Age 65+: why does it hurt on the left side when I take a deep breath?

Pain on your left side when you take a deep breath (often called pleuritic chest pain) is a common complaint, especially in people over 65. While many causes are harmless and temporary, some can be serious. Below is an overview of the most likely reasons, what to look out for, and when to talk to a doctor.

Why does it hurt when I take a deep breath on my left side?
In older adults, chest and side pain can stem from:

1. Musculoskeletal causes
2. Lung-related issues
3. Heart and vascular problems
4. Abdominal or referred pain sources

Each category is outlined below.

1. Musculoskeletal Causes
   Muscle, bone, and cartilage problems are among the most common and least dangerous reasons for pain with deep breaths.

• Costochondritis
– Inflammation where ribs meet the breastbone (sternum)
– Sharp or aching pain worsened by breathing, coughing, or pressing on the front of your chest
– Often follows a minor injury, heavy lifting, or repetitive motions

• Muscle strain
– Overstretching or small tears in intercostal muscles between ribs
– Can follow twisting your torso, sudden movements, or a fall
– Pain is localized, worsens with movement, breathing, or coughing

• Rib fracture or bruise
– More common in older adults with weaker bones (osteoporosis)
– Sharp, stabbing pain that intensifies with deep breaths or direct pressure
– Might be accompanied by swelling or visible bruising

2. Lung-Related Issues
   Problems affecting the lungs or lining around the lungs (pleura) can cause sharp, stabbing pain on deep inhalation.

• Pleurisy (pleuritis)
– Inflammation of the pleural layers that encase the lungs
– Sharp, localized pain that worsens when you inhale, sneeze, or cough
– Often follows a viral infection, but can also come from pneumonia or pulmonary embolism

• Pneumonia
– Infection of lung tissue causing inflammation and fluid buildup
– Symptoms include fever, cough (sometimes producing green or rust-colored phlegm), chills, and shortness of breath
– Chest X-rays and blood tests confirm the diagnosis

• Pulmonary embolism (PE)
– A blood clot in the lung’s arteries; in older adults, often from a clot in the legs (deep vein thrombosis)
– Sudden sharp chest or side pain, worsened by deep breaths
– Shortness of breath, rapid heart rate, lightheadedness, or coughing up blood are red flags

3. Heart and Vascular Problems
   Though classic heart attack pain is more central or on the left, older adults—especially women—can have atypical presentations.

• Pericarditis
– Inflammation of the sac around the heart
– Sharp chest pain that may improve when you sit up and lean forward
– Can follow a viral infection or be secondary to kidney disease or autoimmune conditions

• Heart attack (myocardial infarction)
– Though usually described as pressure or squeezing in the center of the chest, some people feel pain on the left side or in the back, jaw, or arm
– May be accompanied by sweating, nausea, shortness of breath, or lightheadedness
– In older adults, symptoms can be milder or mistaken for indigestion

• Aortic dissection
– A tear in the wall of the major artery (aorta)
– Sudden, severe chest or upper back pain described as ripping or tearing
– May cause a difference in blood pressure between arms, dizziness, or fainting

4. Abdominal and Referred Pain
   Problems in organs below the diaphragm can show up as left-side chest or back pain.

• Splenic enlargement or infarction
– An enlarged or damaged spleen (often from conditions like cirrhosis) can press on the diaphragm
– Pain in the left upper abdomen or lower chest, worse with breathing or movement
– Cirrhosis can be diagnosed by transient elastography (FibroScan) and tracked for severity and survival indicators (Foucher et al., 2006; D’Amico et al., 2006)

• Gastroesophageal reflux (GERD) or esophageal spasm
– Acid reflux or muscle spasms in the food pipe can cause burning or cramping pain
– Might feel worse when you lie down or after eating

• Pancreatitis (tail of the pancreas)
– Inflammation of the pancreas can radiate pain to the left upper abdomen and chest
– Often associated with nausea, vomiting, and mild fever

Key clues to guide you
• Onset and duration
– Sudden, severe pain: Think PE, aortic dissection, or heart attack
– Gradual, lingering pain: More likely costochondritis, pneumonia, or pleurisy

• Aggravating factors
– Worse with breathing, coughing, or movement: Pleurisy, rib injury, muscle strain
– Worse after eating or when lying flat: GERD, esophageal spasm

• Associated symptoms
– Fever, cough, phlegm: Pneumonia
– Sudden shortness of breath, racing heart: PE or heart attack
– Sweating, nausea, arm or jaw pain: Heart attack

What to do next
Most mild, musculoskeletal pains improve with rest, heat or ice packs, and over-the-counter pain relievers (acetaminophen or NSAIDs). However, you should seek immediate medical attention if you experience:

• Sudden, severe chest or back pain
• Shortness of breath that isn’t normal for you
• Dizziness, fainting, or severe sweating
• Coughing up blood
• Pain accompanied by arm, jaw, or neck discomfort
• Any signs of a serious condition

If your pain is milder but persistent or unexplained, consider doing a free, online symptom check for to help you decide if you need urgent care. These tools are not a substitute for medical advice, but they can guide you on next steps.

When to speak to a doctor
Even if your pain seems minor, talk to your doctor if:

• It lasts more than a few days without improvement
• Pain medication provides only temporary relief
• You develop new symptoms (fever, cough, difficulty breathing)
• You have risk factors such as osteoporosis, a history of blood clots, heart disease, or cirrhosis

Always err on the side of caution. Some life-threatening conditions can present subtly in older adults. If you’re ever in doubt, seek immediate medical care or call your local emergency number.

Bottom line
Pain on the left side when you take a deep breath can range from a simple muscle strain to a serious heart or lung problem. Musculoskeletal causes are most common and often improve with rest and over-the-counter remedies. However, sudden severe pain, shortness of breath, or additional concerning symptoms require prompt evaluation. Speak to your doctor about any chest or side pain that feels serious, lasts too long, or doesn’t respond to simple measures. Your health and peace of mind are worth the check.