A cardiologist explains the possible causes of chest pain when you lean forward and backward.
“Pain in the chest with leaning forward or backward is a symptom commonly associated with pericarditis,” says Chester M. Hedgepeth, III, MD, PhD, Executive Chief of Cardiology at Care New England.
“Pericarditis is an inflammation of the thin, protective membrane that surrounds the heart, and keeps it in its proper anatomic location. Inflammation of this membrane may cause chest pain.”
Dr. Hedgepeth says that “the inflammation in the lining around the heart could be related to a recent heart attack.
“Heart attacks can lead to an immune response that causes inflammation in the pericardial sac.
“You may hear your doctor refer to this type of post-heart attack pericarditis as Dressler’s syndrome.”
What if you haven’t had a heart attack yet are experiencing chest pain or discomfort (or a dull ache) when you lean forward and backward?
There are many possible non-cardiac causes.
“More commonly, this inflammation [periocarditis] is related to infection (virus, rheumatic fever or tuberculosis), cancers (lung, breast, renal cell cancer, Hodgkin’s disease and lymphoma), immune diseases such as lupus, recent radiation therapy to the chest area, or certain drugs,” explains Dr. Hedgepeth.
“Recent chest wall trauma, musculoskeletal injury and herpes zoster should all be ruled out.”
How is periocarditis diagnosed?
If you have pain in your chest when you lean forward and back, there can be many possible causes — linked to pericarditis.
The workup for a correct diagnosis is as follows.
Medical History and Symptoms Review: The diagnostic process begins with a detailed discussion of your medical history and symptoms.
The physician will ask about recent illnesses, autoimmune disorders or trauma.
Physical Examination: During the physical exam, the doctor will listen to your heart with a stethoscope.
A key finding in pericarditis is the pericardial friction rub — a distinctive, scratchy sound produced by the rubbing of the inflamed pericardial layers.
Electrocardiogram (ECG): An ECG records the heart’s electrical activity and may show changes typical of pericarditis.
Chest X-ray: A chest X-ray helps visualize the heart’s size and shape and can show the fluid accumulation around the heart.
Echocardiogram (Echo): This ultrasound test provides images of the heart and can detect the fluid and assess the thickness of the pericardium.
Blood Tests: These tests check for markers of inflammation and identify potential underlying causes, such as infection or autoimmune diseases.
Pericardiocentesis: If there is significant fluid accumulation, this procedure may be performed to remove and analyze the fluid, helping to diagnose the cause of the inflammation.
In some cases, CT scans or MRIs may be used for further evaluation.
Bottom line: Chest pain that comes when you lean forward and/or backward should never be ignored. Make an appointment with your doctor.
Dr. Hedgepeth also serves as a physician in the cardiovascular division and arrhythmia service at Brigham and Women’s Hospital, plus is an instructor of medicine at Harvard Medical School.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Chayatorn Laorattanavech
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