Pain in the left arm: infarction or not? other causes?

Have you been feeling pain in your left arm lately? She can be the symptom muscle pain, fracture, nerve pinchingbut also – and we think less about it – of heart pain. How to quickly identify the type of pain to take care of it as best as possible? Muriel Bigot, cardiologist, answers us.

Pain in the arm (left or right for that matter) can manifest itself in different ways:

• a brief pain which manifests itself during a precise movement;
• a sharp painfollowing a trauma, possibly accompanied by swelling or arm deformity ;
• a radiating or shooting pain ;
• a pain that intensifies when using the arm;
• a feeling of electric shocksburning or tingling that does not increase with effort;

« Myocardial infarction is the first diagnosis to rule out when suffering from pain in the left arm. This is the only cause for potentially serious, even fatal consequences« , underlines Dr Bigot. Each year, in France, nearly 80,000 people are victims of it (source 1) and one person in ten dies within the hour following the accident. In question, in particular, a lack of knowledge of the symptoms « atypical » and a difficulty in identifying them as such, believes the specialist.

Concretely, myocardial infarction occurs when the coronary artery (which feeds the heart with blood) becomes obstructed. The heart muscle, then deprived of oxygen, malfunctions and gradually necroses. The consequences manifest themselves very quickly: heart rhythm disorders to total heart failure.

« Typically, the pain manifests in the chest. It can be accompanied by a feeling of tightness and tightness, favored by the effort, and radiate into the arms, into the throat, into the jaw or the left arm, it is sometimes the only sign, especially in women », explains Dr. Bigot. Other signs can appear: digestive problems (nausea, vomiting, etc.), a loss of consciousnessfrom heart palpitationsetc.

Several risk factors can expose to myocardial infarction:

« Age should not be a falsely reassuring criterion“, insists the cardiologist: the infarction does not only affect men over 50. It can also concern young men, athletes and / or smokers, and increasingly, women, especially at the time of perimenopause. .

And the latter often present atypical symptoms which should not be overlooked!

When the left arm colors are not related to the left arm, they are basically related to tendon, muscle or joint causes. Depending on the case, they can be diffuse or localized, brief or persistent and become very disabling. They can also be followed by tingling, a lack of sensitivity in the fingers or a lack of strength. The main causes:

• traumatic causes (fractures or sprains following a shock),
• rheumatological causes (rotator cuff tendonitis for example, tennis elbow, shoulder osteoarthritis, rheumatoid arthritis, etc.),
• neurological causes (nerve compression that can sit in the neck, wrists or elbow).

« The patient is rarely able to tell the difference by himself », insists Muriel Bigot. The main criterion for distinguishing between cardiac pain and muscular or neurological pain? « If it’s left arm pain related to myocardial infarction, no position or alternative will relieve the painas long as we have not unclog the coronary artery”, she answers.

Left arm pain can actually be a warning sign of myocardial infarction, even before the onset of chest pain. It appears suddenly and especially for no apparent reason (no fall or shock).

To describe it, we speak of a retrosternal pain (in other words, the pain is located behind the sternum – the bone on which the ribs are connected) « projected »: its origin is indeed thoracic, but the pain is rarely isolated at the level of the left arm. She can radiate to the neck, jaw, stomach, but also to the right arm, or even both arms – and this, up to the wrists!

Severe pain in the left arm, which does not fluctuate with changes in position and is accompanied by a feeling of general malaise, sweating, pallor, etc. should be considered as a sign of myocardial infarction! In the slightest doubt, it is better to go to the emergency room or contact 15, because it is the speed of care that determines the prognosis.

Once this diagnosis has been ruled out, an interview with your general practitioner will make it possible to establish more precisely the causes of the pain. If necessary, depending on the pathology, he will refer you to a specialized doctor: rheumatologist, neurologist, cardiologist, etc.

To establish the diagnosis, the doctor will proceed by elimination, according to the probabilities, of the « history » of the disease and the history of each patient. Complementary examinations (blood test, Doppler, imaging tests, etc.) are guided by the clinic.

If a myocardial infarction is suspected, the emergency physician will perform an electrocardiogram to assess the situation. « If the slightest doubt persists, he will realize an emergency blood test to measure troponin, an enzyme present in the muscle fibers, which participates in particular in regulating its contractions. If it is present in too large quantities, it is because the heart cells are suffering and there is a high probability of myocardial infarction », explains the cardiologist.

And to continue: « in case of doubt, we renew the blood test after a few hours. But after two encouraging samples, we reassure the patient and we direct him to other examinations: either more in-depth cardiac examinations, or a rheumatological check-up for example ».