Over 65: when is left-side pain with deep breaths an ER sign?

Why does it hurt when I take a deep breath on my left side? When you’re over 65, new or worsening left-side chest or upper abdominal pain on deep breaths can be a sign that you need urgent care. While many causes are minor, some are life-threatening. This guide explains when to consider an ER visit, what common and serious conditions can cause pain, and when to speak to a doctor.

Common, less serious causes

Many people feel sharp, aching, or stabbing pain when breathing deeply. In older adults, these are often due to:

• Musculoskeletal strains

• Twisted or pulled muscles around the ribs (intercostal muscles)
• Costochondritis (inflammation where ribs meet breastbone)

• Mild chest-wall inflammation

• Viral pleurisy (viral infection irritating the lining of the lung)
• Overuse from coughing or heavy lifting

• Digestive issues

• Acid reflux (heartburn) that feels like chest pain on deep breath
• Gastritis or stomach irritation

These usually improve over days with rest, gentle stretches, heat packs, and over-the-counter pain relievers.

When to worry: ER warning signs

Some causes of left-side pain with deep breaths can be severe. If you have any of these, call 911 or go straight to the nearest emergency department:

• Sudden, severe chest pain that radiates to your jaw, left arm, or back
• Shortness of breath that came on quickly or worsens when you lie down
• Fast or irregular heartbeat, sweating, nausea, or lightheadedness
• Coughing up blood or pink, frothy spit
• High fever (above 101°F / 38.3°C) with chills
• Unexplained dizziness or fainting
• Swelling, warmth, or redness in one calf or thigh (possible blood clot)

These could indicate:

• Pulmonary embolism (blood clot in the lung)

• Risk rises with age, recent surgery, or long immobility (Stein et al., 2001)
  • Heart attack or unstable angina
  • Spontaneous pneumothorax (collapsed lung)
  • Pericarditis leading to fluid around the heart
  • Severe pneumonia or lung abscess (Mandell et al., 2007)
  • Aortic dissection (tear in the main artery wall)

Pulmonary embolism: a silent danger

A pulmonary embolism (PE) happens when a blood clot travels from your legs to your lungs. In older adults, the risk is higher after:

• Recent surgery or hospitalization
• Long plane or car trips with little movement
• Cancer, especially if you’re getting chemotherapy
• History of deep vein thrombosis (DVT) or clotting disorders

Symptoms include sudden pleuritic chest pain (worse on deep breath), breathlessness, rapid heart rate, and sometimes fever. Stein et al. (2001) found that quick diagnosis pathways save lives. If you suspect PE, seek immediate ER care.

Pneumonia and pleurisy

Infections of the lung or its lining can cause pain when you breathe in:

• Community-acquired pneumonia

• Cough, fever, chills, shortness of breath (Mandell et al., 2007)
• Elderly may only have confusion or a mild fever

• Pleurisy

• Inflammation of the pleura (lining around the lungs)
• Sharp, stabbing pain worsened by breathing, coughing, or sneezing

If you have fever, productive cough, or worsening breathing with left-side pain, prompt medical evaluation is essential. Antibiotics or other treatments may be needed.

Cardiac causes

Not all heart pain feels like crushing chest pressure. In older adults, heart-related causes of pleuritic pain include:

• Pericarditis

• Inflammation of the heart’s lining; worse on deep inhalation and when lying down
  • Myocardial infarction (heart attack)
• Can have pleuritic features or mimic lung pain
  • Aortic dissection
• Sudden tearing pain in chest/back; pulse differences in arms

Any discomfort you’re not sure about—or pain plus sweating, nausea, or faintness—should prompt ER evaluation.

Gastrointestinal and abdominal issues

Sometimes left-side pain on deep breath is really an irritating belly problem:

• Acid reflux or esophagitis

• Burning pain that may worsen with a deep breath if stomach acid irritates the diaphragm
  • Pancreatitis or stomach ulcer
• Upper abdominal pain possibly radiating to the back
  • Splenic problems
• Splenic infarct (tissue death) or enlargement can cause left upper-abdominal pain, worse on breath

Discuss persistent or worsening abdominal pain with your doctor—especially if you have liver cirrhosis, which affects half of patients within a decade of diagnosis (D’Amico et al., 2005).

When musculoskeletal pain masquerades as serious illness

Muscle-related chest wall pain is common and usually harmless, but in seniors it can still be intense:

• Costochondritis

• Tenderness where ribs join sternum; reproduced by pressing on the area
  • Rib fracture or contusion
• Often from a fall or minor trauma; pain when breathing or moving

Rest, ice/heat, and gentle pain relievers often resolve these in a few weeks. If pain is unrelenting or associated with troubling symptoms, get checked.

What you can do now

• Monitor your symptoms: note onset, severity, and any triggers.
• Try over-the-counter pain relievers (acetaminophen or NSAIDs) if you don’t have contraindications.
• Apply a warm compress or ice pack to sore areas.
• Maintain gentle movement and avoid high-impact activities.
• Consider a free, online symptom check for quick guidance on possible causes.

When to speak to your doctor

Even if you don’t rush to the ER, make an appointment if you have:

• Pain lasting more than a week without improvement
• Recurring episodes of pleuritic pain
• New or unexplained weight loss, night sweats, or appetite changes
• A history of heart, lung, or liver disease
• Persistent cough or blood in your spit

Early evaluation can pinpoint the cause and prevent complications.

Bottom line

Left-side pain on deep breath in those over 65 can range from mild muscle strains to life-threatening conditions like pulmonary embolism, pneumonia, or heart disease. Know the red-flag symptoms—sudden severe pain, shortness of breath, fever, cough with blood—and go to the ER if you experience them. For ongoing, less severe pain, talk to your doctor for proper diagnosis and treatment. Never ignore worrying chest or upper abdominal pain. If in doubt, get evaluated promptly— and always speak to a doctor about anything that could be life-threatening or serious.