Back pain as a symptom of myocardial infarction
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Back Pain as a Symptom of Myocardial Infarction: Prevalence and Recognition
Prevalence of Back Pain in Myocardial Infarction Patients
Back pain is a recognized but less common symptom of myocardial infarction (MI), especially when compared to classic chest pain. Studies show that women are significantly more likely than men to report back pain during an acute MI. For example, one population-based study found that 42.3% of women with a first MI reported back pain, compared to only 14.5% of men, making it a notable gender difference in symptom presentation 14. Other research confirms that women frequently experience back or shoulder blade discomfort both as a prodromal (early warning) and acute symptom of MI, with up to 47% reporting this symptom before their heart attack and 42% during the event .
Back Pain as an Atypical or Less Recognized Symptom
Back pain is often labeled as an "atypical" symptom of MI, particularly in women. This categorization can lead to under-recognition and delayed diagnosis, as healthcare providers may not immediately associate back pain with a cardiac event, especially in the absence of chest pain . The use of "typical" and "atypical" labels has been criticized, as it may disadvantage women and others who present with non-chest pain symptoms, resulting in slower diagnostic and treatment times .
Awareness and Knowledge Gaps in the General Population
Awareness that back pain can be a symptom of MI is generally lower than for classic symptoms like chest pain. Studies in the United States show that only about 68.6–72.0% of people are aware that jaw, back, or neck pain can signal a heart attack, compared to over 95% awareness for chest pain . This knowledge gap is consistent across rural, suburban, and urban populations, and is also seen across different socioeconomic and demographic groups 39. Systematic reviews confirm that public knowledge of back pain as a symptom of MI is moderate at best, and much lower than for more obvious symptoms .
Clinical Implications and Case Evidence
Case reports highlight that back pain can be the main presenting symptom of MI, particularly in older adults and women. In some cases, patients with MI have presented to emergency departments with back pain and no chest pain, leading to initial misdiagnosis or delayed recognition of the cardiac event . This underscores the importance of considering MI in the differential diagnosis when patients, especially women and the elderly, present with unexplained back pain.
Conclusion
Back pain is a significant but under-recognized symptom of myocardial infarction, particularly among women. While chest pain remains the most common symptom, clinicians and the public should be aware that back pain—especially when accompanied by other symptoms like nausea or dizziness—can indicate a heart attack. Improving awareness and recognition of back pain as a possible MI symptom may help reduce delays in diagnosis and improve outcomes, especially for women and older adults 1456710.
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