Review: Left Shoulder Pain And Shortness Of Breath 

Pain in the left shoulder and shortness of breath can be very upsetting. They can also be signs of several health problems.

These symptoms often result from problems with your heart, lungs, or other organs, like your stomach or liver. Heart problems are often linked to pain in the left shoulder, shortness of 

breath, and fatigue. 

In this post, we'll look at some of the most common reasons, how to spot them, and what treatments are available.

Can Heart Problems Cause Left Shoulder Pain?

Yes, heart problems can cause left shoulder pain. 

They are some of the most important things to consider when you have shoulder pain with other signs like chest discomfort, shortness of breath, and tiredness. 

On the other hand, shoulder pain without other symptoms is rarely due to heart problems (with a few exceptions, as we'll discuss later on.)

Heart problems might cause referred pain in your shoulders because nerves from your arms, chest, and shoulders intersect and communicate.

It's important to know that this pain can sometimes travel down your left arm, into your neck and jaw, or, less often, into your right shoulder.

Below, we list some of the most common heart-related causes of shoulder pain.

Angina

Angina is the pain you get when your heart isn't getting enough oxygen-rich blood. It is the main symptom of coronary artery disease (CAD), a type of heart disease in which the arteries in your heart become narrowed or blocked. 

Angina may manifest as pain, tightness, or pressure in the chest, which may radiate to your left shoulder, arm, neck, and jaw. 

You might notice that this pain often comes on with exertion and resolves with rest. This is due to a mismatch in the amount of oxygen your heart needs during physical activity and the amount of oxygen-rich blood that can be supplied. Emotional stress and exposure to cold weather are additional triggers.

Angina can either be stable or unstable.

In stable angina, symptoms are predictable, usually triggered by exertion, and get better within minutes with rest.

On the other hand, symptoms of unstable angina occur even at rest, last longer, and are usually more severe. They may reoccur often or worsen over time.

While angina differs from a heart attack, it may progress to one! It is, therefore, important that you see a doctor if you have persistent left shoulder pain.

What Are the Symptoms of a Blockage in My Heart?

While angina or chest pressure/discomfort is the primary symptom of a blockage in your heart, you may also have one or more of the following symptoms:

• Pain in your left arm, neck, jaw, upper abdomen, or back
• Shortness of breath
• Indigestion
• Palpitations (feelings of having a fast-beating, fluttering, or pounding heart)
• Excessive sweating (frequently reported as cold sweats)
• Nausea or vomiting
• Anxiety and feeling restless
• Fainting spells

Although these symptoms may be due to other causes, having a combination of these could point toward a potential heart blockage.

Heart Attack

As we've already seen, a blockage in your heart's arteries can cause left shoulder pain, among other symptoms. This blockage can sometimes cause a heart attack or myocardial infarction, the sudden death of heart muscle cells.

Usually, a heart attack feels like a dull, squeezing pressure in your chest brought on by physical activity or emotional stress. 

It's important to remember that a heart attack can happen suddenly without any apparent cause.

You may feel pain in your left arm, shoulder, neck, or jaw. This pain may occur at any time, including at rest, and often doesn't go away on its own. Also, the pain from a heart attack usually lasts longer and doesn't get better with regular angina medicines.

Some associated symptoms include:

• shortness of breath
• lightheadedness
• cold, clammy skin
• nausea and vomiting
• Palpitations (irregular heartbeats)

In some people - particularly women, older people, and people with diabetes - classic dull 

chest pain might be absent. Instead, they may experience:

• a sharp, stabbing chest pain
• minimal or no chest pain - as seen in a 'silent MI'
• sharp tip of shoulder pain
• indigestion or pain in your upper abdomen
• anxiety
• extreme fatigue

 Here's a summary of the most common signs of an impending heart attack:

• dull, squeezing pressure in your chest
• dyspnea (shortness of breath)
• heavy sweating and anxiety
• nausea and vomiting
• feeling faint

If you think you might be having a heart attack, you should call for an ambulance immediately.

Can I Be Having a Heart Attack for Days?

If you've had shoulder or chest pain that hasn't gone away and has been constant for several days or weeks, it’s unlikely you're having a heart attack.

However, please remember that every individual's experience with heart disease may vary. 

Heart attack symptoms can come on suddenly or progress slowly, with mild pain or discomfort.

Because a heart attack can appear in many different ways, it's important to tell your doctor about any new or worrying signs as soon as possible.

How Can I Rule Out a Heart Attack at Home?

Experiencing left shoulder pain and shortness of breath can be incredibly distressing. So, it's essential to be able to tell when they are a sign of something dangerous, like a heart attack.

Let's look at some things you can do at home that may help rule out a heart attack and give you some peace of mind.

• Note if your pain changes when you move: pain from the heart often stays the same even when you change positions.
  
  Pain in the right or left shoulder and side that changes when you breathe or move is usually caused by muscle strain or arthritis. 

Also, taking a deep breath or pressing on the area of pain usually doesn't worsen chest pain caused by heart problems.

