Why does your arm hurt during a heart attack?

10 Jul

by Carolyn Thomas  @HeartSisters

Cath Haywood recalls the day in 2006 when she felt a bit “under the weather”. She told her family that her arm ached. At first, she attributed the arm pain to over-enthusiastic ball throwing – she had been tossing lobs to her springer spaniel earlier that day. But on the following evening, the 49-year old former Welsh police officer again experienced what she describes as “a dreadful ache in my right arm”. She remembers thinking:

“I’ve really got to lay off throwing that ball!”

As the arm pain got worse, Cath brushed aside pleas from her husband and two sons to call an ambulance, and she went to bed. After all, as she told herself, she was fit, relatively young, had just lost 28 pounds, did not smoke, and drank only occasionally. So why bother the ambulance crew? 

Finally, however, she relented, and was shocked to learn at the hospital that she had indeed suffered a heart attack.

She was also shocked to find out that in 10% of women’s heart attacks,  there is no form of chest pain at all.(1) Nothing. Zero. Zilch. Nada.

Although in many heart attacks, pain can begin in the chest and spread to other areas, even when there’s no chest pain as an initial symptom, heart attack signs may include pain or discomfort in the left, right or both arms or in the shoulders, elbows, back, neck, throat, lower jaw or stomach. Or as Mayo Clinic cardiologists call it: anything “from neck to navel”.

Men having a heart attack often feel pain in the left arm. In women, the pain is more likely to be felt in either arm. The pain might also come and go. In a previous post called “How Does It Really Feel to Have a Heart Attack? Women Survivors Tell Their Stories”, a number of women interviewed also described unusual elbow pain as an early heart attack symptom.

Why would a heart attack cause pain or discomfort in our arm?

Here’s the technical gobbledygook reason, according to an Indiana cardiac surgeon who answered a patient’s question on HealthTap:

“The pericardium is innervated by C3,4,5 (Phrenic nerve). There may be some neuronal connections to the intercostobrachial nerves.”

(And doctors sometimes wonder why their patients don’t seem to understand them . . .)

Allow me to translate that HealthTap Geek-Speak for you: basically, it’s because of referred pain to the arm.

For example, your heart attack may cause a sensation of pain to travel from your heart to your spinal cord, where many nerves merge onto the same nerve pathway. Your arm may be perfectly fine, but your brain thinks that part of the heart’s pain is the arm (or the jaw or the shoulder or the elbow or the neck or the upper back) calling out for help. That’s what referred pain is.

When  your heart muscle cells begin to run out of oxygen during a heart attack because of a blocked artery preventing oxygenated blood from feeding that muscle, they begin to send off signals of pain through the nervous system. Your brain may confuse those nerve signals with signals coming from the arm (or the jaw, shoulder, elbow, neck or upper back) because of the nerve proximity.

So there are times that we can feel both chest pain and arm pain when our heart muscle is not getting enough oxygen, but there are other times that discomfort in either arm (or the jaw, shoulder, elbow, neck or upper back) may be the only symptom of a heart attack.

In fact, arm pain may be one of the first indications that a heart attack is about to occur. Arm pain has also been reported as the cause of significant sleep disturbances even days before a heart attack.

You might not even describe this symptom as “pain”.  Instead, you may feel it as electrical, tingling, pins-and-needles, dull ache, weakness, heaviness or a crushing feeling.

These symptoms may come and go, and can also fluctuate in severity. They can hit both before and during a heart attack. And remember that heart attack symptoms don’t necessarily include any arm discomfort.

Screen Shot 2016-03-25 at 5.06.28 PM

What else could it be?

Arm pain on its own, of course, can have nothing to do with heart issues. Intermittent arm pain may be due to something as simple as repetitive strain injuries experienced during typing, video gaming or text messaging, especially if done while in an awkward position or while leaning forward to see the screen.

Arm pain can also be caused by a number of other factors. Try keeping a log of symptoms, the severity, time and date they occurred.  Ask your doctor about all possible causes of arm pain, especially if pain becomes severe.
(1) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026

I wrote more about arm pain and other women’s heart attack symptoms in my new book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, November 2017).


