Chest Pain: Is It Bone or Heart-Related?

Chest pain/sternal pain

Hello doctor, I have been experiencing chest pain, specifically in the middle of my chest (a bit above the sternum, roughly along the line connecting my nipples).
Whenever I exert my arms, whether pushing or squeezing inward, I feel pain in the sternum area when I relax.
Sometimes the pain is so severe that I have to move carefully or take deep breaths to alleviate it.
This symptom appeared three years ago after I suffered a clavicle fracture in a car accident.
I initially thought it would heal, but it hasn't.
Is this an issue related to the bones or the heart? I'm a bit worried that the impact might have caused a heart problem.
Which specialist should I see first? Thank you.

Yin, 20~29 year old female. Ask Date: 2020/12/05

Dr. Liao Yaopan reply Family Medicine

Hello, it is recommended that you consult your family physician or an orthopedic specialist for an evaluation first.
Depending on the situation, you may need to see a cardiologist.
Please note that online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2020/12/05

More Info

Chest pain can be a concerning symptom, and distinguishing between its potential causes—whether they are related to the heart or the musculoskeletal system—is crucial for appropriate management. Given your description of the pain being located in the upper center of the chest, just above the line connecting the nipples, and its association with arm movements, it is essential to consider a few factors.

Firstly, the location of the pain you describe suggests that it may be more musculoskeletal in nature, especially since it began after a clavicle fracture from a car accident. Pain that worsens with movement or specific positions often indicates a musculoskeletal issue rather than a cardiac one. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum), muscle strain, or even nerve irritation could be responsible for your symptoms.
However, it is also important to rule out any cardiac issues, especially given your history of trauma. While it is less common for a heart problem to present in this manner, it is not impossible. Symptoms of cardiac issues typically include pressure or tightness in the chest, pain that radiates to the arm, jaw, or back, and may be accompanied by shortness of breath, sweating, or nausea. If your pain is not associated with these symptoms, it is less likely to be heart-related.

Given your concerns about whether the previous injury could have caused any heart-related issues, it is advisable to consult a healthcare professional who can perform a thorough evaluation. You might consider starting with a visit to a primary care physician or an orthopedic specialist who can assess your musculoskeletal concerns. If they deem it necessary, they can refer you to a cardiologist for further evaluation.

In terms of diagnostic tests, your doctor may recommend imaging studies such as X-rays or an MRI to evaluate the condition of your bones and soft tissues. If there is any suspicion of cardiac involvement, an electrocardiogram (ECG) or echocardiogram may be performed to assess heart function.

In conclusion, while your symptoms seem more indicative of a musculoskeletal issue, it is essential to approach this with caution. Seeking a comprehensive evaluation from a healthcare provider will help clarify the cause of your chest pain and guide you toward the appropriate treatment. Remember, it is always better to err on the side of caution when it comes to chest pain, as timely intervention can be critical in preventing more serious complications.

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