The sensation of squeezing, crushing or pressure on the chest could indicate many things -- from “harmless” stress and indigestion to something as serious as a pending heart attack or angina. Are you concerned about your chest pain, and are you unsure about how serious it is and when you should see a doctor?

Question by tontonrokushi

My dad tells me my paternal grandma slept into her death. She was 50 years old and not fat at all. I accept that heart disease is real and can threaten any woman regardless of age and body shape. What is worrying however is the much bandied about assertions that women with chubby necks, chunky thighs and big hips are having more protection from heart disease. (If it were so, I am thinking it will be beneficial for older women who will tend to grow fatter and chunkier with ageing due to inability to run the treadmill.)

Still doctor, I find these assertions really imaginable. albeit consoling. While I am curious, it will also be helpful if you could clarify if these assertions have any truth for the general public. Thanks doctor.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you very much for raising this interesting observation. Many different risk factors contribute to the risk of heart disease. These include age, gender, family history and other modifiable risk factors such as high blood pressure, high cholesterol levels, diabetes mellitus, smoking habit and increase body mass index (BMI).

Body mass index is measured as weight (in kg) divided by the square of height (in m2). It is well recognised that a high BMI, or obesity is associated with an increased risk of heart disease. There are some recent observations that the distribution of fat tissue may also confer different risk of heart disease. It appears that those with wider waist circumference (fat distributed around the abdomen) are associated with a higher risk than those with smaller waist circumference (fat distributed around the thighs and hips).

This may relate to the different way fat tissue behaves in our body. Hence there is the suggestion that women with an “apple-shape” figure will be at a higher risk than those with a “pear-shape” figure. However, this does not imply that women with a high BMI and with more fat distributed around their hips are at lower risk than those with a low BMI.

Question by trevorfernando

Dear Doctor

Sometime I was rushed to hospital with severe chest pain. Having admitted to hospital various tests were performed including calcium deposits. All tets were negative. It was revealed the chest pains was due to high reflux. However since then I have changed my diet pattern. I take more vegetables and fish. Occasionally I eat lean pork meat. I do exercises but not frequent. I work quite late hours and have 5 to 6 hours of sleep a day. My total cholesterol is around 220, LDL is around 149 and HDL is around 58. When I take HYPOCOL 2 capsules in the morning, after a period of 3 months TOTAL Cholesterol comes down to 200 and the LDL to around 130. I take Zantac to control gastric as and when required. When I feel reflux I take NEXIUM which was described from NUH. But I am reluctant to take NEXIUM or Zanatc because it increases the Enzymes in my Liver for which I need to take Essentiale Forte.

With all these known factors how do I differentiate when I get a chest pain is it related to Heart or Reflux?

Thank you

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you for your question. Chest pain due to gastric reflux can sometimes be difficult to differentiate from chest pain due to angina (or coronary artery disease).

Chest pain due to reflux may feel like a burning or tight sensation associated with abdominal bloating that occurs in the stomach as well chest area. It is often associated with meals (or after meals) and can leave a sour taste in the mouth.

Chest pain due to heart disease usually has a squeezing, tight character (like a band around the chest) that may be associated with feeling out of breath and sweating. It may occur after exertion, working, exercise and may last for minutes.

If you cardiac stress test and calcium score is 0, then this will place you at a very low risk of heart attack in the short term. Nevertheless, it is sometimes still difficult to distinguish them. Hence if your doctor has assessed you fully, he/she will be able to advise you on your absolute risk of heart disease. I will also advise you to consult your doctor if you still experience recurrent symptoms.

Question by turquoise

Dear Dr Stanley,

I was at a hawker centre supposingly to have my lunch, after 2 bites, I could felt a very pressured, tightness to the extremeties that I couldn't breathe at all at the centre of chest. I broke out in sweats too & lasted 30 mins.

At A&E, had 2 runs of blood tests & ECG at different timing while under 8 hrs of observation. Was told the results were ok but the report indicated there's blood hamolysis & low in sodium.

Past 2 weeks, been unable to fall asleep & experiencing shortness of breath, difficulty breathing.

Is it a sudden heart attack & what is causing this? Appreciate your advise. Thank you.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you very much for your question. The symptoms that you described could be related to gastric or heart problems.

