Sharp pain in right side of chest and shoulder

Chest pain is frightening and must be taken seriously. So know this: If you are having severe discomfort in the chest—especially if the chest pain is radiating to your neck, jaw or arms—and it’s accompanied by shortness of breath, dizziness and sweating, call 911 immediately. Some people (especially women, diabetics and older adults) may not have chest pain at all during a heart attack, but they may have the other symptoms listed. In that case, it’s still best to call 911.

But sometimes chest pain isn’t a heart attack. It might have a different cardiac cause or be totally unrelated to your heart. Here are three clues that it’s not a heart attack:

1. Pinpointed chest pain. If a sharp pain seems to be coming from a very specific location, it’s probably not heart pain. The pain associated with a heart attack is generally dull and diffusely located in the chest.
2. Chest pain that shows up in different areas. For example: One day your chest pain is on the right side of your chest, and the next day it’s on the left side of your chest. Heart pain can radiate into the arms, jaw and between the shoulder blades, but it rarely moves from place to place on different days.
3. Chest pain that gets worse when you take a breath. This could be anything from pericarditis (a swelling of the membrane surrounding the heart) to a cracked rib.

If you are experiencing chest pain like this, call your doctor to make an appointment.

Chest pain that isn’t a heart attack can be heart-related (cardiac) or not (noncardiac).

The Three Most Common Causes of Noncardiac Chest Pain

1. Gastrointestinal pain. This is the most common type of noncardiac chest pain. It can include acid reflux, esophageal spasm and acidity.
2. Muscular/skeletal pain. This pain is caused when you pull a muscle or injure a bone. It often occurs after patients have done physical activities such as working in the yard.
3. Lung pain. A condition like pneumonia or pleurisy, which is inflammation of the tissues around the lungs, can cause pain in the chest that is sometimes mistaken for a heart attack.

Cardiac Pain That Isn’t a Heart Attack

Cardiac pain, or angina, refers to discomfort in the chest because of something going on with the heart. The first thing a cardiologist will try to determine in a patient with cardiac pain is whether the pain is caused by clogged arteries.

Several conditions of the heart can cause cardiac pain but aren’t related to clogged arteries, including:

• Pericarditis: inflammation of the two thin layers of tissue that surround the heart
• Dissection: when the aorta splits and causes severe chest and back pain
• Myocarditis: inflammation of the heart muscle
• Cardiomyopathy: diseases of the heart muscle

Know What Is a Heart Attack

A heart attack requires immediate emergency care. Symptoms include:

• Discomfort in the form of tight, heavy pressure or a dull, burning sensation in the chest
• Pain that radiates to the shoulders, arms, neck, jaw or back
• Pain that is hard to precisely locate with a single finger
• Sweating
• Nausea
• Dizziness or faint feeling
• Shortness of breath

If you have any of these symptoms, call 911.

Want to know more about your risk for heart disease? Take a free HeartAware online risk assessment. Learn more about our cardiac care at UNC REX Healthcare and UNC Medical Center or find a cardiologist near you.

There can be many possible causes for pain on the right side of the chest. In fact, it's one of the most common reasons people visit the emergency room, says Dr. Stephen Keithahn, an internist at the University of Missouri in Columbia, Missouri.

(Getty Images)

When doctors try to pinpoint the cause of pain on the right side of the chest, they consider what's located in that part of the body. This includes:

• Skin.
• Muscles.
• Ribs.
• Cartilage, a type of connective tissue.
• Pleura, which is a thin lining around the ribs and chest cavity.
• The lungs.
• The diaphragm.
• In women, the right breast.

However, pain can radiate from another part of the body to the right side of the chest. For instance, you may have an injury in the neck or shoulders, but the pain can also be felt on the right side of your chest, says Dr. Mary Ann Bauman, a Seattle-based internist and a spokeswoman for the American Heart Association.

Although the heart usually is located on the left side of the body, in some people it is shifted toward the right, says Dr. Pilar Stevens-Haynes, a cardiologist and director of echocardiography at Mount Sinai South Nassau in Oceanside, New York. This is why heart attack symptoms also can occur on the right side of the chest, not just the left side.

When to Seek Medical Attention

Not every cause of pain on the right side of the chest is serious, but some of them are. Any time you have pain on the right side of your chest, you should let your doctor know. You should seek emergency care for right-sided chest pain if you:

• Are coughing.
• Feel like you are going to pass out.
• Have a much faster or slower heart rate than usual.
• Have pain that comes on suddenly and sharply and isn't going away, or you have pain that is radiating to the jaw and arms. This could indicate a heart attack.
• Already have a respiratory illness.
• Have a fever.
• Have shortness of breath.

