Is Your Back Pain A Sign Of Heart Trouble?

It is sometimes difficult to imagine that back pain could be associated with heart disease, but this is a fact, well-established.

Back Pain: A Symptom of Heart Attack

Heart attack is a disease well known to us. It is a serious and potentially life-threatening condition that requires urgent medical attention. Most of us are familiar with the classic depiction of a heart attack – that of a man clutching at his chest in pain. However, a heart attack in women does not necessarily have the same symptoms.

Women are less likely to experience severe crushing chest pain, but they may experience more subtle symptoms such as chest discomfort accompanied by shortness of breath, vomiting, back pain, numbness in both arms, jaw pain or fatigue. The upper back pain (commonly
between the shoulder blades) could be described as a feeling of pressure, tightening or dull sensation that comes and goes along with other symptoms. This is known as “referred pain” which means that the brain has trouble identifying the origin of pain in the body. The nerves
that are connected to the heart are also linked to those that supply the head and neck regions, and this might cause a misinterpretation of the signals. Heart attack-related back pain is diffuse, thereby making it difficult to pinpoint its exact location.

How do we tell the difference between the back pain of a heart attack and that of a pulled muscle after a physical workout?

The back pain resulting from a heart attack usually feels like a dull ache which lasts for a while; before disappearing and returning minutes later. The back pain does not usually occur in isolation; it could be accompanied by other heart attack symptoms such as chest pain, nausea, and breathlessness. Muscular pain, on the other hand, is sharper in character, focal and localised. The pain is exacerbated by certain movements, and could be associated with tenderness.

You should worry about back pain if the pain in your upper back is unrelated to exertion, and is accompanied by other symptoms such as chest discomfort, unusual fatigue, jaw pain, dizziness, and nausea. You should pay close attention to these symptoms, especially if you have heart attack risk factors such as high blood cholesterol, high blood pressure, diabetes, obesity, and if your lifestyle is characterised by smoking, poor diet, and a lack of exercise.

Back Pain: A Sign of Aortic Aneurysm

Another cardiovascular disease that could present as back pain is an aortic aneurysm. These are balloon-like bulges that occur in the aorta, the main artery carrying oxygen-rich blood from the heart to the rest of the body. The aorta has thick walls that can withstand normal blood pressure. However, with certain medical conditions (such as atherosclerosis or “hardening of the arteries”), genetic conditions or trauma, the wall of the artery could be damaged or weakened. The force of blood pushing against the weakened or injured artery wall could result in an aneurysm. Depending on the location of the aneurysm, it may manifest itself as pain in the neck, jaw, back, chest, upper abdomen or near the region of the stomach, or the shoulder.

The most devastating consequence of an aortic aneurysm is when the aorta starts to tear or rupture. This incident, known as an aortic dissection, could cause serious internal bleeding leading to early mortality. In general, the larger the aneurysm and the faster it grows, the greater the risk of rupture. The classic symptom of an aortic rupture is sudden, intense, and persistent pain in the belly or back, which could be described as ‘ripping or tearing’ in character. The back pain is intense at the beginning, and the patient is usually afflicted with low blood pressure and a fast heart rate. In such cases, an emergency operation has to be performed to save the life of the patient.

How do we detect this condition early?

Most aortic aneurysms grow slowly and without noticeable symptoms. This makes them difficult to detect. They could be detected during routine screening through a chest x-ray or identified by a pulsation in the patient’s abdomen during a physical examination. Some aneurysms never rupture. Most start small and stay small. Others could grow larger over time, and sometimes very quickly. If you notice a deep, persistent pain in your back, belly area, or by the side of the abdomen, consult your doctor early.

Prevention is always better than cure. The best way to prevent aortic aneurysm is to lead a healthy lifestyle, eat healthily, exercise regularly, quit smoking, and keep your blood pressure and blood cholesterol under control.

Article is contributed by Prof Tan Huay Cheem, Chairman of the Singapore Heart Foundation, and Senior Consultant of the National University Heart Centre, Singapore.