Shoulder pain is a common complaint, often stemming from muscle strains, joint issues, or overuse injuries. While most shoulder discomfort is musculoskeletal, it can sometimes signal a more serious underlying condition, such as a heart attack.
Heart Attack Pain and Shoulder Referral
A heart attack can cause pain in areas beyond the chest, known as referred pain. This happens because nerve pathways from internal organs, like the heart, share routes in the spinal cord with nerves from other body parts, including the shoulder and arm. The brain may then misinterpret the discomfort’s origin, perceiving it as coming from the shoulder or arm rather than the heart.
The left shoulder and arm are the most common sites for this referred pain due to the heart’s anatomical position and nerve distribution. This pain is often described as pressure, aching, or squeezing, rather than sharp or localized. Less commonly, referred pain can extend to the right shoulder, back, neck, jaw, or stomach. This discomfort typically feels deep and widespread, not superficial or pinpoint.
Differentiating Heart Attack Pain from Other Shoulder Pain
Distinguishing heart attack-related shoulder pain from other common causes involves specific characteristics. Heart attack pain in the shoulder is often described as pressure, tightness, squeezing, or a dull ache. This discomfort typically does not change with movement, position, or when pressure is applied. It may also radiate down the arm, often the left, or extend to the neck or jaw.
In contrast, musculoskeletal shoulder pain, from issues like a muscle strain, arthritis, or rotator cuff injury, presents differently. This pain is often sharp, localized, or a dull ache that worsens with specific movements or activities. Musculoskeletal pain often improves with rest or positional changes and may be tender to the touch. Unlike cardiac pain, it rarely accompanies systemic symptoms like shortness of breath or nausea.
Accompanying Heart Attack Symptoms
Shoulder pain is rarely the sole indicator of a heart attack; it typically occurs alongside other symptoms. The most common accompanying symptom is chest pain or discomfort, feeling like pressure, tightness, fullness, or a squeezing sensation in the center of the chest. This chest discomfort might last for several minutes or come and go.
Other common signs include shortness of breath, which can occur with or without chest discomfort. Individuals may also experience sweating, nausea or vomiting, and lightheadedness or dizziness. The intensity and combination of these symptoms can vary, and not everyone experiences all of them.
When to Seek Immediate Medical Help
Seek immediate medical attention if you suspect a heart attack. If you experience shoulder pain, especially with other heart attack symptoms, do not delay calling emergency services.
Call 911 or your local emergency number immediately if you or someone else experiences sudden, unexplained, or severe shoulder pain. This is particularly important if it feels like pressure or squeezing and is accompanied by chest discomfort, shortness of breath, sweating, or nausea. Do not drive yourself to the hospital, as emergency medical personnel can provide initial care en route.