Knowing When It’s Time to Call 911
e hear a lot about left-sided chest pain and its relationship to heart disease, but what about right-sided chest pain? What causes this symptom? And, most importantly, when should you be worried?
Pain that occurs primarily on the right side of your chest has many possible causes just as does left-sided chest pain. They may include lung, digestive, musculoskeletal, and, yes, even cardiovascular disorders.It is important to note that pain on the right side of the chest can be due to heart disease. While heart attacks are typically felt on the left and central parts of the chest, there are exceptions, particularly if the right coronary artery is involved.
Since heart attacks involving the right coronary artery tend not to be as quickly fatal as those on the left, a person may be less likely to recognize that he or she is even having a heart attack.
Right-Sided Chest 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 “thorax.This area is home to a portion 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 lymph nodes, and nerves. The ribs lie in this region, and disorders of the spine may be felt in this region as well.
Pain that is felt on the right side may be due to a problem in that particular area or instead can be due to referred pain. With referred pain, pressure or damage to a nerve that runs through the chest may cause pain to be felt at a location some distance from where the pain actually originates.Upper abdominal disorders may be felt on the right side of the chest, and if the diaphragm is irritated, this may be associated with pain in the right shoulder as well. The liver, the gallbladder, and part of the pancreas lie in this region.In an uncommon condition affecting around one in 10,000 people, situs inversus, the organs of the chest cavity and sometimes other structures are reversed in their location, so that sometimes the heart is found on the right side of the body.
The pain experienced in the right side of the chest may be persistent or recurrent, acute or chronic, localize or generalized. It may be deeply felt, typically indicating an internal cause, or be experienced in bone, muscle, or skin. The doctor will use these clues, as well as your description the pain (“sharp,” “dull,” “throbbing,” “burning”), to help pinpoint the cause.
Other symptoms may include:
- Shortness of breath
- Persistent cough
- Unintentional weight loss
- Nausea and vomiting
- Difficulty swallowing
As noted above, angina, a heart attack, or other conditions may lead to pain anywhere in the chest including the right side. Some other heart and blood vessel related conditions which may cause right-sided chest pain include:
- Coronary artery disease – As noted earlier, heart disease may cause pain on both sides of the chest or only on the right side. This is more commonly found with conditions involving the right side of the heart.
- Pericarditis – Pericarditis is an inflammation of the pericardium, the protective membrane surrounding the heart. There are many causes of pericarditis ranging from infections to cancer treatment, to kidney disease, to autoimmune disorders such as rheumatoid arthritis. It is also common after people have had a heart attack. The pain is often worse in certain positions and becomes more intense with a deep breath.
- Dissecting aortic aneurysm – A dissecting aortic aneurysm occurs when a tear in the aorta allows blood to flow between the layers of the blood vessel wall and dissects or tears the blood vessel. The pain is often severe, sudden, and sharp, and may be described as a tearing pain. Unconsciousness may follow rapidly. Perhaps best remembered as the form of trauma Princess Diana sustained, it may also occur without any trauma in people with high blood pressure or connective tissue conditions such as Marfan syndrome.
When to Call 911
Call 911 or seek emergency care if the chest pain is crushing or squeezing and is accompanied by any of the following:
- Cold sweat
- Shortness of breath
- Choking or difficulty swallowing
- Nausea or vomiting
- Fast or irregular heart rate
- Numbness or discomfort in the hand or arm
- Pain that spreads from the chest to the neck, jaw, or one or both arms or shoulders
The three lobes of the right lung, as well as the lining of the right lung and associated lymph nodes, are located 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 your right lung. Possible causes of pain may include:
- Pulmonary emboli – Pulmonary emboli occur when blood clots in the legs (deep venous thrombosis) break off and travel toward the lungs. If the clot lodges in vessels of the right lung, pain may occur. This pain is often sudden and sharp and may be associated with severe shortness of breath. With large clots, unconsciousness may follow rapidly. People may or may not recall having pain, redness, or swelling in one or both legs prior to a pulmonary embolus. Unfortunately, pulmonary emboli are very common, occurring in over half a million people each year. They are fatal around 10 percent of the time. Risk factors include many chronic diseases, prolonged bed rest or surgery, and long-distance travel by plane or by car, yet a significant number of people do not have any obvious risk factors.
