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Don't ignore unpredictable shortness of breath.

I run between nine and 10 miles every other day and now the weather has become quite humid. Recently I have noticed a tightness in my upper, center chest. It's tender when I push on it. It feels like the muscle soreness onset by hard upper body strength training. It doesn't stay sore for long; usually I can push on the area pain-free five to 10 minutes later. At times I feel out of breath running, which is new for me, but other than that I don't have any symptoms. I'm a 44-year-old female and feel in good health overall. One interesting aspect of this is that the soreness doesn't only happen on days I run, and sometimes even seems to radiate into my upper back. There doesn't seem to be a discernible pattern of occurrence. What could be causing this?

Katie Wallace

Wilmington, NC

This is likely costochondritis, or some other type of inflammation of the rib-cartilage joints that you have in each rib on the front of your chest. These joints are the reason we can take deep breaths and change the shape of our chests. When they become inflamed, they get sore. This can happen due to age (even 44 is not too young for mild arthritic changes in the joints) or overuse-- for example, due to asthma, emphysema or weight training. It can occur in runners who breathe hard while running. Furthermore, there are nerve bundles directly under each rib, which is why any rib injury can radiate pain into the back. If you can touch this pain it is not likely heart or esophagus-related.

I would take the shortness of breath seriously since most healthy people who are not overtraining don't often get short of breath running in general. You could have exercise-induced asthma--it can present at any age. This can be pretreated with an inhaler 30 minutes prior to exercise. Or you may have a metabolic issue such as anemia or a thyroid problem, both common in women your age. Most importantly, you could have coronary artery disease, with shortness of breath being the only symptom. Many more women than men have subtle symptoms without the classic deep substernal chest pain. And you can be in great shape and have heart disease.

See your physician and determine your heart disease risk factors. Consider having a chest x-ray to rule out anything structural, as well as an in-office pulmonary function test for asthma. A blood test will rule out anemia or thyroid disease. The heart risk factors are primary here, and if you find that you have two or more, consider a stress test or stress echocardiogram.

Peter Mendel, MD

Woodbridge, VA

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Title Annotation:THE CLINIC
Publication:Running & FitNews
Geographic Code:1USA
Date:May 1, 2011
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