Back pain is a common complaint, usually caused by musculoskeletal issues like muscle strain or disc problems. However, back pain can signal a serious underlying cardiac condition, such as a heart attack or an aortic tear. This atypical presentation is particularly common in women, older adults, and individuals with diabetes. Understanding the specific characteristics of this pain helps recognize when an ordinary ache requires immediate medical attention.
Why Heart Pain Can Feel Like Back Pain
The phenomenon allowing heart pain to be perceived in the back is called referred pain. This occurs because the nerves supplying the heart and those supplying the upper back connect to the same segments of the spinal cord. Pain signals from the heart travel along sympathetic nerves to spinal cord segments T1 through T5.
At these spinal segments, nerve impulses from the heart converge onto the same pathways that receive signals from the skin and deep tissue of the upper chest and back. The brain misinterprets the visceral signal as originating from the more familiar somatic location. The referred pain often registers as a deep, dull ache in the upper back, typically between the shoulder blades.
Cardiac Conditions That Cause Back Pain
Several heart and vascular conditions can manifest with back pain, often without the classic symptom of crushing chest pain. Myocardial infarction, commonly known as a heart attack, can cause pain that radiates to the upper back, neck, jaw, or arms. This back discomfort is frequently reported in women, who are more likely than men to have atypical symptoms.
Angina, which is chest pain caused by reduced blood flow to the heart muscle, can also be felt in the upper back. This ischemic pain is usually temporary and often triggered by physical exertion or emotional stress. The pain typically subsides with rest as the heart’s oxygen demand decreases.
Aortic dissection is a life-threatening condition where the pain is acutely felt in the back. This occurs when a tear in the inner layer of the aorta allows blood to flow between the layers of the aortic wall, forcing them apart. The resulting pain is typically sudden, severe, and described as a tearing or ripping sensation in the chest or upper back, often in the mid-back between the shoulder blades.
How to Distinguish Cardiac Pain from Musculoskeletal Pain
Distinguishing between cardiac and mechanical back pain involves assessing the pain’s characteristics, triggers, and accompanying symptoms. Mechanical pain, which stems from muscle strain, ligaments, or spinal joints, is typically sharp and localized to a specific spot. This pain is often triggered by specific movements, lifting, or poor posture, and frequently improves with a change in position, rest, or localized pressure.
In contrast, cardiac back pain is often described as a dull ache, pressure, or tightness that is less specific and more diffuse. This pain does not usually change with repositioning, stretching, or movement, and may even be present when resting. Furthermore, mechanical back pain can last for days or weeks, while cardiac pain associated with a heart event is often persistent or episodic within a short time frame.
Cardiac pain may begin or worsen with physical exertion or emotional stress. Pain relief from a heart event is generally not achieved through typical over-the-counter pain relievers or position changes.
When to Seek Emergency Medical Care
Back pain potentially related to the heart requires immediate medical evaluation, as delays can be life-threatening. You should seek emergency medical care by calling 911 if back pain has a sudden, crushing, or ripping onset. Immediate attention is also necessary if the back pain is accompanied by other physical symptoms of a cardiovascular event.
These symptoms include shortness of breath, nausea, vomiting, or breaking out in a cold sweat. Pain radiating down one or both arms, or into the jaw or neck, also warrants immediate care. Lightheadedness or dizziness are also red flags. It is safer to call emergency services than to attempt to drive yourself to a hospital.