MadSci Network: Medicine |
Hello Lool, The phenomenon that you are referring to here is called referred pain. This is defined as a pain that is perceived as coming from an area remote from its actual origin, and this does indeed occur in cases of heart disease. Specifically this occurs in cases where the heart is under ischaemic conditions. This means that the heart is not receiving sufficient blood flow to provide it with the oxygen it needs to function properly, which happens when one of the coronary arteries that supply the heart with blood becomes restricted or blocked, during an episode of angina or more seriously during a myocardial infarction, better known as a heart attack. Because the heart is unable to work properly when it does not have a sufficient supply of oxygen this stimulates pain receptors in the heart, which is known as ischaemic heart pain. However, I am not aware that this occurs differently between men and women. The pain originating from the heart during periods of cardiac ischaemia is often felt as a generalised pain in the upper left arm or shoulder. However this can be interpreted as coming from other areas including the stomach although I do not believe there are any strict differences in sex concerning where the pain is felt. One explanation for the pain from the heart being felt in the shoulder is due to the arrangement of the nerves that connect to these two regions. Nerves from the receptors project to the spinal chord and then onward up the spine to the brain. The heart and upper left shoulder project to the same segment of the spinal chord (vertebra), termed T1. The transmission of severe pain involves excitatory stimulation of many nerves, and many nerves that project from the T1 segment of the spinal chord to the brain receive excitatory inputs not only from the skin but also from the muscles and heart. It is a learned experience that when these nerves projecting from the spinal chord to the brain receive a large input it is due to stimulation from areas closer to the surface. Therefore, when these nerves are stimulated by ischaemia the sensation is misunderstood as originating from superficial parts of the body. Good luck in the future and thank you for your interest. Dr David Burton
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