A heart attack occurs when blood flow to the heart muscle is severely reduced or blocked, usually by a blood clot over fatty plaque buildup. This blockage starves the heart tissue of oxygen, causing damage. Recognizing symptoms promptly is important, as early treatment significantly improves outcomes and survival rates. Arm pain is a frequently reported symptom, and understanding its presentation can help identify a heart attack quickly.
Arm Pain: The Common Presentation
The pain most commonly radiates down the left arm or shoulder. This discomfort is often described as a dull ache, heaviness, pressure, or squeezing sensation, rather than a sharp, localized stabbing pain. It may also present as tingling or numbness running from the chest outward.
The pain is not exclusive to the left side; it can manifest in the right arm, both arms, or the shoulders and upper back. This discomfort is generally not relieved by rest or changing position, which helps distinguish it from muscle or joint pain. The quality of the pain—often feeling like a weight or pressure—is a more reliable indicator than its exact location.
The Mechanism of Referred Pain
The physiological reason heart pain is felt in the arm is called “referred pain.” This occurs because the sensory nerves from the heart and the arm share a common pathway leading to the spinal cord and the brain. The heart lacks the precise pain-locating nerves found in the skin or muscles.
When the heart muscle is deprived of oxygen, its pain signals enter the spinal cord at the same segment levels (T1 to T5) as the nerves from the arm and shoulder. Because the brain is accustomed to receiving signals from the arm, it misinterprets the distress signal originating from the heart.
This confusion causes the brain to perceive the pain as coming from the more familiar location, such as the left arm or shoulder, rather than the heart itself. This shared neural circuitry explains why arm pain can sometimes be the only or the first symptom experienced.
Recognizing the Full Spectrum of Symptoms
Arm pain is rarely the only indicator of a heart attack and is often accompanied by other symptoms. The most common symptom remains discomfort in the center or left side of the chest, frequently described as a crushing pressure, squeezing, or fullness. This central discomfort may last for more than a few minutes or may repeatedly come and go.
Other symptoms often accompany the primary discomfort:
- Pain or discomfort in the jaw, neck, teeth, upper back, or upper stomach.
- Shortness of breath, with or without chest pain.
- Nausea, vomiting, lightheadedness, or breaking out in a cold sweat.
Atypical presentations are important to recognize, as they are more common in women, older adults, and people with diabetes. Women are more likely to experience extreme, unusual fatigue that may last for days or weeks. They may also report pain localized only in the jaw, neck, or upper back, without the severe chest pain often described by men. These subtle signs can include a feeling similar to indigestion or heartburn, intense anxiety, or general weakness. Recognizing these non-traditional indicators is important because their subtlety can lead to dangerous delays. Any combination of these symptoms, especially if new or unexplained, warrants immediate medical evaluation.
Emergency Response and Next Steps
If a heart attack is suspected, the immediate action is to call the local emergency services number. Prompt activation of the emergency medical system ensures rapid treatment and improved survival. Do not attempt to drive yourself or the affected person to the hospital, as this delays definitive care and risks a medical collapse.
While waiting for responders, the person should sit down and rest to minimize strain on the heart. If there are no known allergies to aspirin or history of recent serious bleeding, a dose of 162 to 324 mg of non-enteric coated aspirin should be chewed and then swallowed. Chewing the aspirin allows for faster absorption to help inhibit platelet aggregation.
Remaining calm helps reduce the heart’s oxygen demand. If the person has been prescribed nitroglycerin, they may take it as directed. When first responders arrive, provide a clear description of the symptoms and the time they began, as this guides immediate treatment.