Q. Could the pain in my lower rib area be due to a heart problem?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 25, 2017 and last reviewed on: Aug 02, 2021

Hello doctor,

I have been dealing with some health issues lately. When I was 32 years old, I had my first atrial fibrillation, for which cardioversion was done in the hospital. Five years after that, I had a second attack, with the same result. I have never taken any medicines, just started taking CoQ10 and Magnesium, and have not had a problem. I still have PVC and feel those skips, I have had treadmill tests, stress echocardiogram, EP study, coronary calcium scoring, and EKG done, all tests showing the heart to be structurally normal.

Recently, I had a severe pain in my right ribs and I went to the doctor, and he found a liver hemangioma and cysts in the ultrasound, it was benign in nature. That day, my doctor told me to put Nitro under my tongue, and the pain went away immediately. He then did another EKG and blood tests and said he does not feel it was my heart. Because they saw spots on my liver and my pain was in the upper right quadrant, where the liver is located. However, I have looked at three of the EKG sheets, and they say abnormal on them. Also, I have been having bouts of shortness of breath and central chest pain, but I was putting that off as anxiety from this liver mass, and acid reflux that I have had in the past. My CRP levels were fine in the blood workup, and my BP has been fine. Cholesterol has always been high. The most recent coronary calcium score was 0.

My question is, looking at all this could the right side pain in lower rib area be due to the heart? And would heart have anything to do with the multiple hemangiomas and cysts on my liver as well as two parapelvic cysts? I am attaching all my reports.



Welcome to

I have gone through your reports (attachment removed to protect patient identity) very carefully.

  • Your heart looks fine, and your blood tests are also fine, only your cholesterol is elevated. Your ECGs are also normal, so the likelihood of this pain being cardiac is less. This is most likely a pain due to gastritis and reflux disease, which also responds to Nitroglycerin. Also, any spasmodic pain in the abdomen can respond to Nitroglycerin, so it is not a sign of heart disease.
  • For gastritis and reflux disease, I suggest you try the following.
  1. Avoid fatty, oily, and spicy diet.
  2. Go for a walk after having food instead of taking rest.
  3. Have multiple small meals instead of a heavy meal.
  4. Have regular sleep habit and avoid stress.
  5. Eat a lot of green leafy vegetables and fruits.
  6. Try taking tablet Pan DSR (combination of Pantoprazole and Domperidone) before breakfast, once a day for two weeks.
  7. You can also add syrup Sucral O (Sucralfate) or Gelusil (combination of Aluminium and Magnesium hydroxide and Simethicone), two teaspoons, three times a day for a week.
  • For cholesterol, I suggest you try the following.
  1. You should have a healthy lifestyle like avoiding fatty, oily and high-calorie diet.
  2. Have low salt diet and monitor blood pressure regularly.
  3. Regular exercises like brisk walking and jogging, according to your capacity for at least 30 min a day and five days a week.
  4. Eat a lot of green leafy vegetables, fruits, fish once or twice a week and avoid meat.
  5. Avoid smoking and alcohol, if any.
  6. You need to reduce your weight.
  7. If this does not respond in 3 to 6 months, then you should try taking cholesterol medicine like tablet Atorvastatin 10 mg at bedtime.
  • Consult your specialist doctor, discuss with him or her and start taking the medicines after their consent.
  • For your hemangiomas, you need to visit gastroenterologist for further management. Usually, they are benign and harmless.

For further queries consult a cardiologist online -->

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