In heart attack, patient experienced left shoulder pain, what type of this pain?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Nursing Foundation

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Explanation

Referred pain is the correct term for pain perceived at a location different from its actual source.
This occurs because sensory nerves from the heart and the left shoulder/arm converge on the same nerve pathways in the spinal cord.
The brain misinterprets the pain signals from the heart (a visceral organ) as originating from the shoulder or arm (a somatic area).
This is a well-documented physiological phenomenon crucial for diagnosing conditions like myocardial infarction.

Option A: Phantom pain is pain felt in a body part that has been amputated or is no longer present. The patient in this scenario has an intact shoulder.
Option B: Visceral pain is a general term for pain originating from internal organs. While the heart attack causes visceral pain in the chest, the term 'referred pain' specifically and more accurately describes the phenomenon of feeling that pain in the shoulder.
Option C: Chronic pain is defined as pain that lasts for an extended period, typically longer than 3-6 months. The pain from a heart attack is acute, meaning it has a sudden and recent onset.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Referred Pain in Myocardial Infarction to guide bedside assessment, documentation, and the next nursing action.
Recognizing referred pain is a critical nursing skill for the early detection of life-threatening conditions like myocardial infarction (MI), especially when classic chest pain is absent.
Nurses must educate patients, particularly those at risk for heart disease, about the various presentations of MI, including referred pain in the jaw, neck, back, or arms.
What if? If a female patient presents with unexplained jaw pain, indigestion, and extreme fatigue, but no chest pain, the nurse should still have a high index of suspicion for MI. Atypical presentations are common in women, the elderly, and patients with diabetes, and recognizing these patterns of referred pain can be life-saving.

How to Approach the Question

First, analyze the clinical scenario presented: a heart attack causing pain in the left shoulder.
Identify the key relationship: the pain is felt in a location (shoulder) that is different from the source of the injury (heart).
Recall the definitions of the different types of pain provided in the options.
Compare the scenario to the definitions. 'Phantom pain' relates to missing limbs. 'Chronic pain' relates to duration. 'Visceral pain' is pain from organs, but doesn't describe the location shift.
Conclude that 'Referred pain' is the only term that specifically describes pain perceived at a site distant from its origin, matching the question perfectly.

Concept Tested & Keywords

Concept Tested: Pathophysiology of Referred Pain in Myocardial Infarction
Stem keywords: heart attack, left shoulder pain
Lead-in keywords: what type
Clinical cues: Left shoulder pain during a heart attack is a classic clinical sign.
Negative lead-in flag: false

QnhnAieLS68eRqpkMjW41r

E6 Physiology Guyton 4SAE Part 3 pp. 107-109, 108-110

E6 Medicine Davidson Principles Practice 24e p. 197-199