• Watch out for other signs of a heart attack, like pain in the middle of the chest, pain that spreads to the arms, and a strong feeling that something terrible is about to happen.

• You may track what makes your symptoms worse and what makes them better. Stable angina is usually caused by shoulder pain and shortness of breath that go away when you rest. But shoulder pain, shortness of breath, and feeling tired even after resting could be signs of something more serious, like unstable angina or a heart attack. 

• If the pain goes away every time you eat or take an antacid, it could be a problem with your esophagus or stomach.

Remember that these home checks are not foolproof. If you have chest pain that is new, severe, prolonged, or worrisome, call for an ambulance immediately.

How Can I Tell the Difference Between a Heart Attack and Shoulder Pain?

If your shoulder pain comes with shortness of breath, fatigue, irregular heartbeats, or a feeling of impending doom, it is more likely a heart issue than a shoulder problem. 

That said, shoulder pain - right or left - without other symptoms is commonly caused by muscle or bone problems. 

Musculoskeletal pain is usually localized and doesn't usually come with the other severe signs of a heart attack we've already discussed.

Pain from a heart attack is usually very severe and debilitating. It isn't necessarily linked to moving your shoulder as is often seen in musculoskeletal causes of shoulder pain. 

But these signs show up differently for each person, and sometimes heart disease can happen without apparent signs (particularly in older people and those with diabetes.) It's important to see a doctor right away if you have any symptoms that don't go away or are unusual.

Pericarditis and Associated Symptoms

Pericarditis is another type of heart disease that can cause both shoulder pain and shortness of breath.

Pericarditis is an inflammation of the pericardium, the thin sac-like membrane around your heart. It usually comes after a recent lung infection, heart attack, or heart surgery.

Most people feel a sharp pain in the middle or left side of their chest, which may get worse when they take deep breaths, cough, or swallow. This pain - pleuritic chest pain - may improve on sitting and leaning forward. It may also radiate to your neck, back, and shoulders, like angina and a heart attack. 

Besides shoulder pain, pericarditis can cause trouble breathing, a fever, and a cough.

Diagnosing and Treating Pericarditis 

To determine if you have pericarditis, your doctor will usually ask about your symptoms and then do a physical exam. 

An electrocardiogram or ECG and echocardiogram can help confirm the diagnosis and identify if there's fluid buildup around your heart.

The mainstays of treatment include anti-inflammatory drugs and treatment of the underlying cause. 

Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, are first-line treatments. They help reduce inflammation and relieve the accompanying pain and shortness of breath. In some cases, colchicine, a drug used to treat gout and prednisone, a corticosteroid, are also used.

In severe cases, the fluid around the heart must be drained in pericardiocentesis. At other times, a pericardiectomy is done to remove the pericardium completely. 

Does Cardiac Shoulder Pain Come and Go?

The short answer is it can vary, depending on what's causing the pain.

The longer answer? As we've already said, angina (both stable and unstable), pericarditis, and a heart attack can all cause cardiac shoulder pain with various duration of pain.

• In stable angina, pain usually comes and goes in a predictable pattern. Symptoms have identifiable triggers and often go away with rest.

• On the other hand, in unstable angina, pain and other symptoms are not predictable, often coming and going variably.

• Even though acute pericarditis usually goes away on its own or with medical or surgical treatment, it can sometimes come back.
  
  Recurrent (or constant) pericarditis is a complication that affects 15–30% of patients and causes pain that comes and goes over months and years.

• Pain from a heart attack is usually persistent and not relieved by rest or regular antianginal medications.

In summary, the duration of cardiac shoulder pain varies based on the cause. Stable angina has predictable patterns and improves with rest. Unstable angina is unpredictable. Acute pericarditis usually resolves but can come back. Recurrent pericarditis causes intermittent pain. Heart attack pain persists and isn't eased by rest or medication.

How Do I Know if Left Arm Pain Is Not Heart-Related?

If you're experiencing left shoulder and side pain when breathing, it might cause alarm, as this can sometimes be linked to a heart condition. But not all left arm or shoulder pain is heart-related.

Musculoskeletal problems such as a rotator cuff injury or a pinched nerve in your neck can cause left shoulder and side pain when breathing. In the same way, a lung infection or pulmonary embolism can cause pain in your left shoulder, shortness of breath, and fatigue. 

Even issues like acid reflux or gallstones can contribute to shoulder pain.

Unlike cardiac pain, musculoskeletal shoulder pain is usually isolated to one area. Also, it may worsen with movement or upon applying pressure to the site. 

While some musculoskeletal problems can cause shortness of breath, it isn't usually as severe as cardiac issues. It may also be associated with visible inflammation or swelling and localized warmth.

Lung problems, like pleurisy, are also a common cause of non-cardiac shoulder and arm pain.

Pleurisy

Pleurisy occurs when the two thin layers of tissue (pleura) separating your lungs from your chest wall become inflamed. 

What Causes Pleurisy?