- Lung cancer – 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. Roughly half of people, looking back, have some pain in the chest, in their shoulder blades or pain between the shoulder blades, or into their shoulders, prior to the diagnosis of lung cancer. Other symptoms may be present such as shortness of breath or a persistent cough. Since lung cancer is often diagnosed in the later stages after it has spread, it is important to have any unexplained pain on the right side of your chest evaluated.
- Other tumors – Tumors other than lung cancer may occur in the chest cavity as well, particularly lymphomas. In addition, metastases (spread) from other cancers such as breast cancer and colon cancer may occur to the lungs.
- Pneumonia – Pneumonia, especially infections of your right lung could cause chest pain on the right side of your chest. People with pneumonia often, but not always, have a fever and cough.
- Pneumothorax – A collapse of a lung called a pneumothorax may occur and cause pain on the right side of the chest.
- Pleural effusions – A pleural effusion is a build-up of fluid in the space between the pleural membranes surrounding the lungs. There are many causes of pleural effusions. When an effusion is small, there may only be discomfort, but with large effusions shortness of breath is often present as well. With lung cancer and breast cancer, cancerous pleural effusions (malignant pleural effusions) can be quite painful.
- Pleurisy (Pleuritic chest pain) – Inflammation of the linings of the lung, called the pleura, can cause often persistent right-sided chest pain. This pain often increases with a deep breath and can sometimes feel scratchy.
When to Call 911
Acute lung disorders are characterized by breathing problems. Call 911 if the chest pain is accompanied by:
- Shortness of breath
- Blood-streaked sputum
- Rapid heart rate
- Blue-tinged skin or lips (cyanosis)
- Pain that worsens when taking a deep breath or coughing
Abdominal conditions, especially those involving the esophagus or organs on the right side of the abdomen such as the gallbladder and liver may cause pain restricted to the right side of the chest. Some conditions which may cause right-sided chest pain include:
- Gastroesophageal reflux disease (GERD) – GERD may cause classic symptoms of heartburn and indigestion, but may also be felt as pain in the right side of the chest alone.
- Esophageal foreign body – A cause of right-sided chest pain that is sometimes overlooked is that of an esophageal foreign body. If your symptoms began while eating, especially meats, make sure to let your doctor know.
- Esophageal spasm – Esophageal spasm can cause right-sided chest pain. Pain from esophageal spasm may be easily confused with that from heart disease as it often improves with nitroglycerine.
- Gallbladder disease – Both gallstones and cholecystitis, an infection of the gallbladder may be felt as right-sided chest pain. This pain often radiates through to the back and may also radiate to the right shoulder.
- Pancreatitis – The pain associated with pancreatitis can be worse with lying down and better with sitting up. People with diabetes and excess alcohol intake are at an increased risk.
- Peptic ulcer disease/gastritis – Both peptic ulcer disease and gastritis may cause pain which is felt in the right side of the chest, though it is more common on the left. The pain may initially actually improve somewhat with eating.
- Liver disease – Liver diseases such as hepatitis, cirrhosis, and even tumors which have spread to the liver (metastases) may cause pain which is felt in the right side of the chest. There is sometimes associated jaundice, a yellowish discoloration of the skin and the whites of the eyes.
When to Call 911
Call 911 or seek emergency care if the pain or pressure in the right side of your chest is accompanied by:
- Sudden, severe abdominal pain
- A rigid or tender abdomen
- Vomiting of blood
- Bloody diarrhea
With trauma, fractures and damage to soft tissue such as muscles and ligaments can cause chest pain. Without a history of trauma, there are several conditions which may also give rise to right-sided chest pain. Some of these include:
- Costochondritis – Costochondritis is a condition in which there is inflammation of the cartilage where the ends of the ribs join with the sternum (the costochondral junction.) It is usually caused by a chronic overuse type of injury so most people do not recall any specific trauma. The pain tends to worsen with activity or with a deep breath, and there is often tenderness when pressure is placed over the rib junctions. A less common problem, Tietze’s syndrome is similar but includes swelling and usually involves only one rib.
- Muscle strain – Muscle strains are one of the more common causes of right-sided chest pain. Many people can recall activities such as heavy lifting or a new workout program that they engaged in before developing this type of pain.
- Chest wall pain – There are many conditions which may cause chest wall pain in addition to costochondritis ranging from fibromyalgia to stress fractures to sickle cell crisis.
