What could be causing left-sided rib pain that worsens with bending, accompanied by shortness of breath, chest and neck pain, and early satiety, and what are the appropriate next steps?

Immediate Emergency Evaluation Required

This symptom constellation—left-sided rib pain worsening with bending, accompanied by shortness of breath, chest and neck pain for one week, plus early satiety—requires immediate emergency department evaluation to exclude life-threatening cardiac, pulmonary, and gastrointestinal causes before considering benign musculoskeletal diagnoses. 1, 2

Critical Red Flags Present

Your symptoms contain multiple concerning features that mandate urgent assessment:

• Pain interrupting normal activity for one week indicates potential serious pathology 1, 2
• Shortness of breath accompanying chest pain significantly raises concern for pulmonary embolism, pneumothorax, or acute coronary syndrome 1
• Radiation to neck is characteristic of cardiac ischemia 1
• Early satiety combined with upper abdominal/lower chest pain may indicate splenic pathology, gastric issues, or referred cardiac pain 1

Immediate Actions Required

Call emergency services (911 or your local emergency number) now rather than attempting self-transport, as approximately 1 in 300 chest pain patients transported by private vehicle experiences cardiac arrest en route. 2

While waiting for emergency services:

• Take 325 mg aspirin (chewed and swallowed) if you have no aspirin allergy or recent bleeding 1
• Remain at rest and avoid any physical exertion 1
• Do not wait for symptoms to disappear, as symptom severity poorly predicts serious complications 1, 2

What Emergency Physicians Will Evaluate

The emergency team will systematically exclude life-threatening conditions:

Cardiac Causes

• ECG within 10 minutes to exclude ST-elevation myocardial infarction, which requires intervention within minutes 3, 2
• Cardiac biomarkers to detect myocardial injury 1
• Your symptoms of chest pain radiating to neck with dyspnea match the classic presentation of acute coronary syndrome, particularly given the week-long duration suggesting possible unstable angina 1

Pulmonary Emergencies

• Chest X-ray and possible CT angiography to exclude pulmonary embolism and pneumothorax 1, 2
• Shortness of breath with pleuritic chest pain (worsening with movement/bending) raises significant concern for these conditions 1

Gastrointestinal Catastrophes

• Assessment for esophageal rupture, splenic pathology, or gastric issues, particularly given your early satiety 1
• The combination of left upper quadrant pain and early satiety warrants evaluation of the spleen and stomach 1

Aortic Dissection

• Evaluation for thoracic aortic dissection, especially with chest and neck pain 1, 2

Why Benign Causes Cannot Be Assumed

While painful rib syndrome (costochondritis) is common and accounts for 3% of general medical referrals, it can only be diagnosed safely after excluding emergent conditions 4, 5:

• 7% of patients with reproducible chest wall tenderness still have acute coronary syndrome, so chest wall tenderness alone never excludes cardiac disease 3
• Painful rib syndrome typically presents with reproducible pain on palpation of the costal margin without associated dyspnea 4, 5
• Your shortness of breath and neck pain radiation are not consistent with simple musculoskeletal chest wall pain 1, 3

Critical Pitfall to Avoid

Do not allow anyone to dismiss your symptoms based on your age or the positional nature of the pain. 1, 2

• The European Heart Journal explicitly warns that pain severity and character are poor predictors of serious disease 1, 2
• Women are particularly at risk for underdiagnosis of cardiac causes and often present with accompanying symptoms like dyspnea more frequently than men 1
• Physical examination contributes almost nothing to diagnosing myocardial infarction unless shock is present 1, 2

After Emergency Evaluation

Only if emergency evaluation with ECG, cardiac biomarkers, and imaging excludes life-threatening causes can benign diagnoses like costochondritis or slipping rib syndrome be considered 3, 4:

• Systematic palpation of the costal margin reproducing your exact pain would support musculoskeletal diagnosis 3, 4
• Normal ECG, negative cardiac biomarkers, and normal chest imaging are prerequisites for outpatient management 3
• Treatment would then consist of NSAIDs with return precautions for worsening symptoms 3

Do not delay—seek emergency care immediately.