Can costochondritis cause bradycardia?

Costochondritis Does Not Cause Bradycardia

Costochondritis does not cause bradycardia, as there is no established pathophysiological mechanism linking inflammation of the costochondral junctions to decreased heart rate. 1

Understanding Bradycardia

Bradycardia is defined as a heart rate below 60 beats per minute in adults 2. According to the American College of Cardiology/American Heart Association guidelines, bradycardia can be classified as:

1. Physiologic bradycardia: Common in well-conditioned athletes or during sleep due to increased parasympathetic tone 2

2. Pathologic bradycardia: Caused by either:

   • Intrinsic cardiac disease (sinus node dysfunction, atrioventricular block)
   • Extrinsic/reversible causes 1, 2

Known Causes of Bradycardia

The 2018 ACC/AHA/HRS guidelines clearly outline the reversible causes of bradycardia, which include:

• Medications: Beta blockers, calcium channel blockers, digoxin, sodium-channel and potassium-channel blocking antiarrhythmic drugs 1
• Metabolic disorders: Hypothyroidism, severe systemic acidosis, hypokalemia 1
• Other conditions: Elevated intracranial pressure, acute myocardial infarction, severe hypothermia, obstructive sleep apnea 1
• Specific infections: Lyme carditis can cause bradycardia and heart block 1

Notably, costochondritis is not listed among these causes in any of the guidelines.

Costochondritis: Clinical Features and Relationship to Cardiac Symptoms

Costochondritis is characterized by:

• Inflammation of costochondral junctions or chondrosternal joints 3
• Chest wall tenderness on palpation 3
• Usually self-limited and benign condition 4, 3

While costochondritis can present with chest pain that may mimic cardiac conditions, there is no evidence in the medical literature linking it to bradycardia:

1. Costochondritis primarily affects the musculoskeletal system of the chest wall 3, 5
2. It does not involve the cardiac conduction system that regulates heart rate 1
3. Treatment approaches for costochondritis focus on anti-inflammatory medications and physical therapy 3, 5, not on cardiac interventions

Diagnostic Considerations

When evaluating patients with chest pain and bradycardia:

1. Rule out cardiac causes first: Patients over 35 years or with risk factors for coronary artery disease should have an ECG and possibly chest radiograph to rule out cardiac causes 3

2. Consider separate etiologies: If both costochondritis and bradycardia are present, they likely represent two distinct conditions requiring separate diagnostic workups 1, 3

3. Evaluate for common causes of bradycardia: Check medications, thyroid function, electrolytes, and consider Lyme disease in endemic areas 1

Management Approach

For patients presenting with both costochondritis and bradycardia:

1. Address bradycardia according to guidelines:

   • Determine if symptomatic (lightheadedness, syncope, exercise intolerance)
   • Identify and treat reversible causes 1
   • Consider temporary or permanent pacing only if symptomatic and refractory to medical therapy 1

2. Treat costochondritis separately:

   • Acetaminophen or anti-inflammatory medications 3
   • Physical therapy with manual therapy and exercise 5
   • Avoidance of activities that produce chest muscle overuse 3

Conclusion

Based on current medical evidence and guidelines, there is no established causal relationship between costochondritis and bradycardia. If both conditions are present simultaneously, they should be evaluated and treated as separate clinical entities according to their respective guidelines.