MadSci Network: Medicine
Query:

Re: is it true that when a man has a heart disease he feel the pain in his hear

Date: Thu Mar 22 11:29:33 2001
Posted By: David Burton, Post-doc/Fellow, Physiology, University of Oxford
Area of science: Medicine
ID: 984048542.Me
Message:

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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