Pectus excavatum, commonly known as “sunken chest” or “funnel chest,” is the most frequent chest wall deformity. This structural condition involves an inward indentation of the sternum, or breastbone, and the ribs connected to it. While often present from birth or developing during adolescent growth spurts, its potential to cause chest pain is a common concern. This article explores how pectus excavatum can lead to chest discomfort, other common causes of chest pain, and when to seek medical attention.
Understanding Pectus Excavatum
Pectus excavatum is a condition where the breastbone and the cartilage joining it to the ribs grow abnormally, leading to a caved-in appearance of the chest. This indentation can vary in depth, appearing as a slight dip or a more pronounced, scooped-out shape in the center or to one side of the chest. It is the most frequently observed congenital chest wall deformity, affecting approximately 1 in 400 to 1 in 1,000 live births. Though often noticeable in early life, the severity of the indentation can become more apparent during periods of rapid growth, such as puberty.
How Pectus Excavatum Can Cause Chest Pain
Pectus excavatum can contribute to chest pain through several distinct mechanisms. Musculoskeletal pain is a primary source of discomfort, arising from direct pressure or impingement on the underlying structures of the chest. This includes the ribs, cartilage, and intercostal muscles, which can become strained or irritated by the abnormal sternal position. Movement, changes in posture, or physical activity can often aggravate this type of pain. Additionally, individuals with pectus excavatum sometimes exhibit poor posture, such as rounded shoulders or scoliosis, which can further contribute to musculoskeletal back and chest pain.
In more severe cases, the inward-growing sternum can physically compress or displace organs within the chest cavity, such as the heart and lungs. While this compression might not always manifest as direct pain, it can lead to symptoms that are perceived as chest discomfort or pressure. These symptoms often include shortness of breath, particularly during physical activity, reduced exercise tolerance, and heart palpitations or a rapid heartbeat. The sternum’s posterior displacement can specifically cause an anterior indentation of the right ventricle of the heart, affecting its function.
Nerve irritation can also play a role in the chest pain experienced by individuals with pectus excavatum. The abnormal chest wall structure may lead to compression or irritation of the nerves in the area, contributing to localized pain. It is important to recognize that the degree of the deformity does not consistently predict the presence or intensity of chest pain, as some individuals with significant indentations may experience minimal discomfort.
Other Potential Causes of Chest Pain
Chest pain is a symptom associated with a wide array of conditions, and it is important to consider that not all chest pain is related to pectus excavatum. Cardiac issues are a significant concern, with conditions such as angina, caused by reduced blood flow to the heart muscle, or a heart attack, which involves a blockage of blood flow, presenting as chest pain. Inflammation of the sac surrounding the heart, known as pericarditis, or a tear in the body’s main artery, an aortic dissection, can also cause severe chest discomfort.
Gastrointestinal problems are another common source of chest pain that can mimic cardiac symptoms. Acid reflux, also known as gastroesophageal reflux disease (GERD), can cause a burning sensation in the chest. Esophageal spasms, which involve abnormal contractions of the swallowing tube, or issues with the gallbladder and pancreas can also lead to pain that radiates to the chest. Additionally, musculoskeletal problems unrelated to pectus excavatum, such as muscle strains in the chest wall, inflammation of the rib cartilage (costochondritis), or rib injuries, are frequent causes of localized chest pain.
Lung-related conditions like pneumonia, an infection of the lungs, or pleurisy, which is inflammation of the lung lining, can cause sharp chest pain, especially with breathing. A pulmonary embolism, a blood clot in the lung, is a serious condition that can also present with chest pain. Psychological factors such as anxiety or panic attacks can trigger chest pain symptoms that may be difficult to distinguish from physical causes. Even conditions like shingles, a viral infection, can cause a painful rash on the chest.
When to Seek Medical Attention
Anyone experiencing new or concerning chest pain should seek medical evaluation promptly. Certain symptoms warrant immediate emergency medical attention, as they could indicate a serious underlying condition. These include sudden, severe, or crushing chest pain, especially if it does not subside or if it feels like pressure or squeezing. Pain that spreads to the left or right arm, neck, jaw, stomach, or back is also a concerning sign.
Accompanying symptoms such as shortness of breath, sweating, nausea, lightheadedness, or dizziness alongside chest pain require immediate emergency services. If the chest pain occurs during exertion and improves with rest, it could signal a blocked heart artery, necessitating prompt medical attention. For individuals with pectus excavatum, any persistent or worsening chest pain, new onset of symptoms like rapid heartbeat or difficulty breathing, or if the pain significantly interferes with daily activities, a consultation with a healthcare professional is advisable. Self-diagnosis of chest pain is not recommended due to the wide range of potential causes, some of which require urgent intervention.