It's important to rule out more serious causes of chest pain before assuming the pain has a less serious cause, says Dr. Linda Anegawa, an internist with the telehealth platform PlushCare.

Possible causes for pain on the right side of the chest include:

• Anxiety attack.
• Collapsed lung.
• Costochondritis.
• Gallbladder problems.
• Gastroesophageal reflux.
• Heart attack.
• Lung cancer.
• Musculoskeletal strain or injury.
• Pericarditis.
• Pleuritis.
• Pneumonia.
• Pulmonary embolism.
• Rib fracture.
• Shingles.

An anxiety attack is caused by an overwhelming feeling of stress or worry. Some of the symptoms of an anxiety attack include:

• An increased heart rate. You may think you are having a heart attack, says Dr. Sunitha D. Posina, a board-certified internist and locum hospitalist in New York City.
• Feeling very worried or fearful.
• Shortness of breath.
• Nausea or a stomachache.

Anxiety attacks usually last 10 to 30 minutes. If you're not sure if you are having an anxiety attack or a heart attack, see a doctor to rule out other physical causes.

Just as the name implies, a collapsed lung refers to air that pushes on the lung, making it collapse. Another name for this is pneumothorax. It's not always clear what causes a collapsed lung, but it's sometimes attributed to an injury to the chest or damage caused by lung disease.

Another symptom of a collapsed lung is shortness of breath. You should go to an emergency room if you think you have a collapsed lung, particularly if the pain is bad and if you have a lot of trouble breathing.

Pain in the chest from COVID-19 could occur on one side of the chest or both sides. The pain could be caused by muscle strain from coughing or body aches from a fever, Anegawa says.

It's also possible for pneumonia to occur due to COVID-19, and that can cause right-sided chest pain. Heart problems caused by COVID-19, such as heart failure or injury to the heart, also can contribute to chest pain on the right side. These pains typically happen at least five days after initial COVID-19 symptoms and are more common in those who aren't vaccinated against COVID, Anegawa explains.

Cartilage connects our ribs to the breastbone. Costochondroitis is an inflammation of the cartilage in that area of the body. Symptoms of costochondroitis include chest pain and pain that gets worse when you cough or take a deep breath.

Costocondroitis can be caused by trauma to the chest area (like from an accident), excessive physical strain to the chest area or a lot of coughing.

If you're not sure what's causing your chest pain but suspect it's costochondroitis, see a doctor to rule out more serious causes, such as a heart attack. Costochondroitis is seen in a third to half of patients who come to the ER with chest pain, Anegawa says.

Your gallbladder is located in the upper right corner of your abdomen. It stores a substance called bile, which helps your body break down fatty foods. Sometimes, pain on the right side of your chest radiates from the gallbladder.

There are several gallbladder problems associated with pain on the right side of your body, including an infection, gallstones or inflammation of a bile duct, which is one of the tubes in the gallbladder that transports bile in your body.

You should seek immediate medical attention if you suspect you have one of these gallstone-related issues.

GERD, which is short for gastroesophageal reflux disease, is also called acid reflux. It's caused by acid that comes from the stomach up to the esophagus. GERD is a common cause of pain on the right side of your chest. Other symptoms of GERD include:

• A bitter taste in your mouth.
• A chronic cough not connected to a respiratory illness.

Although GERD isn't serious, it can be uncomfortable. If you think you are experiencing GERD, try over-the-counter medicines such as antacids to help. If GERD's symptoms continue to bother you a couple of times each week, set a non-urgent appointment with your doctor.

Although most people's hearts are located toward the left side of their body, right-side chest pain still can be associated with a heart attack. Other symptoms of a heart attack include:

• Dizziness.
• Nausea.
• Shortness of breath.
• Pressure or pain felt in the arms, jaw, neck or back.

The symptoms of a heart attack can be a little different for each patient. They also can be different symptoms in men versus women, Posina says. For instance, women may not feel the same pressure-like pain that men feel. They also may experience fainting, indigestion and a lot of fatigue – symptoms that are not usually common in men.

Call 911 if you think you are having a heart attack. "Don't assume if pain is on the right side that it can't be cardiac pain," Bauman cautions.

Because pain from one part of the body can radiate to another part of the body, liver problems may end up causing pain on the right side of the chest, says Karen Jubanyik, MD, an associate professor in emergency medicine at Yale University School of Medicine in New Haven, Connecticut.

