What arm hurts with a heart attack
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Summary
7 papers analyzed
These studies suggest that a heart attack can cause pain in the arm, often radiating from the chest.
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Pain in the Arm During a Heart Attack: Key Insights
Left Arm Pain as a Symptom of Heart Attack
Historical Context and Common Descriptions
Pain in the left arm is a well-documented symptom of heart disease, dating back to early descriptions of angina pectoris by Heberden in 1772 and Herrick in 1912. This pain often accompanies chest pain, making the diagnosis straightforward when both occur simultaneously. However, when arm pain occurs in isolation, it can be misleading and may not be immediately associated with heart disease, even by medical professionals.
Mechanisms of Referred Cardiac Pain
The pain experienced during a heart attack is due to ischemic episodes that activate chemosensitive and mechanoreceptive receptors in the heart. These receptors trigger afferent fibers that travel through the upper thoracic spinal cord, contributing to the pain felt in the chest and left arm. The spinothalamic tract, which projects to the thalamus and various cortical areas, plays a significant role in this referred pain .
Typical and Atypical Pain Patterns
The typical pain associated with a heart attack is often described as constricting, squeezing, or cramp-like. It is usually felt across the chest or behind the sternum and can radiate to the left arm, both arms, the throat, and the jaw. This pain is often described as a band around the arm or like having blood pressure taken, and it can extend down to the little and ring fingers .
Diagnostic Challenges
Pain confined to the shoulders or arms without accompanying chest pain can be misleading. Patients may not associate this pain with their heart and may seek treatment for other conditions, such as dental issues or musculoskeletal problems. This can delay the correct diagnosis and treatment of heart disease.
Other Causes of Arm Pain
Differential Diagnosis
While arm pain is a common symptom of heart disease, it can also result from other conditions such as traumatic injuries, lung carcinoma, herniated cervical intervertebral disks, and cervical spinal tumors. These conditions can cause pain in the neck, shoulder, and arm, making it essential to differentiate between cardiac and non-cardiac causes.
Diagnostic Tools
A trial of nitroglycerin can be a valuable diagnostic aid. Pain that is not relieved within three minutes is less likely to be coronary in origin. This can help distinguish between cardiac and other causes of arm pain.
Conclusion
Pain in the left arm is a significant symptom of heart attacks, often accompanying chest pain. Understanding the mechanisms and typical patterns of this referred pain can aid in timely diagnosis and treatment. However, it is crucial to consider other potential causes of arm pain and use diagnostic tools effectively to differentiate between cardiac and non-cardiac origins.
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