Severe right chest pain, most noticeable when lying flat—what could be the cause and what should I do?

Severe right-sided chest pain that is most pronounced when lying flat may be caused by conditions such as reflux esophagitis, intercostal neuralgia, or cor pulmonale. Symptoms can be improved through medications, surgery, or other treatments. Specific analyses are as follows:

1. Reflux Esophagitis

Reflux esophagitis refers to inflammation of the esophagus caused by the backflow of stomach acid and digestive juices. When stomach acid flows back into the esophagus, it may cause acid burns and inflammation, leading to radiating pain. Under medical guidance, patients may use proton pump inhibitors such as omeprazole enteric-coated capsules, or prokinetic agents like mosapride citrate tablets.

2. Intercostal Neuralgia

Intercostal neuralgia results from damage to the intercostal nerves, causing localized severe pain. Under medical supervision, patients may be treated with medications such as ibuprofen sustained-release capsules or dexamethasone sodium phosphate injection.

3. Cor Pulmonale

Cor pulmonale refers to heart disease secondary to lung disorders. Lung diseases may lead to symptoms such as dyspnea and pulmonary hypertension, which in turn increase cardiac workload and cause myocardial ischemia, resulting in chest pain or tightness. Treatment options include interventional therapy, thrombectomy, and other procedures.

In addition to the above causes, right chest pain may also result from rib fractures, pulmonary embolism, heart failure, or other conditions. If symptoms are severe or persistent, prompt medical evaluation is recommended to establish an accurate diagnosis and develop an appropriate treatment plan.