Why do you get arm pain when you have heart attack?!?

🧠Visceral and somatic afferent fibres converge on the same second-order neurons in the spinal cord, typically within the dorsal horn, leading to mislocalisation of pain.

💊Visceral afferents are poorly localised due to sparse innervation and low cortical representation.

💊The referred pain often follows a dermatomal distribution corresponding to the spinal cord level of shared innervation.

🧬Example: Myocardial Infarction
The heart receives sympathetic afferent innervation primarily from T1–T4 spinal segments.

These segments also supply somatic afferents from the left shoulder and medial arm via the intercostobrachial nerve (T2) and related dermatomes.

During an MI, visceral afferents from the myocardium activate neurons in T1–T4, leading to referred pain in:
📍Left chest
📍Medial aspect of the left arm
📍Sometimes the jaw, neck, or back

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