I read a lot about running and a lot has been written on the subject but one thing you literally never hear about is the fact that it’s ‘somewhat’ normal to have intense heart pain. But before we get into it a few points: I’m not a medical doctor, there is no badge for surviving this and when in doubt get checked out. Heart pain in general isn’t something to be messed around with. Most of us do start to go a bit stir crazy when sickness or anything else keeps us from working out. So we often get back to it as soon as we possibly can. That part is normal and you’re not alone. It doesn’t mean its a totally safe thing to experience though. If you’ve just been sick and done a hard workout you might feel severe heart and chest pain after. While it’s not totally safe you’re not the first one in that boat either. Here’s why that might happen.
The cause is inflammation of the heart muscle (Myocarditis) or the lining of the heart (pericarditis). The most common cause of both is a viral infection and they are often present together. Here’s the thing most people never learn about this because they are not active enough to aggravate the condition. But if you’re a regular exerciser then it very well might be something you have or will experience. Interestingly both are pretty common after a viral infection though most with the conditions never experience symptoms and it resolves itself in short order. However if you do experience symptoms it really can be a very big deal. That said most health people who do experience symptoms and even rare complications do recover fully.
What it feels like
Both conditions do present very similarly to each other and roughly 85% of cases are caused by a recent viral infection. So the first thing ask yourself if you’ve recently been sick with a cold or flu. Since we’re talking about this in relation to exercise chances are you’ve just done a workout. It doesn’t have to be longer or harder than usual in fact it might even have been an ‘easy’ one for you. You might not have been able to even complete your workout or had to take it easy and you’ll think that’s because you’ve been sick. PS that’s probably the case what you were feeling on the run was probably just the leftovers from your cold.
After your workout either within a few minutes or a few hours you’ll start to feel a stabbing pain in your chest right around your heart. It’s very intense localized inside your ribs and may or may not spread to your shoulder and shoulder blade. Apparently this is a lot different from a heart attack but it doesn’t feel like that at the time, but that is where your mind will go. Pain associated with a heart attack classically radiates through the arm and jaw and feels like intense pressure as if an elephant is sitting on your chest. People who have had both say that there is a major difference in the feeling. Let me tell you though if you haven’t had a heart attack before that’s totally what you think is happening in the moment.
Signs you’re not having a heart attack
Lots of people end up with either or both of these conditions and there are no really distinguishable symptoms between the two. You may get some relief from the pain if you lean forward and it might get worse if you lay down. This is indicative of pericarditis you might also feel changes in the pain level as you breath in or out. During a heat attack the pain level doesn’t vary with your position or breathing. Myocarditis is a little harder though other than the classic locations the pain is felt in and the sharp vs pressure aspect your other symptoms are pretty much the same. But if you’re a regular exerciser you’ve just been sick and done your first workout since then these conditions should be on your radar.
Is it dangerous?
In a word yes, however if you had to pick between all three pick pericarditis then myocarditis second and an actual heart attack last. So lets tackle them in that order shall we. Pericarditis is easily detectable on a non-invasive ECG since it shapes the waves of your heart in a very specific way. Once diagnosed most people will only need regular over the counter pain meds or steroids. There are a few other specialized medications available to treat the condition though too. In very rare cases a surgery can be required but in a pretty short time it usually revolves itself.
Even for myocarditis over 75% of people get better without treatment. It’s not as easy to diagnose with a heart biopsy being the gold standard so it can be harder to figure out if you have it. The good news is twofold one is it’s usual very treatable and though you should go to the ER straight away the risk of imminent death isn’t as extreme as it is with a heart attack. It is more likely that you’ll need an intervention but that is less then 25% of the time while it is virtually 100% with a heart attack. Both are the type of thing you really should get checked out but make sure to steer doctors in the right direction. Tell them you’ve just been sick and did a workout.
What should you do?
Get thee to a hospital especially if this is your first time with chest pain. Notice if your pain changes with position or your breathing if that’s the case you are more than likely not having a heart attack. Chest pain of any sort can be worsened by anxiety. Try to calm yourself down using anything in your means and even distraction. Does it actually feel a lot better if you’re realitivley calm, that’s a good sign too. If you have other unexplained symptoms like tiredness, lethargy or panic that can be another symptom of myocarditis or pericarditis but also overlap with more serious things. But things like nausea, dizziness and a cold sweat are more closely associated with a heart attack so consider calling for an ambulance.
The first thing you should do is tell someone near you what’s going on and if there is any doubt consider calling an ambulance. However if you’re pretty sure at least for the moment you’re fine do your best to calm down and limit the anxiety this is understandably making you feel. You might find it helpful (I did) to remind yourself that you are the age you are and how physically fit you may be. For many people that may reassure you that the chances your probably not currently dying.
Next see if you can change positions (lean forward vs lay down) and see if your pain changes. The next thing you have to do is really seriously consider getting checked out by a medical professional. If you have any doubt the ER is the way to go. If you’re hesitant to go there head to a walk in clinic or see if your doctor can see you. If you decide not to go make sure you keep an eye on it over the next few hours and days and be open to changing your choice. For both conditions most people do improve greatly in the next few hours or days. If you don’t get a lot better fairly fast get checked out.
If you head to the doctor or call a Telehealth provider there is a very good chance that you will automatically be told to head to the ER as soon as you say ‘chest pain.’ The good news is once you’re at the hospital you probably won’t have to wait long. You’ll more than likely be hooked up to an ECG right away. If your dealing with a case of inflammation that’s likely where your emergency will end as both conditions can be either diagnosed or strongly suspected based on these little wires on your chest. You might also have a blood test. You’ll probably be given some sort of medication sometimes just aspirin and monitored. This might be at home or in the hospital. You’ll also know what’s up with you definitively what’s wrong with you and what to look out for in terms of complications.
It’s incredibly scary to have intense stabbing chest pain after a run. This isn’t something we ever hear about but I think it’s important to be aware that there is a potentially serious complication working out can cause after a cold. You should also know that 95% of chest pain is nothing in young athletes. Has this ever happened to you? Did you get checked out? How were you treated? We all want to know more about this and just learning about it is a great start!