Facial pain associated with cardiac origin.

BACKGROUND: Ischemic heart disease manifests as pain on the left side, in the retrosternal or the precordial region, with subsequent radiation to the ipsilateral shoulder, face, and cervical region. Less frequently, it may manifest solely as face pain.

CASE DESCRIPTION: A 57-year-old man sought care at the Massachusetts General Hospital Oral and Maxillofacial Pain Center with a symptom of pain in the mandibular left posterior region, in the medial aspect of the ipsilateral eye, and in the left side of the neck. The pain had started approximately 8 months previously as a mild, constant dull ache in the mandibular left posterior region. However, it became severe in intensity and sharp in quality and radiated toward the medical aspect of the ipsilateral eye and lateral neck region after intense physical activity. Results from comprehensive diagnostic evaluation and a series of diagnostic tests suggested that the facial pain was associated with cardiovascular disease. There was complete resolution of pain symptoms after the patient received appropriate pharmacotherapy.

PRACTICAL IMPLICATIONS: Association of pain with exercise and termination of pain with rest and the presence of risk factors for cardiovascular disease necessitate a thorough investigation of rare and fatal causes of facial pain.