A 49-year-old female experienced a sudden, crushing substernal pain in her chest that radiated along the medial aspect o

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A 49-year-old female experienced a sudden, crushing substernal
pain in her chest that radiated along the medial aspect of her left
arm while having a heated discussion with her husband. Her husband
helped her to the couch where the patient attempted to relieve the
pain by squirming, stretching, and belching. When her husband noted
that she was pale, perspiring, and writhing in pain, he called for
an ambulance. The paramedics administered oxygen and rushed her to
the emergency room. After evaluation, she was admitted to the
intensive care unit (ICU) since the pain, although diminished, was
still present nearly 40 minutes after the event’s onset. She was
placed under observation with EKG monitoring for detection of
potential fatal arrhythmias. She was noted to be hypotensive.
While doing your rounds as a resident, you learn that the
patient has had previous attacks of substernal discomfort during
stressful situations that she was reluctant to describe as pain.
She said that this discomfort always passed when she rested. When
you ask the patient to describe her current chest discomfort, she
said that it was the worst sensation she had ever felt and clenched
her fist to demonstrate its vise-like nature. She said that when
the episodes occurred, she had a feeling of weakness and nausea.
While completing a physical examination, you detect an occasional
arrhythmia on auscultation. The patient is noted to have abnormal
EKG results. Her lab work suggested of elevated serum levels of
substances confirming myocardial necrosis. The patient is diagnosed
with acute myocardial infarction (MI) caused by coronary
atherosclerosis.
1. Explain the anatomical basis of referred
pain from the patient’s heart to the left side of her chest,
shoulder, and medial aspect of her arm.