Intercostal and chest pain
Intercostal and chest pain

Intercostal and chest pain: multiple causes

The pains felt in the thoracic cage and the ribs are relatively frequent and can have various causes, more or less serious. This type of pain always requires medical advice to rule out any risk of a cardiovascular accident.

Definition and symptoms for Intercostal and chest pain

Intercostal or thoracic pain can originate at the intrathoracic level (which may reveal a heart problem) or extra-thoracic (in the case of a peptic ulcer or hepatic colic, for example). It can be of several types (feeling of tightness, burning, cramp, etc.), more or less intense, appear suddenly or gradually, and intensity on inspiration or coughing, key characteristics to ask the diagnosis.

Intercostal pain is particularly anxiety-provoking since it can be a sign of myocardial infarction. It is also “a very frequent reason for consultation ” specifies Doctor Patrick Assyag, cardiologist.

Causes: heart attack, COPD, Tietze syndrome

While most people associate chest pain with angina or myocardial infarction, it can have several other origins.

  • The pain can obviously come from a recent trauma suffered at this location (fractured rib, sprain, or contracture of the intercostal muscle, etc.).
  • It adds the presence of osteoarthritis on the vertebrae or vertebral compression because of osteoporosis to the list.
  • Also, intercostal pain is commonly caused by Tietze syndrome, a mild disorder triggered by a simple “wrong move” or by inflammation of the cartilage. “It is very easy to identify because the pain is reproducible by pressure at a particular point” adds Doctor Assyag. In this case, the pain usually goes away on its own.
  • In addition, the origin can be neurological: intercostal neuralgia, shingles or fibromyalgia can, for example, be the cause of the pain felt.
  • Note that certain abdominal pathologies (in the stomach, liver, or pancreas) can sometimes cause pain that radiates to the ribs or chest.
  • Pulmonary pathologies are less likely to cause these symptoms: “People suffering from a chronic lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema, especially have significant respiratory discomfort”, explains Dr. Assyag. A pulmonary embolism, on the other hand, can cause sudden severe chest pain. The pain can also be psychogenic, or related to taking a psychotropic drug; it can sometimes be felt during a panic attack.

When to consult?

“If we are in the presence of an intense pain in the chest which goes up to the jaw and radiates to the arm, we are clearly facing the beginning of a heart attack and we must contact the emergency room” warns Doctor Assyag. More generally, pain in the chest should not be taken lightly and requires medical advice to verify that it is not a sign of a serious condition.

Emergency cases for Intercostal and chest pain

A call to the emergency medical service is necessary if the person has sudden chest pain, accompanied by neurological (agitation, anxiety, etc.), respiratory (congestion, cyanosis, etc.) disorders. ..) and/or cardiovascular (hypotension, mottling, pallor, …).


Depending on the outcome of the standard medical examination (which includes cardiac and pulmonary auscultation ), it may require the patient to perform additional examinations in order to detect any abnormalities. A chest x-ray and/or an electrocardiogram usually help to remove the doubt.

Thanks to Doctor Patrick Assyag, a cardiologist for his explanations.