A leading dentist calls me just now saying he has a patient with a suspected heart attack. The patient had gone to him with severe jaw pain. An astute dentist he was quick to identify it as referred pain of cardiac origin. Rest is history. #Heart attack is a great masquerader.

The cardiac innervations depend on the afferent sympathetic and parasympathetic nerves (lazy nerve). The majority of the innervations are transferred through the first five thoracic roots. The link between the lazy nerve and the trigeminal nucleus explains the pain in the jaw.

Another atypical manifestation of a heart attack is interscapular pain and shoulder blade pain. This is often seen in women and ECG and Echo are usually silent in this case. It is often due to left circumflex artery involvement.

ECG unravelled the mystery of jaw pain.