Chest Pain in Heart Attack
Chest pain associated with a heart attack (myocardial infarction) is often described as tightness, pressure, squeezing or crushing chest pain. It is usually central, located just behind the breastbone (retrosternal chest pain, breastbone pain) on the anterior surface of the chest. In a patient at a high risk of a heart attack, pain of this nature may be sufficient cause to seek emergency medical attention even without other signs and symptoms present. Chest pain alone, however, is not necessarily an indication of a heart attack without the presence of other clinical features.
The character of chest paid due to heart attack can vary. While it is usually accepted as being a severe pain, it can at times present just as a mild discomfort. At other times it may just be a burning chest pain, similar to heartburn caused by acid reflux. Understanding the nature of chest pain due to a heart attack is therefore imperative for early diagnosis and quick medical attention.
Heart attack chest pain :
- Arises spontaneously or triggered by emotion or exercise.
- Not relieved by rest or the use of nitrates.
- Accompanied by :
- Shortness of breath
- Dizziness and/or fainting spells
- Nausea and/or vomiting
- Radiates to arm, neck, jaw or upper abdomen (epigastrium)
- Anxiety – impending sense of doom
- Abnormal breathing sounds – wheezing
One or more of these symptoms associated with chest pain should be sufficient reason to seek medical attention.
Other Common Causes and Features
- Burning chest pain relieved by antacids and accompanied by nausea and regurgitation may be due to acid reflux.
- Chest pain associated with pain upon deep breathing (particularly inhalation) and tenderness may be due to causes discussed under chest wall pain.
- Chest pain with coughing, particularly a productive cough, fever and prior history of upper respiratory symptoms like a runny nose and sneezing and sore throat may be due to lower respiratory infections like bronchitis or pneumonia.
Arm Pain in Heart Attack
Arm pain, specifically left arm pain, is a common symptom of a heart attack. It usually accompanies the crushing central chest pain, shortness of breath and excessive sweating that are considered characteristic symptoms of a heart attack. The may also be other symptoms such as dizziness, confusion, anxiety and even loss of consciousness. Pain is not always limited to the chest and arm. Sometimes neck, jaw and even epigastric pain may occur.
However, left arm pain is usually the most common accompanying pain in a heart attack. There are instances where left arm pain may be one of the only pain symptoms in a heart attack even in the absence of the typical chest pain. This presentation is considered to be a atypical for a heart attack. Accompanying symptoms like fatigue are non-specific and there may be no other conclusive indication of a cardiac event.
This atypical presentation where there is little to no symptoms is also referred to as a silent heart attack. These types of heart attacks are more common than is often thought. It is estimated that as many as 25% of heart attacks are not typical in presentation and is therefore not accurately identified as a heart attack. Silent heart attacks tend to be more common in the elderly and particularly in diabetic patients.
Read more on silent heart attack.
Why does a heart attack cause arm pain?
In a heart attack the blood supply to the heart muscle is interrupted. The lack of oxygen causes damage and death of the heart tissue supplied by the affected artery. Pain signals from the damaged heart muscle are transmitted by the nerves to the spinal cord. These signals are then relayed to the brain where the pain sensation is perceived. As these pain signals are transmitted it joins common nerve pathways which are shared by the arm.
Therefore the chest pain due to the heart muscle damage also results in upper arm pain. Due to common nerve pathways, there is also pain in the neck and jaw. Similarly pain may arise from the dermatomes, which are strips of skin on the torso that supplied by certain spinal nerves. Therefore cardiac pain also causes pain in certain dermatomes which is perceived in the epigastrium (upper middle abdominal pain).
Warning Signs that Arm Pain is Heart Pain
When chest pain is accompanied by arm pain then a possible cardiac condition should be considered. Certain people are at greater risk of a heart attack and these symptoms should immediately raise the concern about a possible heart attack. However, this may not be the first consideration in some cases like with children or teens.
Risk factors include being over 45 years of age, being overweight or obese, cigarette smoking, excessive alcohol consumption and a history of coronary artery disease, hypertension (high blood pressure), high blood cholestrol and diabetes among a host of other factors. A family history of heart disease is also an important risk factor.
If chest pain and arm pain are accompanied by these signs and symptoms then immediate medical attention is necessary.
- Shortness of breath
- Excessive sweating
- Unexplained fatigue
- Loss of consciousness
It is important to note that heart attacks can also occur in younger adults with few if any of the above risk factors. Always consult with a medical professional about chest and arm pain even if a heart attack seems unlikely.
Causes and Symptoms
Several non-cardiac conditions can cause chest pain and even simultaneous arm pain at times. It is not uncommon for heart pain to be mistaken for non-cardiac pain and vice versa. Some of the more likely causes of chest pain with or without arm pain has been discussed below.
Read more on cardiac vs non-cardiac chest pain.
Although this is cardiac pain often caused by coronary artery disease, angina pectoris is not a heart attack. It is a momentary interruption in the blood supply to the heart muscle. The muscle tissue may be injured without tissue death like with a heart attack. Symptoms are similar to a heart attack but relieves with rest and nitrates. Angina pectoris may be a prelude to a heart attack with episodes persisting for months or even years prior.
Acid reflux is one of the common causes of chest pain and is often mistaken for a heart attack or other cause of cardiac pain. Due to the weakening of the lower esophageal sphincter (LES), stomach acid and enzymes enter the esophagus and cause irritation. Typical symptoms include heartburn (burning chest pain), nausea, vomiting (sometimes), bloating and loss of appetite. Arm pain is usually not present.
Muscle strain is one of the common causes of superficial chest pain and arm pain. It arises after physical exertion which like with lifting heavy weights or overuse of the arms, particularly when the pectoral muscles as well as the upper arm muscles are strained. Trauma to the chest wall and upper arm with a fall or contact sports can also lead to both chest and arm pain. Persistent coughing or violent wretching and vomiting may cause chest wall pain.
The following conditions may also cause chest pain, usually without arm pain. Sometimes accompanying arm pain may be due to a different cause than the existing chest pain.
- Myocarditis and endocarditis
- Lower respiratory tract infections
- Pulmonary embolism
- Esophagitis and esophageal ulcers
- Esophageal rupture/tears
- Hiatal hernia
- Gallstones and other gallbladder diseases
Jaw Pain in Heart Attack
Chest pain due to a heart attack may radiate to the jaw, usually lower jaw (mandible) rather than the upper jaw (maxilla). Often the pain is isolated to the TMJ (temporomandibular joint) just in front of the ear or the angle of the mandible. When the teeth are involved, the pain may be felt on both the upper and lower jaw extending all the way to the incisors at the front. Neck pain may also be reported.