We hear a lot about left chest pain and its association with heart disease, but what about right chest pain? What is causing this symptom? And most importantly, when is it worth worrying about?
Pain that occurs primarily on the right side of the chest has many possible causes, as does pain in the left breast . These can include diseases of the lungs, digestive system, musculoskeletal system, and even cardiovascular disease.
It is important to note that pain in the right side of the chest can be caused by heart disease. Although heart attacks are usually felt in the left and central chest, there are exceptions, especially if the right coronary artery is affected.
Because heart attacks that involve the right coronary artery are generally not as rapidly fatal as heart attacks on the left, a person is less likely to recognize that they even have a heart attack.
It is also important to remember that heart symptoms in women are often different from those in men. Women are less likely to experience classic left chest pain and instead may experience a burning sensation on both sides of the chest or even no pain at all. When in doubt, check immediately.
There are other emergencies that can be accompanied by right-sided chest pain. These include pulmonary embolism (blood clots in the legs that break off and travel to the lungs) and dissecting aortic aneurysms (in which the aorta swells abnormally).
Right breast anatomy
If you have pain on the right side of your chest, you may first think about what "lives" on the right side of your chest cavity or "rib cage."
This area houses a part of the right side of the heart, the right lung (three lobes), large blood vessels such as the ascending aorta and pulmonary blood vessels, the esophagus, and other structures such as the lymph nodes and nerves. The ribs are in this area and abnormalities of the spine can also be felt in this area.
Pain felt on the right side may be related to a problem in that specific area or, conversely, to reflected pain . When pain is reflected, pressure or damage to a nerve traveling through the chest can cause pain to be felt some distance from where it actually occurs.
Upper abdominal disorders can be felt on the right side of the chest and, if the diaphragm is irritated, it can also be associated with pain in the right shoulder. In this area are the liver, gallbladder, and part of the pancreas.
In an unusual condition, which affects about one in 10,000 people, the reverse body posture, chest organs, and sometimes other structures are reversed, so that sometimes the heart is on the right side of the body .
Pain on the right side of the chest can be constant or recurring, acute or chronic, localized or generalized. It can be felt deeply, which usually indicates an internal cause, or it can be felt in the bones, muscles, or skin. The healthcare professional will use these clues and your description of the pain (sharp, dull, stabbing, burning) to determine the cause.
Other symptoms can include:
As noted above, angina, heart attack, or other conditions can cause pain in any part of the chest, including the right side. Some other conditions related to the heart and blood vessels that can cause pain in the right side of the chest include the following conditions.
As mentioned earlier, heart disease can cause pain on both sides of the chest or just on the right side. This is more common in diseases of the right side of the heart.
Pericarditis is an inflammation of the pericardium, the protective membrane that surrounds the heart. There are many causes of pericarditis, from infections to cancer treatments, kidney disease, and autoimmune diseases like rheumatoid arthritis.
Pericarditis is also common after a heart attack. The pain is usually worse in certain positions and worsens with deep breaths.
Aortic dissecting aneurysm
Dissecting aortic aneurysm occurs when a ruptured aorta allows blood to flow between the layers of the wall of a blood vessel and cuts or breaks a blood vessel.
The pain is usually intense, sudden and sharp and can be described as a gut-wrenching pain. Unconsciousness can follow quickly. Perhaps best remembered for the form of injury that Princess Diana suffered, it can also occur without injury in people with high blood pressure or connective tissue conditions such as Marfan syndrome .
When to call 911
Call 911 or seek emergency help if chest pain is crushing or tight and is accompanied by one of the following:
- Cold sweat
- Difficulty breathing
- Choking or trouble swallowing.
- Nausea or vomiting
- Fast or irregular heartbeat
- Numbness or discomfort in the arm or arm.
- Pain that spreads from the chest to the neck, jaw, one or both arms, or shoulders.
Causes associated with the lungs.
The three lobes of the right lung, as well as the mucous membrane of the right lung and associated lymph nodes, are found on the right side of the chest. The lungs themselves do not have pain receptors, but you may still experience pain that "feels" like it is in the right lung. Possible causes of pain can include the following conditions.
Pulmonary embolism occurs when blood clots in the legs ( deep vein thrombosis ) break off and travel to the lungs. If the clot gets stuck in the vessels of the right lung, pain can occur.
This pain is usually sudden and sharp and can be associated with severe shortness of breath. Loss of consciousness can quickly follow with large clots. People may or may not remember that they had pain, redness, or swelling in one or both legs before a pulmonary embolism.
