Acute Left Arm Pain Management

Cardiac Causes

The American College of Cardiology recommends immediate exclusion of acute coronary syndrome (ACS) in patients with left arm pain, as it represents the highest mortality risk, requiring ECG within 10 minutes and immediate troponin measurement 1, 2
Acute Coronary Syndrome is the most urgent consideration when left arm pain is present, particularly if accompanied by chest discomfort, with subtypes including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina 1, 2
Diaphoresis has 95% specificity (LR 5.18) for ACS, indicating a high likelihood of acute coronary syndrome in patients presenting with diaphoresis 1, 2
The European Society of Cardiology guidelines suggest that aortic dissection must be considered with sudden, tearing pain radiating to the back, especially with hypertension history, bicuspid aortic valve, or Marfan syndrome, and requires immediate blood pressure control with beta-blockers 2, 3

The American Heart Association recommends obtaining a 12-lead ECG within 10 minutes to identify STEMI, ST depression, or ischemic changes, and measuring cardiac troponin immediately with repeat according to protocol 1, 2
A focused cardiovascular examination for murmurs, rales, and signs of heart failure is essential in the initial diagnostic workup 1
Chest radiograph to evaluate for mediastinal widening (dissection), pneumothorax, or pneumonia is a crucial diagnostic step 2

If troponin elevated or ECG shows ischemic changes, admit immediately for ACS management per cardiology protocols, as recommended by the American College of Cardiology 1
If cardiac workup negative and pericarditis suspected, consider admission or close outpatient follow-up depending on hemodynamic stability, according to the European Society of Cardiology guidelines 1
Do not delay ECG and troponin testing to obtain chest X-ray in unstable patients, as this causes treatment delays, as stated in the European Heart Journal 3