At the A&E, the doctors had performed blood tests to make sure that you did not have a heart attack that day. The implication of “haemolysis and low sodium” is less certain and can be related to a blood sampling issue rather than an actual medical problem.

We will need to review the actual results to be able to comment if it is significant. However, if you are still experiencing symptoms of breathlessness, I would advise you to consult your doctor early for further investigations to ensure that there is no underlying heart problem.

Question by eileensohyeeli

I have a chest pain in the centre. Like a pressure , crushing feel that lingers for about 15-30min.

Went for full medical check up with resting ECG, doctor says no problem.

Lately the chest pain came back in the middle of night. I did some accu pressure at the ribcage near the centre of chest pain to relieve the pain. If I wan to find out more, what kind of tests should i go ?

I excercise 2-3 times a week(60 -90 min of continuous cardio excercises). Family history , both parents have cholestrol 7 diabetes. Father went through heart bypass & mainly heart conditions on relatives side, mother with colon cancer history. Pls advise. Many thanks.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you very much for consulting us. Chest discomfort that feels like a “pressure, crushing” sensation can be related to heart, gastric or even musculoskeletal condition and should be evaluated further.

If you still able to exercise 2-3 times a week without recurrence of the chest pain, it will be more reassuring.

Nevertheless, we should take a full history and note the details of what precipitates the symptoms, and consider further cardiac evaluation with stress tests or imaging tests to exclude any significant heart conditions.

Question by sim.jane@rocketmail.com

Dear Dr Chia

My dad had an heart attack and is in a coma for 4 months now.We were told that his heart function is left only 15% & his brain is also damaged.

Can I check what is the likelihood that he can become concious again?Or otherwise, how long more can he survive if the coma carries on?He's aged 82 this year.

Thanks.
Jane

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

I am sorry to hear that your father is still very unwell. It would be difficult for me to predict his progress and his likelihood of regaining consciousness.

Many aspects of his health need to be considered including the extent of the damage to his brain, what part of his brain function has been affected, whether his heart function (although poor) is stable as well as other co-existing medical problems.

If a patient is not conscious, we will want to ensure that he has good medical and nursing care to prevent complications such as infection, bed sores or pneumonia. As for his long term outlook, I would encourage you to have a frank and honest discussion with his attending physicians to consider his prognosis.

Question by s1143685d

What are the risk factors that cause heart attack? How will I know if I have these risk factors?

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

We should all know our risks for heart disease.

These are categorised as those that “we cannot change”, such as gender (male are at higher risk), positive family history of heart disease (if your brother, father, or grandfather had a heart attack before age 55, or your sister, mother, or grandmother had a heart attack before age 65) and advancing age.

There are modifiable risk factors that “we can change”: smoking habit, high blood pressure, high blood cholesterol, diabetes mellitus, obesity and overweight, stress, sedentary lifestyle and excessive alcohol intake.

Although there are risks that we cannot change, such as family history, it is important for all of us to know that there is a lot that we can do to minimise our risk of developing heart disease.

Question by sikmunchan

Dear Dr Chia, my blood pressure is excellent, weight and cholesterol level good and I exercise about twice a week - walking or on a stationary bike. Over these two weeks however, twice when I woke up in the morning, I felt a squeezing sensation on my chest, it does not hurt but it certainly is a sensation that I've not felt before. The sensation goes away almost immediately when I get out of bed. Should I be concern?

Thank you.
SM

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you for your question and I applaud you for keeping a healthy lifestyle. There can be a variety of explanations for the sensation that you experience in your chest and can include heart, gastric, muscle problems to bone and joint inflammation. Hence, I would encourage you to consult your physician for a formal assessment in order to exclude any significant underlying condition.

Question by sky

Dear Dr Chua I am 55 years old, encountered chest pain 2 years ago, admitted A & E, have ECG, angiogram, scan, all ok.but on and off still feel tightness, heart pumping hard, my total cholesterol level is 229, HDL 76, LDL 135,Triglycerides 90. went to see heart specialist, was told not necessary on medication,what is my problem,do i need to go for further check on my heart, what kind of test ?

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

If you are experiencing intermittent chest tightness and “heart pumping hard”, we will have to assess the details of these events: when these symptoms occur, are they associated with exercise or do they occur saddening as well as their frequency and duration, in order to obtain some clues as to their underlying cause.