Viral infections most commonly cause pleurisy. Some other causes are:

• bacterial infections like pneumonia and tuberculosis
• inflammatory conditions such as lupus and rheumatoid arthritis
• lung conditions like lung cancers and pulmonary embolisms
• certain drugs 
• some heart conditions, including heart attacks

Symptoms of Pleurisy

The most common symptoms of pleurisy include:

• sharp chest pain that's worse when you cough, swallow, or breathe deeply
• shortness of breath
• fatigue and feeling generally unwell
• a dry cough and fever

Can a Bad Shoulder Cause Breathing Issues?

Shoulder problems do not usually cause breathing issues. However, fractures and dislocations in the shoulder may sometimes result in difficulty breathing. 

For instance, in one 68-year-old man who developed shortness of breath after a fall, doctors discovered a shoulder dislocation was the cause of his breathing issues.

When Should I Go to the Hospital for Left Shoulder Pain?

See your doctor if you have new pain in your shoulder, arm, or chest that stays for a long time or worsens, especially if you are short of breath and tired.

When Is It an Emergency?

As several conditions may cause left shoulder pain and shortness of breath, you should know how to spot red flags and when to seek immediate medical care.

You should go to the ER or call 911 if you experience any of these:

• severe chest, shoulder, or arm pain
• pain that persists or worsens despite rest or over-the-counter pain meds
• sudden shortness of breath 
• shoulder pain and shortness of breath accompanied by fatigue
• dizziness or fainting

If you already have a heart, lung, or other medical condition, tell your doctor immediately about any new or worsening symptoms.

How Is the Cause Diagnosed?

Diagnosing the cause of your left shoulder pain and shortness of breath will involve multiple steps.

Your doctor will begin by taking a comprehensive health history. They'll ask about your symptoms, including their onset, character, duration, location, and associated symptoms. They'll also want to know if you've had these symptoms in the past.

The next step is a physical exam, which usually includes a quick look at your whole body and a more thorough check of your heart, lungs, and shoulders.

In some cases, blood tests may be requested. These tests can detect enzymes typically released during a heart attack. They can also help determine if an infection, inflammation, or blood disorder causes pain and trouble breathing.

Other tests that may help your doctor reach a diagnosis include:

• an ECG, which measures the electrical activity of your heart and can help find unusual patterns that could be signs of heart disease or myocardial infarction.

• an echocardiogram, which utilizes sound waves to produce images of your heart to check for any structural issues

• an x-ray to look at your lungs, shoulders, or other organs

• lung function tests to rule out lung conditions, like asthma and chronic obstructive pulmonary disease (COPD), that could contribute to shortness of breath.

• endoscopy, to scope out your digestive system as issues like gallstones can sometimes present with shoulder pain

• a heart CT scan or coronary CT angiography to look for blockages in the heart

• an MRI to assess the structure and function of your heart

Treatment for Left Shoulder Pain and Shortness of Breath

Treatment for left shoulder pain and shortness of breath depends on what's causing it. It may also be different for each person.

After extensive assessment and evaluation, your doctor will choose the best treatment plan for you.

Let's look at some of the treatment options available for the causes of shoulder pain and shortness of breath we outlined earlier.

If your shoulder pain is caused by heart disease, your doctor might offer the following:

• antianginal drugs (e.g., beta blockers and nitroglycerin)
• aspirin
• blood thinners like warfarin
• procedures such as widening and placing a stent within a blocked artery or bypass surgery. 
• fluid drainage or antibiotics in pericarditis

These options are usually offered with lifestyle changes such as smoking cessation, weight loss, and a healthy diet.

Pain associated with pleurisy often resolves with NSAIDs like Ibuprofen. Depending on what's wrong, your doctor may also give you other medicines, like antibiotics for bacterial infections or corticosteroids for autoimmune conditions.

If your pain is not related to a heart or lung issue, your doctor may offer the following:

• antacids and acid-suppressing medication in reflux and esophagitis
• pain medications, physical therapy, and other specific treatments for musculoskeletal issues
• lifestyle modifications or surgery for gallstones

Lifestyle Changes To Manage and Reduce the Occurrence of Symptoms

Depending on what's causing your shoulder pain and breathing problems, making simple changes to your diet, activities, and daily life can make a big difference in how you feel.

Examples of things you can do to feel better include:

• a diet rich in whole grains, fruits, olive oil, fish, and dark green leafy vegetables, which has been shown to reduce the risk of heart disease.
• quitting smoking and limiting your intake of alcohol
• staying active with regular exercise such as yoga, Tai Chi, and weight lifting 
• effectively managing stress (physical, mental, or emotional)
• getting enough sleep as studies have shown that a lack of sleep may predispose you to pain and heart disease

Takeaway

Pain in your shoulder and shortness of breath could point to several health conditions. Often, these symptoms are linked to serious heart and lung diseases but can also be caused by less serious problems.

A key point to remember is that persistent shoulder pain combined with shortness of breath should never be ignored or shrugged off.

It is essential to understand and pay close attention to these symptoms, especially if they happen along with other worrying signs like fatigue.

Always speak to your doctor or other health care provider if you experience new, worsening, or worrying symptoms.