- Cervical or thoracic spine conditions – Conditions such as disc disease or compressed vertebrae may cause pain that is felt on the right side of the chest, either due to the location of a condition or due to referred pain from involved nerves. Sometimes metastases to the spine from breast cancer, lung cancer, and other tumors are first noted as chest pain on the right side.
When to Call 911
An acute musculoskeletal infection can cause symptoms similar to a heart attack. Call 911 if you experience:
- Generalized chest pain not well localized
- Shooting arm pain or numbness
- Rapid heart rate
- Body chills
- A high fever that doesn’t respond to fever medication
There are several other possible causes of pain in the right side of the chest. Some of these include:
- Shingles – Shingles is a condition which occurs when the chickenpox virus (which lives in nerve roots) is reactivated. If the virus has been lying dormant in nerve roots supplying the right side of the chest, pain may occur in this region. A rash usually occurs in the distribution of the nerve roots and helps to make the diagnosis, but the pain may precede the rash by several days making the diagnosis at first difficult.
- Mediastinal tumors – Tumors or enlarged lymph nodes in the mediastinum, the area of the chest between the lungs, can cause chest pain felt on either side of the chest but may occur only on the right side. Enlargement of the mediastinal lymph nodes may occur with both Hodgkin’s disease and non-Hodgkin’s lymphomas as well as from the spread of lung cancer or breast cancer. Thymomas, bronchogenic cysts, and other benign tumors may occur in this region.
- Breast pain – If pain due to a breast condition occurs deep in the breast it may feel like the pain lies deeper in the chest.
- Anxiety and panic disorder – About 40 percent of people with panic disorder experience frightening chest pain at some time. Atypical chest pain associated with panic disorder is unique in some ways, but you always want to err on the side of caution. People who have anxiety or even panic disorder can also experience life-threatening causes of chest pain.
Depending on your symptoms and other factors, there are several tests your doctor may order. The first thing she will do is to make sure your “ABC’s” are stable. This stands for airway, breathing, and circulation, essentially the function of your heart and lungs. If you appear stable she will then ask you many questions (take a careful history looking for any risk factors) and do a physical exam.Some conditions can be diagnosed during a physical exam, for example, tenderness over the joint between your ribs and sternum may suggest costochondritis or a classic rash may suggest shingles.
- A chest x-ray and/or chest CT scan (chest x-rays can miss lung cancer and people who don’t smoke can get lung cancer)
- Cardiac stress testing
- PET scan
- Cardiac catheterization and angiography
- Upper GI endoscopy or barium swallow (to evaluate your esophagus and digestive tract)
Questions Your Doctor May Ask
Your doctor will ask you many questions to try and narrow down the possible causes of your symptoms. If you are waiting to see your doctor, you may want to write down anything that comes to mind so you can give her as many “clues” as possible. Questions may include:
- When did your pain begin? Have you ever had the pain before?
- Did the pain begin rapidly or did it come on gradually? Did it come on with activity or at rest? Were you eating when the pain began?
- How would you describe the pain? Is it sharp or dull, mild or severe, or does it have any other characteristics such as a tearing feeling, burning, crushing, or squeezing?
- Does anything make your pain worse or make it better?
- Does the pain get worse with breathing or with eating?
- Does the pain radiate (move) anywhere, such as to your back, your jaw, or elsewhere?
- Where exactly is the pain located? Is it is a specific area or is it diffuse across your chest?
- What other symptoms have you had, for example, shortness of breath, a persistent cough, hoarseness, unexplained weight loss, difficulty swallowing, nausea or vomiting, or jaundice?
- What other medical conditions do you have?
- Are you on any prescription medications or do you take any over-the-counter medications or nutritional supplements?
- Do you smoke or have you ever smoked?
- How much alcohol do you drink?
- What medical problems run in your family?
A Word From Verywell
Right-sided chest pain is not as likely as left-sided chest pain to be related to heart disease, but that doesn’t mean it is any less serious. If your pain is severe or if you’re noticing shortness of breath, or even wonder if your symptoms could be life-threatening don’t wait. Call 911.If you will be seeing your doctor, consider the questions above. Finding the source of right-sided chest pain is sometimes like putting together a puzzle, and the more puzzle pieces available, the easier it sometimes is to solve.If you’re not getting answers, keep asking questions. Pain is a message to our minds that something is wrong. If it’s lasting, talk to your doctor again. Sometimes further testing is needed, for example, one in four people with lung cancer had normal chest x-rays at the time of diagnosis, and a CT scan was needed to find the tumor.