Unfortunately, pulmonary embolism is very common, affecting more than half a million people each year. They are fatal in approximately 10% of cases. Risk factors include many chronic diseases, prolonged bed rest or surgery, and long-distance air or car travel, but a significant number of people have no apparent risk factors.
Tumors in the right lung, the lining of the right lung, or nearby lymph nodes can cause pain on the right side of the chest. In retrospect, about half of people experience some type of pain in the chest, shoulder blades , or pain between the shoulder blades or in the shoulders before they are diagnosed with lung cancer.
Other symptoms such as shortness of breath or persistent cough may occur. Because lung cancer is often diagnosed at a later stage after it has spread, it is important to evaluate any unexplained pain on the right side of the chest.
Tumors in addition to lung cancers, especially lymphomas, can also develop in the chest cavity. Also, other cancers, such as breast and colon cancers, can metastasize (spread) to the lungs.
Pneumonia, especially an infection of the right lung, can cause pain on the right side of the chest. People with pneumonia often, but not always, have a fever and a cough.
A collapsed lung, called a pneumothorax , can cause pain on the right side of the chest .
Pleural effusion is a collection of fluid in the space between the pleural membranes that surround the lungs. There are many causes of pleural effusion. When the spill is small, there may be only discomfort, but when the spill is large, there is often shortness of breath as well. In lung and breast cancers, cancerous pleural effusions ( malignant pleural effusions ) can be quite painful.
Pleurisy (chest pain from pleurisy)
An inflammation of the lining of the lung, called the pleura , can often cause persistent pain in the right chest. This pain is often aggravated by taking deep breaths and scratching can sometimes be felt.
When to call 911
Acute lung diseases are characterized by respiratory problems. Call 911 if chest pain is accompanied by:
- Difficulty breathing
- Blood-stained sputum
- Bluish skin or lips ( cyanosis )
- Pain that worsens with deep breathing or coughing.
Abdominal diseases, especially those involving the esophagus or organs on the right side of the abdomen, such as the gallbladder and liver, can cause pain limited to the right side of the chest. Some conditions that can cause pain on the right side of the chest include:
Gastroesophageal reflux disease (GERD)
GERD can cause the classic symptoms of heartburn and indigestion, but it can also feel like pain only on the right side of the chest.
Foreign body of the esophagus
The cause of right chest pain, which is sometimes overlooked, is a foreign body in the esophagus. If your symptoms start with food, especially food, be sure to tell your healthcare provider.
A spasm of the esophagus can cause pain in the right chest. Esophageal spasm pain can easily be mistaken for heart disease pain, as it is often relieved by taking nitroglycerin.
The pain associated with pancreatitis can get worse while lying down and better while sitting. People with diabetes and heavy alcohol use are at higher risk.
Peptic ulcer / gastritis
Liver diseases such as hepatitis , cirrhosis , and even tumors that have spread to the liver (metastasized) can cause pain that is felt on the right side of the chest. Sometimes there is jaundice, a yellowing of the skin, and the whites of the eyes.
When to call 911
Call 911 or seek emergency help if pain or pressure in the right side of the chest is accompanied by:
- Sudden severe abdominal pain
- A hard or painful belly
- Vomiting blood
- Bloody diarrhea
When injured, fractures and damage to soft tissues, such as muscles and ligaments, can cause chest pain. With no history of injury, there are several conditions that can also cause right-sided chest pain. Some of them include the following conditions.
Costochondritis is a condition in which the cartilage becomes inflamed at the junction of the ends of the ribs with the sternum (costochondral junction). This is usually caused by chronic trauma associated with overuse, which is why most people don't remember any particular injury.
Pain tends to be worse with activity or deep breathing, and pain often occurs when the rib joints are pressed. Tietze syndrome is a less common problem, but it involves edema and usually affects only one rib.
Muscle sprains are one of the most common causes of right chest pain. Many people can remember activities like lifting weights or a new exercise program that they were doing before developing this type of pain.
There are many conditions that can cause chest wall pain in addition to costochondritis, from fibromyalgia to stress fractures and sickle cell crises.
Diseases of the cervical or thoracic spine.
Conditions such as disc disease or pinched vertebrae can cause pain that is felt on the right side of the chest, either due to the location of the condition or due to reflected pain from the affected nerves. Sometimes spinal metastases from breast cancer, lung cancer, and other tumors are first noticed as right-sided chest pain.
When to call 911
Acute musculoskeletal infection can cause symptoms similar to those of a heart attack. Call 911 if you have:
- Generalized chest pain is not localized enough
- Pain or numbness in the arm when shooting
- Body chills
- High fever that cannot be treated with fever medicines.
