Internal Medicine

Stinging in the right chest - what can it be?

definition

If a stinging sensation occurs more on the right side, there can be various reasons for this. The cause of the complaints is often a problem emanating from the heart. This expresses itself more on the left than on the right, but the pain can radiate via various nerve connections to superficial regions that do not participate directly in the disease process and are also a little further away. However, there may also be musculoskeletal problems such as adhesions between muscles and bones or pulmonological causes caused by the lungs.

causes

In the case of a sting, the cause of the symptoms must first be divided into two main pillars. It is important to differentiate potentially life-threatening causes from harmless and usually well treatable causes.

Please also read:

Right Chest Pain - These Are the Causes!
Stinging in the chest

Potentially life threatening causes

Among the life-threatening causes are primarily diseases that start from the heart. In the following you will find possible polluters from this category:

Stable angina pectoris symptoms in which there is a temporary circulatory disorder of the heart muscle tissue that often occurs during exercise. Angina pectoris typically also includes a feeling of pressure in the front of the chest and shortness of breath (Dyspnea) in front.
An acute myocardial infarction (heart attack) manifests itself in many cases by radiating to other regions. These are usually in the anterior chest area, in the left armpit, on the left arm or in the area of the neck, lower jaw and upper abdomen, with decreasing frequency. All symptoms of angina pectoris can also occur with a myocardial infarction, as both clinical pictures often arise from the same cause (especially CHD - Coronary Heart Disease).
life-threatening arrhythmias such as ventricular tachycardias and atrial fibrillation
High blood pressure with spikes in blood pressure of around 230 mmHg can cause stinging in the right and left chest.
A pulmonary embolism is an acute occlusion of an arterial vessel in the pulmonary circulation. In addition to sudden onset of shortness of breath (Dyspnea), Tachycardia (Racing heart), A drop in blood pressure and a generally reduced general condition can result in sharp pain in the right breast. Pulmonary embolism can manifest itself in conditions ranging from asymptomatic to severely symptomatic. Due to often unspecific complaints, misdiagnoses are currently very common and not infrequently an unexpected finding in the autopsy.
Also a pneumothorax (Accumulation of air in the chest) is possible. The lungs are covered by the pulmonary membrane (Pleura), which is important for respiratory function. In the case of a pneumothorax, air enters the gap between the two halves of the lung membrane, which increases the risk of lung collapse with potentially acute onset of shortness of breath (Dyspnea) and stinging in the right chest.

Less common causes, but which can be life threatening, include:

Inflammation of the pleura (Lung membrane), the mediastinum (middle layer) or the pericardium (Pericardium).
A mitral valve prolapse, in which there is a bulging of the valve between the left atrium and the left ventricle, can also be the cause.
Tumors in the lungs or skeletal metastases in the ribs can cause the stinging in the right breast described above.
Aortic dissection, i.e. bleeding between two layers of the wall of the aorta, can also be responsible for the symptoms.

The causes tend to be harmless

The second main pillar of the causes of stinging in the right chest is also made up of several different diseases, which together have a much more favorable prognosis.

Heartburn due to reflux of gastric acidic secretions into the esophagus
In the case of a diaphragmatic hernia, parts of Pass the stomach and esophagus through the diaphragm and into the chest, causing a stinging in the right chest.
The term musculoskeletal causes includes muscular (e.g. sore muscles, tension, muscle fiber tears, etc.) and skeletal (e.g. block vertebrae with radiation, fractures of vertebrae and ribs, etc.) pathologies.
Shingles (possible late effects with the herpes zoster virus) can also be a potential cause.
This can also be observed in the case of problems with the gallbladder or the pancreas, as nerve pathways run from the upper right half of the body to some abdominal organs.
Rare syndromes such as Römhild syndrome can lead to increased air retention in the abdomen and compression pain in the right chest.
Tietze syndrome is also rare and is characterized by a painful swelling in the area of the rib-sternum transition, typically at the level of the 2nd or 3rd rib.
Also are all diseases of the liver; especially with an enlarged liver (Hepatomegaly) associated with sharp pain in the right breast. The reason for this is the close proximity of both regions to one another. The liver tissue is actually not sensitive to pain. However, if there is an enlargement of the organ due to pathologies of the liver, the pain-sensitive organ capsule can be stretched and cause pain under the right chest.
Often, psychogenic causes are behind the appearance of chest pain. They should not be neglected but adequately treated. Often the symptoms can be alleviated or completely resolved in this way. Sometimes special breathing techniques can help.

