“I’ve got chest pain — I’m terrified it’s my heart — but it’s sharp, worse when I press on it or breathe deeply”

COSTOCHONDRITIS is musculoskeletal chest-wall pain — sharp, LOCALISED anterior pain, worse on movement/deep breathing/palpation and REPRODUCIBLE on palpation of the costochondral junctions — but it should be a POSITIVE diagnosis made after taking chest pain seriously and EXCLUDING the serious causes: cardiac (ACS/angina — central/heavy/exertional pain, radiation, sweating, breathlessness, risk factors), PE (pleuritic, breathless, calf, risk factors), pneumothorax, pneumonia, GORD, pericarditis and aortic causes, assessing history/risk factors (PE: two-level Wells and PERC per NICE NG158), using a recorded or in-person examination, and doing an ECG where any doubt — while suspected acute coronary syndrome means emergency referral without delaying transfer for tests (NICE CG95; a normal resting ECG does not exclude ACS). Visible swelling of a single junction suggests Tietze’s syndrome. Crucially, reproducible chest-wall tenderness alone does NOT fully exclude cardiac disease, so the absence of red flags and an appropriate assessment matter, and any doubt or atypical/risk features warrant investigation rather than false reassurance. Manage costochondritis with reassurance and clear explanation, analgesia (topical NSAID or paracetamol; an oral NSAID at the lowest dose for the shortest time only after checking asthma, GI, renal, cardiovascular risk and pregnancy — BNF), heat and activity modification, reassuring that it is self-limiting over weeks and avoiding over-investigation once the serious is excluded. The communication core is the patient’s cardiac FEAR/health anxiety (often google-fuelled): address it with genuine, grounded reassurance — which lands precisely because the serious has been taken seriously and excluded — rather than a dismissive "it’s nothing", exploring and supportively addressing recurrent health anxiety (NICE CG113). Safety-net clearly for red flags warranting urgent/999 care (central/crushing/exertional pain, breathlessness, radiation, sweating, collapse, or pain unlike this).