What’s causing your chest pains: an anxiety attack, a heart problem or COVID-19?

Common causes of chest pain and when to see a heart specialist.

As one of the symptoms of COVID-19, chest pains can be a cause for concern these days. But even outside of the COVID-19 pandemic, it’s important not to ignore any discomfort in the chest as heart disease is responsible for 23.2% or more than one in five deaths in Singapore1.

But chest pains aren’t always a sign of a heart attack or flu complications. Discomfort in the area could be due to many other causes. Some, like air in the lining of the lungs or a ruptured digestive tract, are more serious problems, while less worrying reasons for the pain include stress and indigestion.

According to Dr Tan Svenszeat, a cardiologist at Orchard Heart Specialist Clinic, “The common types of chest pain that one could experience are typically benign and musculoskeletal in nature. This means the pain usually arises from muscles and bones, not the important organs within the chest, such as the heart, oesophagus and lungs. 

“However, one needs to understand the character of the pain in order not to miss important conditions that may be life-threatening, like a heart attack.”

The doctor, who specialises in interventional cardiology with a focus on patients with coronary artery blockage, clears the air about chest pains.

Is chest pain always a sign of a heart attack or some other heart problem?

Understanding the character of the chest pain is important to determine the underlying problem. It can be something harmless like bone and muscle aches or it can be something requiring urgent medical attention. Potential life-threatening causes are a heart attack, blood clots in the lungs, air within the lining of the lungs, a tear in a major artery, a lung infection and a ruptured digestive tract. All these can cause chest pain because these organs are all located within the chest wall close to each other. Their symptoms can sometimes mimic one another. However, there are subtle difference that one can take note of to differentiate between the different types of chest pain.

Does age affect the cause of chest pains?

Depending on your age group, your chest pain could have different causes. 

Age Common cause of chest pain
Under 40 years old

- tear of the big artery of the heart (aortic dissection)

- abnormal collection of air between the lining of the lungs (pneumothorax)

- blood clots in arteries to the lungs

Above 40 years old

- lung infection

- blocked arteries of the lungs

- ruptured digestive tract  

All of these are potentially life-threatening and need hospital treatment. So, always call for an ambulance if you think your pain might be due to any of these.

How does one distinguish between chest pain due to heart problems and non-heart chest pain?

Learning to understand the character of a chest pain can help put your mind at ease. 

If you experience…

It’s probably due to…

- Sharp, stabbing pain in an area of the chest wall

- Tenderness when you apply pressure on the area and breathe deeply

- Pain that increases when you move your chest, twist your torso or raise your arms

Musculoskeletal strain

- Pain centered behind your breastbone or just underneath it 

- Usually accompanied by burning sensation behind breastbone that doesn’t travel to the arm

-Pain that is temporary, and becomes severe when coughing or inhaling deeply

- Pain appears to originate from closer to the surface of the skin 

Gastroesophageal reflux disease

- Dull pressing ache on the front central part of the chest

- Pain appears to originate from deep within the chest

- Pain may commonly radiate to the jaw and upper arm

- May be accompanied with cold sweat and nausea

- In severe cases, accompanied by breathing difficulty

A heart attack

If I don’t have a family history of heart disease, eat reasonably well and exercise whenever I can, is it safe to ignore sudden chest pain?

Individuals who lead a healthy lifestyle and have good genes are at significantly lower risk of developing a heart attack, so such pain is most likely due to musculoskeletal pain. However, one cannot ignore the chest pain as it could be a sign of other serious health problems. And remember, despite having a healthy lifestyle, one can still develop blockage of the arteries.

What are the signs of a medical emergency?

A dull ache on the front-centre of the chest, pain that moves to the jaw and upper arm, and in some cases, accompanying cold sweat and nausea is an emergency sign. If you experience this, seek medical treatment immediately. The sooner treatment is rendered, the better the outcomes and death can potentially be avoided. So, it’s best not to bear with the pain and wait till it goes away, especially if the pain is prolonged and accompanied with shortness of breath or dizziness due to low blood pressure. At the extreme end of a medical emergency presentation, an individual may collapse due to a heart attack. By this time, it means their heart has stopped pumping and needs to be revived immediately by performing cardiopulmonary resuscitation.

What are some of the common heart treatments patients undergo?

The common heart treatments patients undergo depends on the conditions they are experiencing. If the patient has a heart attack (totally blocked heart arteries), for instance, the blocked arteries need to be unblocked immediately through a procedure called angioplasty. This should be done as quickly as possible because a blocked heart artery will cause permanent damage to the heart muscle if blood flow is not established quickly.

Another important aspect of managing heart ailments are medications. Taking long-term medication may reduce the risk of a heart attack and even death in those with heart ailments.

In a situation where the artery blockages are very severe, the patient may be advised to undergo a surgery called a coronary artery bypass graft. In this procedure, new routes are created around clogged and narrowed major blood vessels, usually using blood vessels from another part of the body, in order to restore normal blood flow and oxygen supply to the heart.

What should I do if I’m worried about an underlying heart problem?

There are ways to determine if someone is at risk of getting a heart attack. Advances in medical technology have made it possible to diagnose things like narrowing of the heart arteries and assess the potential risk of future events like heart attack and death due to these causes. Not all tests are suitable for everyone, however. Hence, it’s best to seek advice from a cardiologist to determine which test best suits you.

Source

1 Principal Causes of Death, Ministry of Health, retrieved on 2 August 2020 from https://www.moh.gov.sg/resources-statistics/singapore-health-facts/principal-causes-of-death

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