Some liver problems that also may cause pain in the chest include:

Typically, you'll work with your primary doctor or a specialist to manage these liver diseases.

• An unexplained cough.
• Feeling more tired.
• Weight loss for no apparent reason.

Smoking is the largest risk factor for developing lung cancer. Set an appointment with your doctor if you have these symptoms. Lung cancer that is in earlier stages is associated with better outcomes.

Musculoskeletal Strain or Injury

You can cause an injury to your chest area after a heavy cough or after strenuous activity such as exercise, Stevens-Haynes says.

If this type of injury occurs and you have pain on the ride side of the chest, let your doctor know. However, if you otherwise feel OK, it doesn't need to be an urgent appointment. Your doctor may recommend over-the-counter pain relievers or heat/ice therapy.

Pancreatitis is an inflammation of the pancreas, which is an organ behind the stomach that helps with digestion and management of blood sugar. Pancreatitis is often caused by alcohol or a viral infection. Pancreatitis can lead to chest pain that may be felt on the right side of the chest, Jubanyik says.

Other symptoms associated with pancreatitis include:

• Fatigue.
• Nausea or vomiting.
• Poor appetite.
• Abdominal pain.

If you have the symptoms of pancreatitis and severe stomach pain, go to the emergency room for help.

There are two layers of tissue called the pericardium that surround the heart and help to hold it in place. When there's an inflammation of this tissue, it's called pericarditis. Chest pain is a common symptom of pericarditis. The pain can feel like the pain from a heart attack. The pain can feel worse with taking a deep breath similar to the pain from a heart attack. It tends to be positional, worse when you lay flat and better when you lean forward.

However, the pain also can be caused by a heart attack. It also can be caused by an infection, injury or heart surgery. Because you may not know the exact cause, seek immediate medical attention if you suspect pericarditis.

On the outside of the lungs and inside your chest cavity there's a thin membrane called the pleura. Pleuritis or pleurisy is the name for an inflammation in the pleura. Usually, there is fluid that coats the layers of the pleura. If you have pleuritis, the layers rub against one another and cause pain. It also can cause shortness of breath and a cough.

The cause of pleuritis isn't always clear, although an infection is one possible culprit. See your doctor if you think you might have pleuritis.

Pneumonia is an infection in one or both of your lungs. Symptoms of pneumonia, in addition to pain on the right side or both sides of the chest, include:

• Pain that is worse when you cough.
• Coughing.
• A fever.
• Feeling more fatigued.

Pneumonia can be especially serious in those who are over age 65 and who have heart problems or chronic lung disease. See a doctor promptly if you think you have pneumonia.

A pulmonary embolism is a block that occurs in one of the lung's pulmonary arteries. Most pulmonary embolisms are caused by a blood clot that starts in the leg and moves to the lungs. Symptoms associated with a pulmonary embolism include:

• Dizziness.
• A fever.
• An irregular heartbeat.

Risks for pulmonary embolism include:

• Long periods of being immobile.
• Increased clotting risk, which can be genetic or related to conditions like cancer.
• Past history of pulmonary embolism.

A pulmonary embolism can be life-threatening, so seek immediate medical attention.

Pulmonary hypertension is what happens when blood pressure rises in the blood vessels of the lungs, Jubanyik says. Other symptoms associated with pulmonary hypertension are:

• Fainting.
• Heart palpitations.
• Shortness of breath.
• Weakness.

A rib fracture often is caused by an injury to the ribs. The pain from a rib fracture on the right side of the chest may get worse when you cough, laugh or sneeze. You also may have swelling or bruising near where the break occurred.

Seek immediate medical attention if you think you have a rib fracture. If you had an accident or injury, there could be other internal organ damage that requires treatment, Posina says.

Shingles is caused by a virus called varicella-zoster. That virus is also the cause of chickenpox. Once you have chickenpox, that virus stays in your body. However, late in life, it can reactivate in your body as shingles.

Shingles often causes a painful rash or blisters on the left or right side of your torso. Pain can precede or follow the development of a rash or blisters. If it's on the right side of your body, it can cause pain on the right side of your chest. The pain from the virus is a type of nerve pain, which extends in a line pattern called dermatomal distribution.

If you notice a rash or blisters along with right-side chest pain, call your doctor promptly, Bauman advises. There are anti-viral treatments for shingles, but they need to be started early. There also is a shingles vaccine for those age 50 or over to help prevent a shingles attack.

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