Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack
Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.
Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.
- If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
- If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.
Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.
- If exertion exacerbates the pain, this makes the heart more likely as a cause.
- If rest does not relieve the discomfort, this makes the heart more likely as a cause.
- Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
- Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain.
If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.
You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
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