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The Hidden Link Between Upper Back Pain and Heart Health

Upper back pain is an extremely common problem that most people will experience at some point in their lives. While there are many potential causes, ranging from poor posture to strained muscles, one overlooked source of upper back discomfort may be heart health issues.

Though not immediately obvious, there is an important connection between the upper back and heart that, when disrupted, can manifest as pain. Understanding this relationship, and being aware of certain warning signs, can potentially help uncover underlying cardiovascular problems early and prevent further complications.

The Cardiac Connection

To understand how heart health can generate upper back pain, it helps to know that the heart and spine are closely linked both anatomically and functionally.

The heart resides within the thoracic cavity, which is the upper body region surrounded by the rib cage. At the upper boundary of the thoracic cavity is the thoracic spine, consisting of 12 vertebrae running from the base of the neck down to the bottom of the ribs.

This means the heart and thoracic spine share a very tight space and have an intimate anatomical relationship. In fact, the heart physically rests right against the thoracic vertebrae and is anchored to the spine via numerous connective tissue attachments.

Functionally, the heart and spine also influence each other through an array of nerves embedded throughout the thoracic cavity. For example, sympathetic nerves originating from the thoracic spinal cord serve to increase heart rate and contractility during times of stress or exertion. Meanwhile, vagus nerves originating in the brainstem provide important parasympathetic input to lower heart rate during rest.

This nerve supply forms an indirect connection between the spine and heart where dysfunction in one can negatively impact the other. Upper back pain may arise when cardiovascular issues lead to inflammation or irritation of these thoracic nerves.

Warning Signs From The Upper Back

Given the close ties between the heart and upper back, certain types of upper back pain may be an informative red flag for potential heart problems. While many cases of back pain have musculoskeletal causes, doctors say that certain accompanying symptoms should raise suspicion of a cardiac origin.

Some important symptoms to watch for include:

  • Pain predominantly between the shoulder blades or mid-upper back
  • Pain that feels sharp and stabbing, sometimes described as “knife-like”
  • Pain that is brought on or aggravated by deep breathing
  • Upper back discomfort that radiates outwards to the arms, neck, or jaw
  • Back pain associated with simultaneous symptoms like chest pain, shortness of breath, dizziness, or fatigue
  • Diffuse upper back pain without a clear mechanical cause, such as injury or muscle strain
  • Worsening upper back pain during physical activity or when lying down

If upper back pain is accompanied by any of the above warning signs, experts caution that heart disease may be a contributing factor. Some heart-related issues that can generate upper back pain include:

Ischemic Heart Disease

This refers to heart problems caused by narrowed coronary arteries and reduced blood supply to the heart muscle. Ischemic heart disease includes angina (chest pain from inadequate oxygen) and heart attacks. In cases of severe blockage, upper back pain may result from irritation of the thoracic spinal nerves that also supply the heart.

Aortic Dissection

This is an emergency where the inner layer of the aorta tears, allowing blood to split the artery walls. The aorta extends directly from the heart through the upper back. Aortic dissections generate intense upper back pain that rips or tears in sync with the heartbeat.


This condition damages the actual heart muscle, often making it rigid and enlarged. One subtype called hypertrophic cardiomyopathy causes excessive thickening of the heart which can compress nearby nerves and sometimes the spine itself.


When the sac surrounding the heart becomes inflamed, it is called pericarditis. This can irritate the many nerves embedded in the pericardium, refer pain to the upper back, and limit heart mobility within the chest.

Catching The Clues

While most upper back pain is not heart-related, recognizing possible cardiac clues allows for prompt diagnosis and treatment when needed. Warning signs like location and type of pain, aggravating factors, and other accompanying symptoms may hint that more serious issues are brewing.

If suspicious upper back pain comes on suddenly and intensely, or occurs alongside other alarming symptoms like chest pain or shortness of breath, seek immediate medical care. Call 911 without delay.

For milder upper back pain that may be associated with heart issues, making an appointment with your doctor is wise to investigate further. Diagnostic tests like EKGs, stress testing, and imaging can help pinpoint any underlying cardiac problems.

Treating The Source

If heart disease is determined to be the source of upper back discomfort, treatment will focus on the specific cardiovascular condition to relieve symptoms.

Options may include medications to improve blood flow and oxygen supply to the heart, surgery to reopen blocked arteries or repair structural damage, or devices like pacemakers to normalize heart rhythms.

Simultaneously, steps like physical therapy, massage, and posture correction can provide relief for back pain caused by compression, muscle spasms, or nerve irritation related to the heart problem. Lifestyle changes to promote cardiovascular health will also benefit the upper back indirectly.

The upper back can be an informative indicator of heart health due to their close anatomical proximity and shared nerve connections. Learning to recognize and respond to red flag symptoms originating in the upper back could prove critical in identifying underlying cardiac conditions early, when they are most treatable. Monitoring for subtle clues can empower individuals to take proactive steps for protecting both heart and spine.