Most of us often ignore right-sided chest pain, thinking it is either muscle strain or indigestion. We hardly think that it could indicate a heart attack, which we associate with pain on our left side. This assumption may delay treatment and endanger lives as heart problems can manifest variably.
Dr Prashant Pawar, a cardiology consultant at Fortis Hiranandani Hospital, Mumbai, recalls how a 62-year-old male patient with right-sided chest pain had come to his OPD after taking antacids. “He had even had an aerated beverage, which led to breathlessness and profuse sweating. It wasn’t until after two hours of pain and distress that he sought medical attention. His ECG revealed an anterior wall myocardial infarction, accompanied by reduced heart pumping. In short, he had had a heart attack caused by a blocked artery. An angioplasty was done. He was in the ICU for three days because of fluid accumulation in the lungs. His condition wouldn’t have worsened had he consulted us on time,” he says. Sometimes, people mistake a heart attack on the right side of the chest as a bad muscle pull.
Why is right side chest pain a potential symptom of a heart attack?
Chest pain, irrespective of origin, location and radiation, should not be taken lightly if it persists for over 10 minutes. The character of the pain is important. Dr Maulik Parekh, head, TAVR and structural heart programme, Department of Cardiac Sciences at HN Reliance Hospital lists three things to watch out for:
1.Check whether the pain is localised or is radiating to the neck and shoulders.
2. Is it associated with exertion? Does it happen after a heavy meal or a hot shower?
3. Is it continuous or intermediate?
4. Is the pain intense and sharp?
Any of these could signal a heart attack or a developing blockage that needs to be addressed pronto. “The same nerves supply both the right and left side of the chest, neck, jaw and shoulders. So the pain from the heart can radiate towards the right shoulder more frequently than the left shoulder. The pain can also affect the back of the chest, the neck and the jawline,” says Dr Parekh.
What are the common warning signs of a heart attack and how is chest pain on the right side different from them?
Common symptoms involve central chest pain known as typical angina, described as heaviness, discomfort or occasionally sharp shooting pain. Other symptoms include shortness of breath, nausea, jaw pain and left shoulder pain extending to the arm or back. “The right side pain is about heaviness than a stab. It does not increase or decrease by pressing on that side or by deep inspiration. If the pain increases by pressing on the particular site or by deep inspiration, it is likely to be from the muscle or some bones or ribcage rather than the heart,” explains Dr Parikh.
Dr Pawar warns that people with diabetes may not experience any symptoms at all. “Also, heart attack pain is a retrosternal pain and the patient clenches their fist. Localised pain in the finger is not a heart attack pain,” he says.
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What are the challenges of treating heart attacks that manifest through right-sided chest pain?
The biggest challenge, feels Dr Pawar, is sifting through many causes of right chest pain, ranging from muscle strains, pulmonary embolism, acid reflux to shingles. Doctors should remain vigilant.
Can diagnostic tests differentiate causes?
A comprehensive clinical examination remains irreplaceable, with additional tests used as adjuncts. These tests encompass ECGs, 2D-Echo, stress tests, CT coronary angiography and blood work, including troponin levels. “We can also do a right-sided ECG,” says Dr Parekh. A troponin test, which measures levels of protein in the heart, is the best.
