What Causes Simultaneous Chest and Arm Pain, and When to See a Doctor

Simultaneous chest and arm pain related to heart trouble can occur because pain signals that originate in the chest can radiate out to one or both shoulders and arms, as well as the back, neck, and jaw.

But sometimes concurrent chest and arm pain is due to a sports injury, a psychological disorder, or other noncardiac cause.

The following is a list of common causes of simultaneous chest and arm pain and what it means if they affect you.

Muscle strain

An especially strenuous strength-training workout, sports injury, fall, or other accident can strain the pectoral muscles in the chest, as well as muscles in the shoulders and arms.

These types of injuries can often heal on their own, but serious injuries may need medical attention.

Heart attack

A heart attack occurs when an artery to the heart becomes severely blocked, preventing oxygen-rich blood from reaching the heart muscle and permanently damaging heart muscle. This condition is known as coronary artery disease (CAD).

For some, CAD can be diagnosed and treated before a blood vessel becomes completely blocked and a heart attack happens.

Medical emergency

A heart attack is a potentially life-threatening emergency that demands immediate medical attention. Call 911 and have someone drive you to the nearest emergency room if you have chest and arm pain in addition to any of these symptoms:

• shortness of breath
• cold sweat
• sudden nausea
• a feeling of impending doom
• symptoms that come and go for several minutes or longer, sometimes escalating in severity with each occurrence

Heart disease

Heart disease is a catchall term for any problem related to the heart. It’s often used interchangeably with CAD, but it can refer to other cardiac disorders, such as heart valve disease and heart failure (when the heart’s pumping becomes dysfunctional and can’t provide adequate blood flow throughout the body).

Myocarditis

When the myocardium, the layer of heart muscle that helps the heart contract and relax, becomes inflamed, the result is a potentially serious condition known as myocarditis. A wound or infection can trigger inflammation.

Other symptoms of myocarditis include:

• shortness of breath
• swelling in the legs
• fatigue

In some cases, it can heal on its own, but these symptoms should always be evaluated by a doctor.

Pericarditis

Surrounding the heart is a thin sac called the pericardium. It can become inflamed due to an infection or other cause. This is called pericarditis, and it’s often a temporary condition, though it can reoccur.

Other symptoms of pericarditis include:

• fever
• heart palpitations

Angina

Though it’s sometimes mistaken for a heart attack, angina is a condition marked by intense chest pain that can often radiate out to the neck, back, and arms.

It’s caused by a reduction, but not a halt, in arterial blood flow to the heart muscle. It’s not always a medical emergency, but it does need to be evaluated, and treatment should be supervised by a doctor.

There are two types of angina: stable angina, which is predictable, usually emerges after physical exertion, and typically resolves with rest, and unstable angina, which can come on at any time in an unpredictable fashion.

Either type of angina is a risk factor for a heart attack.

Acid reflux

A big dinner, spicy food, or alcohol can trigger a feeling of chest irritation known as heartburn, a common symptom of acid reflux. It’s a condition in which stomach acid moves up into the esophagus, where it can cause a painful, burning sensation.

If you experience heartburn often, you may have a condition called gastroesophageal reflux disease (GERD).

When chest and arm pain are joined by other symptoms, it could further suggest a heart attack or indicate that other possible conditions may be present.

Chest and right arm or left arm pain

While you may primarily associate pain on your left side with a heart attack, don’t ignore chest pain that then shoots down your right arm. Pain in either or both arms can signal a heart attack.

Chest and armpit pain

Heart attack-related chest pain can also be felt in either or both armpits, but chest pain with armpit pain may also be signs of a muscle injury or something more serious, like breast cancer or enlarged, swollen lymph nodes.

Chest, arm, and shoulder pain

Heart attack and angina pain can be felt in the chest and shoulder, and down the arm.

A muscle strain from lifting something heavy over your head or from a repetitive act like throwing a ball is also often the cause of shoulder pain.

Chest and arm pain after eating

Chest pain that begins after eating tends to be GERD, which is usually limited to the middle of the chest. However, GERD-related pain can be felt elsewhere, including in the arm and the abdomen.