Q:  Have you experienced symptoms in your arm during a cardiac event?

See also:



22 Responses to “Why does your arm hurt during a heart attack?”

  1. Georgina December 13, 2014 at 7:38 pm #

    Hi – I’m 45 years of age and I’m just now having pain in my upper left arm muscle and I’m a smoker. I hope it’s just the muscle in my arm and not my heart. It feels like I’ve been using it too much, like a burning ache feeling. I do have anxiety so I’m hoping it’s nothing serious. I’m wanting to cut back and eventually quit smoking.


    • Carolyn Thomas December 13, 2014 at 10:20 pm #

      Georgina, see your doctor if symptoms persist. And good call to quit smoking – which will not only improve your heart health but your overall health as well.


  2. Charlotte Louise MILLS September 26, 2014 at 9:14 pm #

    Hi, I have recently had different symptoms but not all at the same time. First I awoke one night with mild pins & needles sensation in my chest left hand side, never had that before. Then the other night I had really bad lower jaw ache, I remember thinking it was due to me biting my lip or something. Then last night all of a sudden started getting shooting pains on and off in my forearm, never had this before either. Should I be worried? I am worried especially about the pains in my arm. My dad died of a heart attack March last yr, miss him so much, am under a lot of stress too; my ‘blood sister’ has been very difficult to deal with and has made life hell since Dad’s death and can’t get rid of her until our inheritance is sorted. Please tell me I am not going to have a heart attack? I have two young children totally dependent on me, love them so much I never want anything to happen to me because I need to be here for them, couldn’t bear to ever leave them, they don’t even have their nan, my mum passed when I was 7 yrs old. Thanks in advance for any replies xx


    • Carolyn Thomas September 27, 2014 at 5:57 am #

      Hello Charlotte – if your symptoms continue, do not hesitate to see your physician. You’ve been under considerable stress lately, and anxiety can cause similar symptoms – and ongoing anxiety can make all symptoms worse, which then escalates the anxiety – a vicious circle. I’m not a physician, so of course cannot tell you if your occasional symptoms may or may not be heart-related. Until you and your doctor find out what’s causing them, for the sake of your kids, you need to find ways to manage this stress every day. Consider also making an appointment to talk to a therapist, pastor or other mental health professional to help you through the emotional chaos you’re experiencing now (which is NOT good for your heart). Best of luck to you.


  3. Nathi September 17, 2014 at 3:08 am #

    My wife has been having troubling arm pain for years. She has been to hospital several times but the pain goes and come. These few days she can hardly sleep her right arm is real painful, I rub her arm to ease pain and she takes panando tablets but this only subsides and comes back again. Tomorrow I will take her to hospital again. I am very worried about this.


  4. bveltrop72 May 23, 2014 at 9:45 am #

    Reblogged this on Nurse’s Links to Resources and commented:
    “Great info on signs and atypical symptoms of a heart attack. Women and Diabetics often do not have the same if any symptoms of a MI.”

    Liked by 1 person

  5. Rad Basa August 27, 2013 at 8:46 am #

    It was worsening arm pain, in my case despite my being male, that made me bring myself to the ER. It was the best decision I made in my life. I was at the ER 20-30 minutes before the actual heart attack.


    • Carolyn Thomas August 27, 2013 at 8:51 am #

      Glad you paid attention to that arm pain, Rad! Both men and women can feel unusual symptoms in their arms (either left or right) during a cardiac event.


  6. Mary July 10, 2013 at 6:36 pm #

    Excellent posting, Carolyn! According to this list of symptoms, I should just fuggedaboutit and reserve the presidential suite at the local hospital! 🙂 Just kidding. My arm has been a lively voice in my chorus of symptoms for a long time. Just wish I could understand the lyrics! Very helpful actually ~ glad you investigated it.


    • Carolyn Thomas July 10, 2013 at 8:34 pm #

      Hi Mary and thank you! Arm pain turned out to be the ‘niggling voice’ that forced me to the ER, only because I remembered reading or hearing something about arm pain being a sign of heart attack! I could talk myself out of paying attention to my chest pain, nausea and sweating, but it was that arm pain that scared me the most. Wish I could have had that presidential suite while in CCU . . .



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