Can jaw pain be a sign of myocardial infarction (heart attack)?

Jaw Pain as a Sign of Myocardial Infarction

Yes, jaw pain is a recognized symptom of myocardial infarction and should always be considered as a potential cardiac equivalent, particularly in women, older adults, and patients with cardiovascular risk factors. 1

Why Jaw Pain Occurs in MI

• Jaw pain represents an "anginal equivalent"—a symptom that substitutes for or accompanies typical chest discomfort during myocardial ischemia. 1
• When jaw pain has a clear relationship to exertion or stress, or is relieved promptly with nitroglycerin, it should be considered equivalent to angina. 1
• The pain typically involves the mandibular region and may radiate from the neck or occur in isolation without chest discomfort. 1, 2

Who Presents with Jaw Pain During MI

Women are significantly more likely to experience jaw pain during acute coronary syndrome compared to men:

• In the Global Registry of Acute Coronary Events study, 10% of women versus 4% of men with ACS presented with jaw pain. 1
• Women presenting with chest pain commonly have additional symptoms including jaw and neck pain, along with palpitations and back pain. 1
• In the VIRGO study of patients ≤55 years old with MI, 61.9% of women versus 54.8% of men reported pain or discomfort in the jaw, neck, arms, or between shoulder blades. 1

Older adults (>75 years) frequently present with atypical symptoms including isolated jaw pain without chest discomfort. 1

Critical Clinical Recognition Points

• Less than 75% of both men and women at high risk for MI recognize jaw pain as a potential heart attack symptom, making patient education essential. 3
• Some patients present solely with jaw, neck, ear, arm, shoulder, back, or epigastric discomfort without any chest symptoms. 1
• Jaw pain accompanied by diaphoresis, nausea, shortness of breath, or unexplained fatigue should trigger immediate cardiac evaluation. 2, 4

Immediate Action Required

When a patient presents with jaw pain concerning for cardiac origin:

• Obtain a 12-lead ECG within 10 minutes of presentation. 2, 5, 4
• Place the patient on continuous cardiac monitoring with defibrillation capability available. 2, 5
• Draw cardiac biomarkers (troponin) at presentation with planned repeat at 6 hours. 5, 4
• Assess cardiovascular risk factors including age, sex, diabetes, hypertension, hyperlipidemia, and family history. 1, 5

Common Pitfalls to Avoid

• Never dismiss jaw pain as dental or musculoskeletal without excluding cardiac causes first, especially in women over 50, diabetics, and elderly patients who commonly present with atypical cardiac symptoms. 1, 5
• Traditional risk score tools and physician assessments often underestimate risk in women and misclassify them as having nonischemic pain. 1
• Assuming all jaw pain requires typical exertional patterns—jaw pain occurring at rest can represent unstable angina or acute MI. 1
• Relying on a single troponin measurement can miss NSTEMI; serial measurements at least 6 hours apart are necessary. 5

Sex-Specific Pathophysiology

• Women have higher rates of MI caused by plaque erosion (58% versus 24% in men) rather than plaque rupture, which may contribute to different symptom presentations including jaw pain. 1
• Women also experience MI from coronary microvascular dysfunction, coronary vasospasm, and spontaneous coronary artery dissection more frequently than men, all of which can present with atypical symptoms. 2