Chest and arm pain after sneezing

Though back pain from sneezing is a more common muscle-related injury triggered by a sneeze, the unexpected, violent jerking of the body caused by a big sneeze can strain muscles in the chest, neck, and arms too.

Anxiety is a common psychological disorder that can bring about many physical symptoms, including:

• dizziness
• shortness of breath
• sweating
• nausea
• a racing heart

Left arm pain caused by anxiety can also occur, possibly because anxiety can make you more sensitive to even minor sources of pain.

A serious anxiety disorder or panic attack can trigger alarming physical symptoms, such as pain in the chest and arms, as well as severe tension or migraine.

The onset of heart attack symptoms should always be treated as a medical emergency. If you feel them coming on, call 911 or have someone near you do so. Never try to drive yourself to the emergency room if you feel you may be having a heart attack.

If you experience a brief episode of chest and arm pain and have no other symptoms, you should still see a doctor soon. You may have undiagnosed angina or another condition that should be evaluated.

If you have the following previously diagnosed conditions, you should also see a doctor:

• heart disease
• diabetes mellitus
• kidney disease
• high blood pressure
• high cholesterol
• obesity

If you experience heart attack symptoms, you may undergo a few tests while in the emergency room:

• Blood tests check for cardiac enzymes, such as an elevated troponin level, which can signal that a heart attack occurred or is ongoing.
• An electrocardiogram measures the heart’s electrical activity and determines if a heart attack has occurred, is occurring, or is likely to occur soon, as well as whether there’s been a change in heart rate or rhythm.
• A chest X-ray can show if the heart is enlarged or if fluid is building up within the lungs — one sign of a heart attack.
• An MRI scan can reveal changes in the heart’s features that could indicate myocarditis or valve disease.

A doctor will also ask for your medical history and perform a physical exam, including gentle movement of your arms and torso to check for signs of a muscle strain or joint problem.

Rest

Muscle strains can usually heal on their own with rest. Applying heat may be helpful in increasing blood flow to the injured area to help speed up healing.

If there has been a muscle tear or damage to tendons or ligaments, some kind of medical treatment, such as surgery, may be needed to repair it.

Stable angina often subsides with rest too, though a doctor may recommend you take medications such as a nitrate to help relax the coronary arteries and aspirin to help reduce the risk of dangerous blood clots forming in the heart. Other risk factors will likely be addressed as well, including high blood pressure and high cholesterol.

Heart surgery or stenting

Severe CAD or a heart attack may be treated with coronary artery bypass grafting (CABG), which is done with open chest surgery or with ballooning and stents, which are tiny mesh tubes that are inserted into a blocked artery via a catheter to restore blood flow.

Heart valve disease may require surgical valve repair or replacement, depending on which one of the heart’s four valves is affected and the severity of the disease.

Antibiotics

Bacterial infections of the heart triggering a bout of pericarditis or myocarditis may require antibiotics.

Digestive medications

Treating GERD includes lifestyle changes, such as weight loss, opting for several smaller meals during the day instead of two or three large meals, reducing alcohol intake, quitting tobacco smoking, and sleeping with your head slightly elevated.

But having GERD may also mean you need to take one or more of the following types of medications:

• antacids to neutralize stomach acid
• H2 blockers to help the stomach produce less acid
• proton pump inhibitors to reduce stomach acid production

Anti-anxiety medications

Anxiolytics, also called anti-anxiety medications, target certain brain chemicals responsible for anxiety and emotional regulation.

Other medications, such as beta-blockers, help slow the heart rate and address heart palpitations, a common anxiety symptom.

Antidepressant medications can also help ease anxiety symptoms.

Simultaneous chest and arm pain could be signs of something as temporary and mild as a muscle strain or as serious as a heart attack. Noting the type of pain is important in deciding whether to see a doctor immediately.

If the pain is more of a burning sensation during or after a meal, it may be heartburn. If the pain worsens with movement or when lifting something, it could be muscular.

Otherwise, consider a pressure or tightness in your chest and pain or heaviness in your arms as possible heart attack symptoms and get medical attention immediately.