There are several other possible causes of pain on the right side of the chest. Some of these include:
Shingles is a disease that occurs when the varicella-zoster virus (which lives in nerve roots) is reactivated. If the virus is inactive in the nerve roots that supply the right side of the chest, pain may develop in that area.
The rash usually appears in the distribution of the nerve roots and helps to make the diagnosis, but pain may precede the rash by several days, making diagnosis difficult at first.
Tumors or enlarged lymph nodes in the mediastinum , the area of the chest between the lungs, can cause chest pain that is felt on both sides of the chest, but only on the right side.
Mediastinal lymph node enlargement can occur with both Hodgkin's disease and non-Hodgkin's lymphomas, as well as with the spread of lung or breast cancer. Thymomas, bronchogenic cysts, and other benign tumors can develop in this area.
If the chest pain occurs deep in the chest, the pain may appear deeper in the chest.
Anxiety and panic disorder
About 40 percent of people with panic disorder sometimes experience terrifying chest pain. Atypical chest pain associated with panic disorder is unique, but caution should always be exercised. People with anxiety or even panic disorder can also experience life-threatening causes of chest pain.
Depending on your symptoms and other factors, your healthcare provider may order various tests. The first thing they will do is make sure their alphabets are stable. This means the airways, breathing, and circulation, essentially the function of your heart and lungs. If he looks stable, she will ask you lots of questions (take a close look at your history and look for any risk factors) and perform a physical exam.
Some conditions can be diagnosed during a physical exam, for example, tenderness in the joint between the ribs and the breastbone may indicate costochondritis, and a classic rash may indicate shingles.
Other tests may include:
Questions Your PCP May Ask
Your healthcare provider will ask you many questions to try to narrow down the possible causes of your symptoms. If you are itching to see your doctor, you can write down whatever comes to mind to give you as many "clues" as possible. Questions can include:
- When did your pain start?
- Have you ever experienced pain before?
- Did the pain start quickly or gradually?
- Did it occur during activity or at rest?
- Did you eat when the pain started?
- How would you describe the pain? Is it sharp or dull, light or strong, or does it have some other characteristic such as a tearing, burning, crushing, or crushing sensation?
- Is there anything that makes your pain worse or easier?
- Is the pain worse when you breathe or eat?
- Does the pain radiate (travel) somewhere, like the back, jaw, or anywhere else?
- Where exactly is the pain? Is this a specific area or is it spreading across your chest?
- What other symptoms have you had, such as shortness of breath, persistent cough, hoarseness, unexplained weight loss, trouble swallowing, nausea or vomiting, or jaundice?
- What other illnesses do you have?
- Are you taking prescription drugs, over-the-counter drugs, or dietary supplements?
- Do you smoke or have you ever smoked?
- How much alcohol do you drink?
- What health problems does your family have?
Get the word of drug information
According to the American Heart Association, if you think you are having a heart attack, call 9-1-1 right away. Don't wait to take aspirin before seeking emergency care. Your emergency medical team or other healthcare provider can help you decide if you can take aspirin.
Right-sided chest pain is not as likely as left-sided chest pain and is associated with heart disease, but that does not mean it is less severe. If your pain is severe, or you notice shortness of breath, or even wonder if your symptoms could be life-threatening, don't wait. Call 911.
If you are going to see your doctor, consider the questions above. Locating the source of chest pain on the right side is sometimes like putting together a puzzle, and the more puzzle pieces available, the easier it will be to solve.
If you don't get answers, keep asking questions. Pain is a message to our mind that something is wrong. If this continues, talk to your doctor again. Sometimes more tests are required – for example, one in four people with lung cancer had normal chest X-rays at the time of diagnosis and a CT scan was required to detect the tumor. If you don't have the answers yet, ask for a second opinion.
Frequently asked questions
Disorders of the esophagus can cause chest pain on the right side when swallowing. This includes:
The pain may be associated with a muscle strain or rib chondritis , an inflammation of the cartilage in the ribs. Chest pain during exercise can also be caused by angina or a heart attack. Seek medical attention if you have new or worsening chest pain.
According to the American Heart Association, if you think you are having a heart attack, call 9-1-1 right away. The dispatcher or paramedics can help you decide if you can take aspirin.
Treatment depends on the cause of the pain. Blood thinners may be prescribed for clotting problems, and other medications may be prescribed for anxiety or panic attacks. If someone experiences pain in the right side of the chest associated with a heart attack, call 9-1-1 immediately. Emergency services can initiate other treatments such as oxygen therapy, aspirin, and nitroglycerin.