Incidence of Neck Pain in Myocardial Infarction
Neck pain occurs as a radiation symptom in approximately 22.7% of patients with acute myocardial infarction, though it is rarely the sole presenting complaint. 1
Frequency of Neck Pain as a Radiating Symptom
Radiation of chest pain to the shoulder, neck, and jaw occurs in 22.7% of patients with acute myocardial infarction. 1
The European Heart Journal guidelines describe that ischemic cardiac pain may radiate to the left and/or right arm as well as to the neck and back, though specific incidence rates are not quantified in this broader context. 2
Women suffering from acute myocardial infarction have been reported to have pain more frequently in the back, neck, and jaw compared to men. 2
Neck Pain as Part of the Clinical Presentation Pattern
The American Heart Association characterizes typical myocardial infarction symptoms as central/substernal compression or crushing chest pain that radiates to neck, jaw, shoulders, back, or one or both arms. 3
Most patients (93.1%) with acute myocardial infarction present with chest pain as the primary complaint, with neck pain occurring as a secondary radiation pattern rather than an isolated symptom. 1
In a systematic review of atypical presentations, patients commonly presented with pain and discomfort in the abdomen, head, and neck regions, particularly in those over 50 years of age with multiple comorbidities. 4
Clinical Context and Recognition
Pain radiation patterns help distinguish cardiac from non-cardiac causes: severe and prolonged precordial chest pain in males aged 41-70 years with radiation to left shoulder, neck, and jaw is highly suggestive of acute myocardial infarction. 1
The presence of associated symptoms such as diaphoresis has a specificity of 95% and likelihood ratio of 5.18 for acute coronary syndrome when combined with typical pain patterns including neck radiation. 5
Important Clinical Pitfalls
Neck pain alone without chest discomfort represents an atypical presentation that can lead to missed diagnoses, particularly in women, diabetics, and elderly patients who may present without classic symptoms. 3, 4
Failing to obtain an ECG in patients presenting with neck pain who have cardiac risk factors (especially elderly, diabetics, women) is a critical error that can delay life-saving treatment. 3
Approximately 6.9% of myocardial infarction patients present with clinical features other than chest pain entirely, which may include isolated neck discomfort as part of an atypical presentation. 1