There’s one symptom that emergency room doctors say people should always pay special attention: sudden, severe pain in the upper back. It can strike without warning, and some may assume it’s just muscle tension or a pulled shoulder blade. Doctors say this kind of pain can signal something far more serious.
Emergency physicians like Dr. Yanina Purim-Shem-Tov and Dr. David Benaron warn that upper back pain, especially when it feels sharp, tearing, or radiates to the neck or arms, could point to a heart attack or even an aortic dissection, a life-threatening tear in the main artery. Here’s why this symptom deserves urgent attention, and what other red flags you should never ignore.
Upper back pain is not always “just a pulled muscle”
Most people expect a heart attack to come with crushing chest pain, but that’s not always the case. “Don’t shrug it off”, says Dr. Purim-Shem-Tov. “Call 911. It could be a sign of a heart attack”. The problem, doctors say, is that people frequently mistake this pain for a muscle strain or poor posture and wait it out.
Upper back pain that appears suddenly, feels deep or pressure-like, or comes with nausea, dizziness, or shortness of breath can indicate that blood flow to the heart is being blocked. Some patients describe the pain as burning or “tearing”, often centered between the shoulder blades. Others feel it spread to the jaw, neck, or down one arm.
In some cases, this pain may signal an aortic dissection, which happens when the wall of the aorta tears and blood leaks between the layers. It’s rare but often deadly if not treated immediately. The pain tends to be sudden, severe, and unlike anything the person has ever felt before. If you have hypertension and experience this kind of pain, don’t try to tough it out. Even if the discomfort seems to fade, it’s worth being checked.
Other symptoms you shouldn’t ignore
Doctors say there are several other warning signs that can indicate something serious.
- Sudden confusion or personality change: If someone suddenly seems disoriented, forgetful, or unable to speak clearly, it could be a stroke, infection, or dangerously low blood sugar, says Dr. Purim-Shem-Tov.
- A sense of doom or intense anxiety out of nowhere: Overwhelming dread that appears suddenly, especially with a racing heart or shortness of breath, may signal a heart attack, blood clot, or severe allergic reaction.
- White or pale-colored stool: This could mean the bile duct is blocked, sometimes due to pancreatic or liver problems, Dr. Benaron explains.
- Vomiting that looks like coffee grounds or bright red: That’s often a sign of internal bleeding and should be treated as an emergency.
Each of these symptoms can point to conditions that become dangerous quickly if ignored. While some may turn out to be benign, ER doctors agree it’s always better to get checked than to risk waiting too long. When something feels “off”, trust that instinct. Sudden, intense pain or changes in your body—especially those that don’t have a clear explanation—are signals to pay attention.