Heart Attack: Which Arm?

All of us have heard that one of the symptoms of a heart attack is experiencing pain in your arms. However, not all of us know why this is the case, or which arm we should be concerned about. Keep reading to find out more about the relationship between heart attacks and pain in the arm, where we debunk existing myths and provide scientific explanations.

What is a heart attack?

A heart attack, also known as myocardial infarction or MI, is an emergency whereby the blood supply to the heart is suddenly stopped. This is a life-threatening situation that can lead to cardiac arrest,  and even death, if not treated properly. A heart attack is generally caused by coronary heart disease, also known as CHD, where a major blood vessel that supplies blood to your heart becomes clogged by the build-up of cholesterol plaque. If one of the vessels burst and form a blood clot- known as a thrombus, which would restrict blood flow within the heart- it would lead to a heart attack.¹

Common symptoms of a heart attack

The symptoms of a heart attack are listed below, per the British Heart Foundation. These symptoms may vary and not be present simultaneously but are the most common things to look out for:

• Tightness, heaviness or pain in your chest that begins suddenly and doesn’t go away, similar to the feeling of heartburn or indigestion. 
• Pain in the left or right arm, irradiated into the shoulder, neck, jaw, back or stomach.
• Feeling sick, sweaty and/or short of breath.
• Although less common, it can also make you feel anxious and/or wheezy.

The link between pain in the left arm and a heart attack

There is a link between pain in the left arm and heart attacks, although this symptom is not always present. The reason why you may experience pain in your left arm during a heart attack is that the nerves found in your left arm and the ones that branch from the heart and send signals to your brain. The brain is not able to locate the exact source of the pain, which is why you experience it in areas where it isn't necessarily originating from.³ 

Does a heart attack cause right arm pain?

Some people also experience pain in the right arm and shoulder, jaw, neck, back or stomach, but as mentioned earlier symptoms may vary. 

Is left arm pain a common symptom for men and women?

When comparing the differences in the experiences of men and women, there are no symptomatic variations. However, women are more likely to dismiss the symptoms of a heart attack and delay medical attention.²

Other causes of left arm pain

Although having left arm pain may be due to a heart attack, other common conditions may cause pain in the left arm. Some of which are:⁴

• Angina - This occurs when your heart is not receiving enough oxygen. It usually lasts for a few minutes and feels worse on exertion. 
• Bursitis - Pain that starts in your shoulder and radiates to the arm when the bursa, a little sack full of fluid that allows the joints to move, swells up.
• Fractured or broken bone.
• Neck problems - Herniated discs in your neck may cause nerve problems, leading to pain, numbness or a tingling/burning sensation in your arm.
• Rotator cuff tear - Overexercising your shoulder, resulting in a tear in the tendon, causing pain and weakness.
• Tendinitis sprains - If you have injured the tendons or ligaments in your shoulder it may cause difficulties moving and feeling of pain. 

Diagnosis and Treatment

A heart attack requires different tests to be diagnosed:⁵

1. Electrocardiogram (ECG) - This is a painless reading of your heart activity. It involves attaching electrodes to your body to capture cardiac rhythm. This procedure is important to determine not only the presence of a heart attack but also the type of heart attack you are having.
2. Blood test - If you are having a heart attack, it can be deduced through the assessment of heart protein levels in your blood.
3. X-ray - Although X-ray’s are slightly less important, they help to rule out other conditions that may cause similar symptoms to a heart attack.
4. Echocardiogram - This procedure scans to observe the inside of your heart.
5. Coronary angiography - By inserting a thin tube in your groin or arm, doctors can use this procedure to find the cause of the heart attack, such as a narrowing of your heart vessels or a blockage.

What happens after a heart attack?

Once the diagnosis has been confirmed, your treatment will depend on the type of heart attack that you are suffering from:⁶

• Primary Percutaneous Coronary Intervention (PCI) - This procedure is carried out by inserting a tube in your groin or arm which is guided into your heart, where a stent (a small plastic/metal tube that widens arteries) is inserted which allows the blood to flow in your heart vessels again.
• Medication - You can be prescribed either an antiplatelet (like aspirin) or anticoagulants (like warfarin, or rivaroxaban). These drugs will prevent the formation of clots in your blood vessels and will break down any that may already exist.
• Coronary Artery Bypass Graft or CABG - This is a complicated procedure carried out when a PCI is inadequate. The affected heart vessel is substituted with a healthy one from another part of the body, generally the arm or leg. This new vessel is known as a graft.

What should I do if I get left arm pain? 

Despite the varying causes of left arm pain stated above; if you are experiencing prolonged, sudden sharp pain in your left arm that is accompanied by the other symptoms of a heart attack mentioned, call 999 and wait for paramedics to arrive. In the meantime, try to remain as calm as possible and if you have aspirin with you, take 300mg while you wait for the medical assistance to arrive. If a heart attack has been ruled out, you should see your GP and discuss possible reasons behind this and keep an aspirin with you, just in case. 

Summary

To summarize, a heart attack occurs when the blood flow to your heart is interrupted by a narrowing or blockage of your blood vessels, causing a lack of oxygen supplied to the heart. One of the most common symptoms to look out for is developing a sudden, sharp pain in the left arm. This is caused because the nerve branches connected to your heart and left arm cannot be differentiated in the brain, so it cannot pinpoint where the pain is exactly coming from. Although common, the varying symptoms of a heart attack may occur simultaneously or not at all. There are no differences between the symptoms experienced by women and men; however, women are more likely to dismiss the signs of a heart attack. Other causes of pain in the left arm include neck problems or injuries in the shoulder joints, tendons or ligaments. The diagnosis of a heart attack is done through an ECG and blood tests. Once confirmed, the treatment will vary depending on the severity of the heart attack, and will be treated with medication, stent insertion in your affected blood vessels and, in extreme cases, having your affected blood vessel removed and substituted with an existing healthy one from your arm or leg. If you suspect that you may be having a heart attack, call 999, remain calm and take 300mg of aspirin while you wait for medical assistance.