diagnosis

In the context of a diagnosis, the medical discussion is of particular importance. Here, the doctor hopes to get specific information from the information on time, duration, trigger and possible activities to clarify the sharp pain in the right breast.

Due to the wide range of potential causes, a detailed clinical examination should follow. The eavesdropping (Auscultation) of heart and lungs as well as palpation (Palpation) the organ systems of the abdominal cavity are very important. Of course, other diagnostic methods such as an X-ray or a CT are also used. In principle, all diagnostic methods are possible (e.g. a biopsy if there is a suspicion of e.g. tumors in the chest).

Concomitant symptoms

Depending on the cause of the stabbing pain, various accompanying symptoms can be found. With musculoskeletal problems, movement-dependent, easily localizable pain often occurs. In vertebral body pathologies with impairment of the associated spinal nerves, there may be a loss of movement and sensory impressions in the affected segment. In principle, side effects such as the occurrence of panic attacks, anxiety, cold sweat, tachycardia / palpitations, etc. are possible. Breathing work can also be difficult due to the pain in the right chest.

therapy

The treatment of sharp pain in the right chest can be divided into a causal treatment of the underlying disease and a symptomatic therapy with relief of the accompanying symptoms. In acute panic attacks or tachycardia triggered by pain or fear, the patient can be given a sedating or anti-anxiety drug (e.g. Lorazepam or Diazepam) are given.

In principle, the stabbing pain can also be treated with opioids (e.g. morphine) or initially rather non-opioid analgesics (e.g. Ibuprofen or Diclofenac). Causal treatments - if available - can be considered for all triggering diseases. The spectrum ranges from the therapy of a myocardial infarction to surgical interventions e.g. for vertebral body fractures.

Duration and forecast

Due to the wide range of possible causes, the stinging in the right breast can be both temporary and chronic and persistent symptoms. The stinging in the right breast can be a manifestation of many diseases and therefore a general prognosis cannot be established. This depends on the disease or cause and the extent to which it is present.

Occurrence of pain in pregnancy

Especially in the late phase of pregnancy, pressure-related pain symptoms in the right breast can occur. As a pregnancy progresses, the uterus moves (uterus) more and more upwards and exerts pressure on the other organ systems in the abdomen. Since the liver, with an organ weight of 1200-1400 grams, takes up a lot of space in the right upper abdomen, pressure can be transferred to the area of the right breast.

For more information, see: Breast pain in pregnancy

Stinging in the right chest in special regions

in the right nipple

Stinging in the nipple can have different reasons. For example, constant rubbing of a bra or sports shirt that doesn't fit perfectly can cause an uncomfortable stinging of the nipple.

Hormonal causes are also possible. In this regard, the woman's pregnancy and breastfeeding period should primarily be pointed out, while the woman's hormonal balance changes. There is a differentiation of the gland ducts in the female breast and the onset of lactation / milk production. This can lead to irritation with sharp pain in both the breast and the nipple. Inflammatory processes in the ducts of the mammary glands or dermatological diseases can also manifest themselves with pain in the nipple.

on the right costal arch

With stinging in the right costal arch, pathological processes can be found on the ribs themselves, the lungs or, for example, diseases of the liver. Finally, damage or irritation to the intercostal nerves that run on the underside of the costal arches can lead to a stinging of the right costal arch.

For further information please also read: Pain in the right costal arch - that's behind it