Pain under the right rib cage most often comes from the gallbladder, liver, a strained muscle or the right lung. A cardiologist becomes involved when the pain may be heart-related, such as heart failure causing a congested, swollen liver, or a heart attack felt in the upper abdomen. Severe pain, fever, yellow skin or chest pressure with breathlessness needs urgent care.
Medically reviewed by
Board-certified cardiologist · Katy & Sugar Land, TX
Fellowship-trained in cardiovascular disease, interventional cardiology, echocardiography and advanced heart failure and transplant cardiology. Former Assistant Professor of Cardiology at McGovern Medical School.
What causes pain under the right rib cage?
The right upper abdomen and lower right chest hold the liver, gallbladder, part of the bowel, the right kidney behind them and the base of the right lung above the diaphragm. Most pain here comes from one of these organs or from the ribs and muscles themselves.
| Cause | Typical clues | Who usually treats it |
|---|---|---|
| Gallstones or gallbladder inflammation | Steady pain after fatty meals, can last hours, nausea, may reach right shoulder blade | Primary care, surgeon, gastroenterologist |
| Liver inflammation or fatty liver | Dull ache, fatigue, sometimes yellow skin or eyes | Primary care, gastroenterologist |
| Heart failure with liver congestion | Right-sided fullness, swollen legs or belly, breathlessness, weight gain | Cardiologist |
| Heart attack (inferior wall) | Upper abdominal or lower chest pressure, nausea, sweating, breathlessness | 911 |
| Pneumonia, pleurisy or lung clot | Sharp pain with breathing, cough, fever or sudden breathlessness | Primary care or ER |
| Muscle strain or rib injury | Tender to touch, worse with movement or twisting | Primary care |
| Kidney stone or infection | Pain in the back and side, may move toward the groin; urinary symptoms | Primary care, urologist |
| Shingles | Burning band of pain on one side, then a rash | Primary care |
How the heart can cause right rib cage pain
When the right side of the heart is weak or under high pressure, blood backs up into the veins that drain the liver. The liver swells and stretches its capsule, causing a dull ache or fullness under the right ribs. Doctors call this congestive hepatopathy. It often comes with other signs of heart failure:
- Shortness of breath with activity or when lying flat.
- Swelling in the legs, ankles or abdomen.
- Rapid weight gain from fluid, loss of appetite or early fullness.
- Fatigue and reduced exercise tolerance.
Causes include left-sided heart failure, lung disease raising pressure in the lungs, valve problems and conditions affecting the heart’s lining. Read early signs of heart failure and learn about heart failure treatment.
Heart attack felt in the upper abdomen
A heart attack involving the lower (inferior) wall of the heart can be felt as pressure in the upper abdomen or lower chest, sometimes with nausea and vomiting, and can be mistaken for indigestion or a gallbladder attack. This is more common in women, older adults and people with diabetes. The NHLBI lists upper stomach discomfort among heart attack symptoms.
- Chest pressure, shortness of breath, cold sweat or pain spreading to the arm, jaw or back
- Severe pain that will not ease or makes it hard to sit still
- Fever and chills, or yellowing of the skin or eyes
- Vomiting that will not stop, or vomiting blood
- Sudden sharp pain with breathlessness or coughing blood
Gallbladder and liver: the most common causes
Gallstones are hardened deposits in the gallbladder. When one blocks the gallbladder’s outlet, it causes steady pain in the right upper abdomen, often after a fatty meal, lasting from 30 minutes to several hours. According to NIDDK, pain with fever, yellowing of the skin or eyes, or pain lasting several hours needs prompt medical care. Fatty liver disease and hepatitis can also cause a dull right-sided ache.
When to see a cardiologist for right rib cage pain
Most patients with right upper abdominal pain start with a primary care doctor, who may order an abdominal ultrasound and liver tests. A cardiology evaluation makes sense when:
- Pain comes with breathlessness, leg swelling or weight gain.
- You already have heart failure, valve disease or a weak heart.
- Liver tests are abnormal without a clear digestive cause.
- Pain feels like pressure and appears with exertion.
A cardiologist may order an EKG, an echocardiogram to measure pumping function and pressures in the right heart, a BNP blood test, and stress testing if coronary disease is possible.
Treatment depends on the cause
Liver congestion from heart failure improves when heart failure is treated with guideline-based medicines, diuretics to remove extra fluid, salt and fluid guidance and treatment of the underlying cause. Gallbladder disease may need surgery. Muscle strain improves with rest and time. The key is identifying which organ is responsible.
Cardiology evaluation in Katy and Sugar Land
If right-sided pain comes with breathlessness, swelling or a known heart condition, Advanced Cardiology can check whether your heart is involved. Dr. Khalid, who completed fellowship training in advanced heart failure and transplant cardiology, evaluates patients at our Katy and Sugar Land offices, with EKG and echocardiogram testing in the office.
Katy office: 410 W Grand Pkwy S, Suite 4D, Katy, TX 77494
Sugar Land office: 7102 Tarrington Ave, Suite 505, Sugar Land, TX 77479
Phone: (713) 258-6111
We also see patients from Fulshear, Richmond, Rosenberg, Stafford, Missouri City and west Houston.
Swelling, breathlessness and right-sided pain?
These can be signs of heart failure. Request a cardiology visit in Katy or Sugar Land.
Having symptoms right now? Call 911. Do not wait for an appointment.
Frequently asked questions
What causes pain under the right rib cage?
Common causes include gallstones, liver inflammation, muscle strain, lung infections and kidney problems. Heart causes include heart failure with liver congestion and, less often, a heart attack felt in the upper abdomen.
Can heart problems cause pain under the right rib cage?
Yes. Right-sided heart failure can congest and swell the liver, causing a dull ache under the right ribs, often with leg swelling and breathlessness. A heart attack can also cause upper abdominal pressure.
Should I see a cardiologist for right rib cage pain?
See a cardiologist if the pain comes with shortness of breath, swelling, weight gain or exertion, or if you have known heart disease. Otherwise, start with your primary care doctor.
How do I know if right rib cage pain is my gallbladder?
Gallbladder pain is usually steady, follows fatty meals, lasts 30 minutes to several hours and may spread to the right shoulder blade. An abdominal ultrasound can confirm gallstones.
What does liver congestion from heart failure feel like?
It often feels like dull fullness or aching under the right ribs, with poor appetite, abdominal swelling, leg swelling and breathlessness.
When is pain under the right rib cage an emergency?
Seek emergency care for severe pain, fever with yellow skin or eyes, persistent vomiting, or chest pressure with breathlessness or sweating.
Trusted health resources
- Gallstones, National Institute of Diabetes and Digestive and Kidney Diseases (NIH)
- Heart Attack: Symptoms, National Heart, Lung, and Blood Institute (NIH)
- Heart Failure, MedlinePlus, U.S. National Library of Medicine
- Gallstones, MedlinePlus, U.S. National Library of Medicine
- Shingles, MedlinePlus, U.S. National Library of Medicine
Medical disclaimer: This article is for general education and is not a diagnosis or a substitute for care from your own doctor. If you think you may be having a heart attack, stroke or another emergency, call 911 right away.
