#144 TMD Can Feel Like You Are Having A Heart Attack

Temporomandibular Joint Disorder, TMD, is well known for its long list of disparate symptoms. The most common are frequent, and/or recurring headaches, earaches, jaw pain, neck pain, ringing in the ears (tinnitus), a feeling of fullness in the ears (subjective hearing loss), dizziness (vertigo), arm/hand/finger tingling and numbness, and various kinds of jaw locking. There are several lesser known, but well documented symptoms, like visual disturbances, and confusion with toothaches which additionally confuse medical professionals.

Several years ago, a patient presented for a TMD consultation with a very confusing history. She was referred by her dentist who recognized several of the symptoms routinely seen with TMD. My first step during a consultation is to take a thorough history and note all the symptoms including when they were first experienced. She had many of the usual symptoms and related a recent experience of a trip to the emergency room at a local hospital. She had gone to the hospital because she had jaw pain and her chest hurt so much, she thought she was having a heart attack. The emergency room doctor and staff did all the routine tests including an ECG and blood test looking for protein markers specific to heart damage. The ECG returned normal as were the protein markers, and the patient was sent back home with a prescription for pain medication.

Upon completing the history and physical exam, I confirmed the diagnosis of TMD and the patient went on to treatment and eventually all her symptoms were resolved. But the part of her history complaining of chest pain made no sense to me at the time, and I filed it away as interesting, but not meaningful. A year later a second patient, this time a man, presented for TMD consultation with a similar history of previously seeking aid in an emergency room because he thought he has having a heart attack which turned up no evidence of heart muscle disfunction. Shortly thereafter, a third patient shared a similar experience at a hospital emergency department.

I now had three similar cases of patients with known TMD who went to the hospital with chest pain thinking they were experiencing a heart attack. At that point I got very interested in investigating if TMD could be confused with cardiac ischemia. After reviewing how inflammation within the Temporomandibular Joint, TMJ, creates the other disparate symptoms, the answer to the question is yes. TMD can cause chest pain.

Here is a brief review of how this phenomenon occurs. Damage to the TMJ creates inflammation within the joint to heal the damage. If the joint does not heal, the inflammation changes characteristics to become chronic inflammation. Chronic inflammation signals the brain that the joint is damaged, and the brain signals the muscles that move the jaw to contract and tighten up to hold the joint motionless to enhance healing. If the TMJ does heal, it continues to signal the brain about the unresolved damage and the brain responds by sending signals of the muscles of the neck to tighten up to hold the head motionless. (The second most common symptom of TMD is neck pain, after headache) When the neck muscles tighten, they can squeeze a group of nerves called the brachial plexus which supplies feeling to the chest, arm, hands, and fingers. Nerves within the brachial plexus supply the pectoralis major muscle and pectoralis minor muscle which overlies the chest and is responsible for moving the upper arm. The pectoralis major and pectoralis minor muscles can get so tight it can create chest pain. The patient may think they are having a heart attack. This is fascinating for sure.

Please don’t mistake the confusion of TMD and heart attack as an attempt to dissuade patients from calling 911 or making the trip to the emergency room if they experience chest pain. Ischemic heart pain can be lethal, and you should always err on the safe side.

With that said, don’t be surprised if you have several of the disparate symptoms of TMD, that at times, includes chest pain.