerbate or alleviate it, like exercise or rest. This can help clarify patterns.
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Self-Care Measures:
- Rest: Avoid activities that intensify the discomfort.
- Ice or Heat: Applying ice or a warm compress to the chest area can help alleviate any muscular pain.
- Over-the-Counter Medication: If aspirin was helpful, you might consider continuing to use it as directed on the packaging, unless you have other contraindications.
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Continue Light Activity: Since you felt fine during light exercise, try to integrate some gentle activity, like walking, as tolerated. Pay attention to how your body responds.
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Prepare for Your Appointment: Since your consultation is set for April 16th, consider writing down your symptoms and history so that you can provide your doctor with detailed information.
Red Flags
If you experience any new symptoms such as:
- Chest pain that increases in intensity or lasts longer than a few minutes
- Shortness of breath that feels sudden or excessive
- Dizziness, fainting, or severe headache
Then it’s essential to seek immediate medical attention, regardless of your initial concerns about being dramatic.
Conclusion
While it’s normal to have concerns about chest discomfort, based on what you described, it seems more likely to be musculoskeletal in nature. Continue managing your symptoms at home and keep track of any changes. You're taking the right steps by preparing for your future medical appointment, and it’s perfectly okay to seek help when you're in doubt.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.