Referred spine pain or a heart attack?

Referred pain from the thoracic spine (mid back) and referred pain from the cervical spine (neck) can both make people feel as if they are having a heart attack.  

This very thing happened to a friend of mine this week and that is why I thought it would be appropriate to discuss.  

She rose from the couch and immediately got a sharp stabbing pain on the left side of her chest/ribs.  As she would take a deep breath the pain became sharper and more intense.  The only relief that she could get was from bending forward but even that did not totally relieve her pain.  The pain was so bad initially that she was feeling nauseous.  Of course my friend immediately thought she was having a heart attack because of the chest pain and difficulty taking a deep breath.  Was my friend crazy for thinking she was having a heart attack?  Lets look at the “symptoms of a heart attack” as published by the American Heart Association.

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​Symptoms of a Heart Attack
• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. 
• Shortness of breath with or without chest discomfort. 
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

Now doesn’t that sound like the symptoms she was describing?

In fact, what she was having was referred thoracic spine pain.  So the next question to ask is how do we differentiate the two?  There is a couple easy ways: 
1)  Are they someone that would likely be having a heart attack? Here is a list of common traits of those that have a heart attack:
     • Diabetes
     • Overweight and obesity
     • Poor diet
     • Physical inactivity
     • Excessive alcohol use
The person in my story was a 38 year old female that was thin, has an excellent diet, and exercises every day.

2)  Can you change their pain with movement of the head, neck, or thoracic spine?
If yes then it is not likely coming from the heart, as gentle spine motion should have not effect on signs and symptoms of heart attack.

3)  Are the symptoms made worse when the person is elevating their heart rate?  Notice I didn’t just say “made worse with activity” because many spine  problems can be made worse with simple activity.

Certainly I am not advocating that people ignore signs and symptoms of a heart attack but what I am advocating is a logical approach that uses common sense.  In this age of medicine we spend a lot of time on unnecessary testing that could have been avoided with a thorough evaluation of the person.
​In case you are wondering the outcome of my friends pain here is the rest of the story (as Paul Harvey would say).  We evaluated her thoracic motion because she was getting rib pain.  She was limited with left rotation more than right.  As a PT I know that frequently you can reduce thoracic rib pain by rotating toward the side of pain.  She did multiple sets of 5 repetitions of rotation and her pain began to subside and she was able to take a deep breath again.  By the next day the pain was gone and she no longer was worried that she was having a heart attack.

Take home message….think logically about your pain and let a trained professional do a thorough evaluation before blindly submitting to testing that is not likely to get you any closer to a diagnosis or treatment.

John Oxley, PT, DPT,
Cert. MDT, CSCS

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