Right arm pain in heart attack

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Right Arm Pain in Heart Attack: Understanding the Symptoms

Introduction to Heart Attack Symptoms

Heart attacks, or myocardial infarctions, are often characterized by a range of symptoms, including chest pain, shortness of breath, and pain radiating to various parts of the body. While left arm pain is a well-known symptom, right arm pain can also occur, though it is less common. Understanding the nuances of these symptoms can aid in timely diagnosis and treatment.

Right Arm Pain in Heart Attack: Clinical Observations

Typical Pain Distribution in Heart Attacks

In most cases of angina pectoris, the pain is typically felt in the precordial or mid-sternal regions and often radiates to the left shoulder and down the left arm. This pain can also extend to the back, left side of the neck, and, in rare cases, to both arms or the right arm alone . The sensory nerve supply from the heart is bilateral, meaning that pain impulses can travel to both sides of the spinal cord, although they predominantly affect the left side when the heart is in its normal position .

Exceptional Cases: Right Arm Pain

Right arm pain as a symptom of heart attack is considered exceptional but not unheard of. In some rare instances, patients may experience pain radiating exclusively to the right arm. This can be particularly misleading and may result in a delayed diagnosis if not properly recognized . For example, a case study of a patient with congenital dextrocardia (a condition where the heart is situated on the right side of the chest) showed that the pain was localized to the right side of the chest and radiated to the right arm, highlighting the importance of considering anatomical variations .

Misdiagnosis and Overlooked Symptoms

Pain confined to one or both shoulders or arms without accompanying chest pain can be misleading. Such cases may be misdiagnosed, as the pain might be attributed to musculoskeletal issues rather than cardiac problems. For instance, a professor who experienced pain in both shoulders and arms was undergoing physiotherapy for these symptoms, only to be later found to have suffered a cardiac infarction . This underscores the need for healthcare professionals to consider cardiac causes when patients present with arm pain, especially if it is associated with exertion.

Conclusion

While left arm pain is a more common and recognized symptom of heart attacks, right arm pain can also occur, albeit rarely. It is crucial for both patients and healthcare providers to be aware of this possibility to avoid misdiagnosis and ensure timely treatment. Recognizing the full spectrum of symptoms, including those that are less typical, can significantly improve outcomes for individuals experiencing a heart attack.

Sources and full results

Most relevant research papers on this topic

Coronary thrombosis in a case of congenital dextrocardia with situs inversus

In a case of congenital dextrocardia with situs inversus, pain pathways from the heart enter on the right side of the spinal cord, leading to angina attacks affecting the right side of the chest.

Case Report

1938·

16citations

·J. Crawford et al.

A Clinical Lecture ON THE CAUSATION OF ANGINA PECTORIS *

Angina pectoris is caused by a variety of different factors, with the pain often radiating down the left arm, but in some cases, it radiates down both arms, or only down the right arm.

1910·

0citations

·B. Bramwell

Pain in the Arm: A Symptom of Heart Disease

Ischaemic heart disease can cause pain in the arm, often described as cramp-like, squeezing, or like having blood pressure taken, and may radiate beyond the chest to the throat and jaws.

1959·

0citations

·W. Somerville

The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.

Several 'atypical' symptoms make acute myocardial infarction more likely, while many 'typical' symptoms have no diagnostic value in ED patients with suspected acute coronary syndromes.

Observational StudyHighly Cited

2010·

86citations

·R. Body et al.

Cardiac Pain: Anatomic Pathways and Physiologic Mechanisms

Cardiac pain is mainly referred to the upper 4 thoracic spinal segments due to limited sensory endings in the heart and limited secondary sensory fibers in the spinothalamic tracts.

Highly Cited

1957·

150citations

·James C. White

PAIN IN THE SHOULDER AS A SEQUEL TO MYOCARDIAL INFARCTION

The pain in the shoulder may be a secondary effect of the heart disease, and its presence suggests a more than chance relationship with the heart disease.

1940·

38citations

·A. C. Ernstene et al.

Mechanisms of cardiac pain.

Cardiac pain is primarily caused by sympathetic and vagal afferent pathways, with the spinothalamic tract playing a key role in generating pain in the chest, arm, and neck.

Highly Cited

1999·

253citations

·Foreman Rd

Mechanisms of cardiac pain.

Cardiac pain is mediated by spinal cord, vagal cardiac afferent fibers, psychological state, and other factors, with atypical pain originating in the back, neck, and jaw.

2015·

58citations

·R. Foreman et al.

The electrocardiogram of the month.

This case study demonstrates that electrocardiograms can be normal during attacks of pain and abnormal in the absence of pain, as ischemia in the epicardial layers of the left ventricle can cause RS-T segments to reverse their direction during angina attacks.

Case Report

1958·

1citation

·M. Gardberg et al.

Angina Pectoris

Angina pectoris is a heart attack caused by exertion, causing pain and discomfort in the chest, often waking the patient from sleep.

Highly Cited

1909·

145citations

·Angina Pectoris

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