Can throat pain be a symptom of myocardial infarction (heart attack)?

Throat Pain as a Symptom of Myocardial Infarction

Yes, throat pain is a recognized symptom of myocardial infarction and should trigger immediate emergency evaluation with ECG and cardiac monitoring. 1

Clinical Recognition

Throat pain represents a well-documented atypical presentation of acute MI that occurs through referred pain patterns from cardiac ischemia:

• The ACC/AHA guidelines explicitly state that chest discomfort in MI can be referred to the arm, throat, and lower jaw, making throat pain a legitimate cardiac symptom requiring urgent evaluation 1
• The European Society of Cardiology guidelines identify radiation of pain to the neck as an important diagnostic clue for MI, alongside radiation to the lower jaw or left arm 1
• The Third Universal Definition of Myocardial Infarction describes ischemic symptoms as including various combinations of chest, upper extremity, mandibular or epigastric discomfort, confirming that throat/neck pain falls within the recognized symptom spectrum 1

Why This Matters Clinically

The significance of recognizing throat pain as a cardiac symptom cannot be overstated:

• Atypical presentations like throat pain are associated with delayed diagnosis, less frequent reperfusion therapy, and worse outcomes 1, 2
• Up to 30% of STEMI patients present with atypical symptoms, making awareness of these presentations critical for reducing mortality 1
• Research demonstrates that symptoms labeled "atypical" (including throat pain) are often misdiagnosed and attributed to gastrointestinal, neurological, or musculoskeletal disorders, leading to dangerous delays 1, 2

Immediate Management Protocol

When a patient presents with throat pain and cardiac risk factors:

• Obtain a 12-lead ECG within 10 minutes to identify ST-segment elevation ≥1 mm in contiguous leads or new left bundle branch block 3, 4
• Initiate continuous cardiac monitoring immediately to detect life-threatening arrhythmias 3, 4
• Administer aspirin 160-325 mg orally immediately while awaiting ECG results 3, 4
• Assess for accompanying symptoms including diaphoresis, nausea, dyspnea, or a feeling of impending doom, which increase the likelihood of MI 1

High-Risk Features to Recognize

Throat pain is more likely to represent MI when accompanied by:

• History of coronary artery disease or known cardiac risk factors 1
• Pain lasting more than 20 minutes that does not respond to nitroglycerin 1
• Observed sweating (diaphoresis), which significantly increases the probability of MI (adjusted OR 5.18) 5
• Vomiting, which also strongly predicts MI (adjusted OR 3.50) 5
• Elderly patients, women, or those with diabetes, who more commonly present with atypical symptoms 1, 2

Critical Pitfalls to Avoid

• Do not dismiss throat pain as "atypical" and therefore less concerning—this terminology is misleading and contributes to missed diagnoses and delayed treatment 2, 6
• Do not wait for "typical" chest pain to develop before initiating the MI protocol, as some patients never develop classic substernal chest pressure 1, 2
• Do not attribute throat pain to gastroesophageal or upper respiratory causes without first ruling out cardiac ischemia with ECG and troponin, especially in patients over 50 with cardiac risk factors 2
• Do not delay ECG beyond 10 minutes while pursuing alternative diagnoses 3, 4

Evidence Quality Note

The recognition of throat pain as a cardiac symptom is supported by multiple high-quality ACC/AHA and ESC guidelines spanning decades 1, with consistent messaging that pain radiation to the throat/neck represents a diagnostic clue for MI. Recent systematic reviews confirm that neck/throat pain is among the common atypical presentations, particularly in patients with comorbidities 2. The Third Universal Definition provides the most authoritative current framework, explicitly listing mandibular discomfort (anatomically continuous with throat) as part of the ischemic symptom complex 1.