Pain Patterns with Myocardial Ischemia

The usual distribution of pain is referral to all or part of the sternal region, the left side of the chest, the neck, and down the ulnar side of the left forearm and hand. With severe ischemic pain, the right side of the chest and right arm are often involved as well, although isolated involvement of these areas is rare. Other sites sometimes involved, either alone or together with pain in other sites, are the jaw, epigastrium, and back.