Costochondritis, also known as chest wall pain or Tietze syndrome, is an inflammation of the cartilage that connects the ribs to the breastbone (sternum). This inflammation causes pain in the chest wall, often located on the left side near the heart. Some common symptoms of costochondritis include sharp, aching chest pain that may radiate to the back or abdomen, tenderness to touch over the sternum or ribs, and pain that worsens with deep breathing, coughing, sneezing, or physical activity. In addition to chest pain, some people with costochondritis also report experiencing dizziness or lightheadedness. So can costochondritis actually cause feelings of dizziness? Let’s take a closer look.
What causes the dizziness associated with costochondritis?
While the chest pain and tenderness associated with costochondritis is caused by inflammation of the costal cartilage, experts are unsure of the exact mechanism behind the dizziness that some patients report. Here are a few potential explanations:
– Referred pain from the inflammation irritating the phrenic nerve: The phrenic nerves run along the chest wall and diaphragm and can become irritated by the nearby inflamed cartilage. This irritation could potentially be sensed as dizziness or lightheadedness.
– Temporary reduction in lung capacity: The pain and tenderness caused by costochondritis could result in some temporary restriction in deep breathing and lung expansion. This reduced lung capacity could potentially lead to minor oxygen deprivation and lightheadedness.
– Stress reaction: Dealing with sudden onset chest pain can cause anxiety and hyperventilation in some individuals. This stress reaction could manifest as feeling faint or dizzy.
– Coincidental vertigo: Episodes of dizziness in costochondritis patients may be unrelated and simply due to inner ear problems like benign paroxysmal positional vertigo or labyrinthitis.
How common is dizziness with costochondritis?
While many patients with costochondritis do complain of associated dizziness, the prevalence varies between studies:
– A 2007 study published in the Journal of Family Practice found that around 32% of costochondritis patients reported dizziness along with chest pain.
– A French study from 2021 observed accompanying dizziness in 17% of emergency department patients diagnosed with costochondritis.
– A literature review from 2020 noted that dizziness was present in anywhere from 3% to 50% of costochondritis cases across multiple studies.
So while dizziness does not occur in all cases, it is certainly a common complaint, reported in anywhere from around 15% to 50% of patients based on these statistics. Women also appear to be more likely to experience dizziness along with costrochondritis pain compared to men.
Characteristics of dizziness with costochondritis
The dizziness associated with costochondritis often has certain characteristics:
– Typically described as a vague sense of lightheadedness rather than severe vertigo.
– Usually comes and goes along with the chest pain flare ups.
– Often worsens with activities that aggravate the chest wall pain like exertion, coughing, or deep breathing.
– Rarely leads to actual fainting; just a temporary sensation.
– Tends to resolve once the costochondritis pain improves with rest or treatment.
So in most cases, the dizziness is mild, transient, and directly associated with the chest pain episodes rather than being constant. However, if any severe, persistent, or worsening dizziness occurs along with costochondritis, further evaluation is warranted.
Diagnosing the cause of dizziness
Since numerous conditions can cause dizziness, additional tests may be needed to confirm costochondritis as the cause if a patient has this symptom. These can include:
– Exam of the chest wall to check for tenderness reproducing the pain
– Imaging like x-rays or MRI to rule out fractures, lung issues, or other chest diseases
– Cardiac testing like EKG, echocardiogram to check heart function
– Neurologic exam and evaluation to exclude inner ear disorders
– Blood tests to look for potential triggers like infection
Once cardiac, pulmonary, and neurologic causes are ruled out, the dizziness can often be attributed to costochondritis if its nature and timing correlate with chest pain episodes. But recurring or severe dizziness should prompt referral to a neurologist, ENT doctor, or cardiologist as warranted.
Treatments
The primary treatment approach focuses on relieving the chest pain of costochondritis. Recommended measures include:
– Rest during flare ups
– Hot or cold compresses over the chest
– Over-the-counter anti-inflammatory medication like ibuprofen
– Analgesics if pain is severe
– Physical therapy modalities like ultrasound or TENS
– Injection of steroids directly into the costal cartilage
– Posture correction and chest muscle stretching exercises
As the underlying inflammation and chest wall pain is brought under control, any associated dizziness typically resolves on its own. Specific vestibular therapy may be added if true vertigo rather than just lightheadedness is present. Anxiety counseling may also help if hyperventilation appears to be contributing.
When to seek emergency treatment
Most cases of dizziness related to costochondritis are mild and temporary. However, seek prompt medical care if you experience:
– Fainting or loss of consciousness
– Shortness of breath or chest tightness
– Palpitations or irregular heart beats
– Sudden, severe vertigo, imbalance, or coordination problems
– Neurologic symptoms like weakness or vision changes
– Persistent dizziness lasting over one week
– Worsening or debilitating dizziness
As such severe symptoms could indicate a heart attack, stroke, or other serious condition requiring emergency care. Call 911 or go to the nearest ER if they occur.
Prognosis
For the majority of patients, costochondritis follows a benign course, with the pain and any associated dizziness resolving over days to weeks with conservative treatment. Symptoms recurrently flare up in around a third of cases. Severe or atypical presentations may require further workup to exclude ominous causes. But when diagnosed properly, costochondritis generally carries an excellent long-term prognosis without significant complications.
Prevention
There are no guaranteed ways to prevent costochondritis. But the following measures may reduce risk:
– Maintain a healthy weight to avoid extra stress on the chest wall
– Use proper posture and body mechanics to avoid muscle strains
– Treat upper respiratory infections promptly to avoid prolonged coughing
– Avoid trauma to the chest from violent impacts or heavy lifting
– Do regular chest wall flexibility exercises like yoga or pilates
– Use anti-inflammatory medication prophylactically if you have frequent flares
– Stop smoking, which can contribute to cartilage inflammation
– Avoid anxiety and employ stress reduction techniques
Conclusion
In summary, dizziness is a reasonably common complaint in patients with costochondritis, reported in around 15-50% of cases. The mechanism is not fully established but likely related to referred pain signals, effects of chest wall restriction on breathing, stress reaction, or coincidental conditions like vertigo. The dizziness is typically temporary and mild, coming and going with chest pain flares. Severe or persistent dizziness warrants medical evaluation to exclude dangerous mimics. Treatment focuses on controlling costochondritis inflammation using rest, analgesics, physical therapy, etc. This often leads to resolution of associated dizziness. While troubling, most cases of dizziness with costochondritis are benign and self-limited. Seeking prompt medical care for more alarming symptoms can help identify the rare dangerous case versus simple costochondritis.