From your description, you have undergone quite a few tests for your heart. Hence it will be helpful to review all the results to determine if there are any abnormal findings that may be related to your symptoms.

The symptoms may be related to a heart condition, irregular rhythm or may even be related to gastric, muscle tension or stress. Hence before we plan for any further tests, I would recommend that you discuss your symptoms fully with your physician to see if there is already a good explanation for your problem.

Question by cherubin

I'm in my late 20s. From time to time i will get a dull pain at my chest area. ECG results are normal. I was advised by the doctor that the heart muscles may be inflamed and was prescribed medicine to bring the inflammation down. Should I be concerned?

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

In your age group, it is less common to have heart disease, although it can still occur. Our heart muscles can be inflamed in a specific condition when viral infection affects our heart function. This however is rare. You may like to clarify with your doctor whether he meant inflammation of your heart muscles, or inflammation of the chest wall muscles which is a benign condition that can occur with exercise, stretching or stress.

Question by lydiateoh

Hi Dr, I have a chest pain (not sure is it chest pain,centre part of the chest) if I sleep on my left side. It is pain when I try to turn from left to any other position. I have to ask my husband to press on my chest strongly and I can turn slowly. Once I turned, the pain just gone. Sometimes when my sitting/lying on bed and want to get up from bed, it will feel pain on the centre part of my chest. For the rest of time, it just as normal without any pain. Please advise. Thanks.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you for your query. From your description, your symptoms of chest pain appear to be positional and vary with your posture and how you sit or lie down. This is usually associated with a musculoskeletal origin, which are symptoms related to the muscles, bone and nerves (coming from our neck or upper back). Pain from the heart is usually more related to exertion or work. I would still urge you to discuss with your physician to evaluate this fully.

Question by s1740634e

Will chest pain be affected by fast heart rate an long QT interval?

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

With fast heart rate, we can experience a discomfort in the chest area either with the heart “pounding very hard” or because it has to “work harder”.

It does not necessarily imply that there is underlying heart disease. However, the symptoms will need to be evaluated formally.

Long QT interval is an observation on the electrocardiogram, a test performed to assess the electrical activity of the heart. QT interval reflects the time it takes the time for the heart to “relax” electrically after each contraction of the heart. There are specific congenital conditions where the QT intervals are very long and this increase the risk of abnormal heart rhythm.

QT interval can also be prolonged due to slow heart rate, certain cardiac medications, antibiotics or gastric medication. Occasionally, QT interval can also be misread on the ECG as being long if the end of the interval cannot be clearly defined on the ECG, even when the interval is normal. Long QT interval does not cause chest pain, but can increase the risk of irregular heart rhythm.

Question by jlow1944

Dear Dr

How do I tell what kinds of chest pains or discomfort should be checked out? Sometimes, I can't even tell if the discomfort is in the chest/heart or the breast.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Chest pain or discomfort can be due to a variety of conditions, ranging from pain due to heart disease, lung conditions, arthritis, gastritis or muscle aches.

Although pain caused by these different diseases usually have a slightly different character, duration and precipitating factors, it is indeed difficult to distinguish them. Hence if you are worried, I will advise you to discuss this further with you physician so that a proper assessment can be made.

Question by rsim

Dear Dr Chia,

What are the causes for chest pain?

Because I used to be a heavy smoker before till one day I have severe chest pain and have difficulty breathing, after that day, I stop smoking. Is heavy smoking one of the causes for chest pain?

Also is chest pain definitely a symptom of pending heart attack? i.e if I experienced chest pain before, there is a chance of me having heart problem?

Appreciate very much for your advise.

Thanks a lot
rsim

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Chest pain can be due to a variety of conditions that can be related to the heart, lungs, joints, gastric or muscle aches. However, smoking is well recognised to be an important risk factor of heart disease and can increase a person’s risk of coronary artery disease or heart attack by several fold. Smoking can also cause long term damage to the lungs that can lead to breathing difficulty. Hence if you are experiencing chest pain and you have significant risk factors for heart disease, you may be at risk of heart attack. Hence I would advise you to consult a doctor soon to have it fully evaluated to exclude coronary artery disease.

Question by mosmos

May I know how to differentiate between chest pain and heart burn? Sometimes my chest pain only last a less than a minute with both upper arms feeling slightly numb.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Thank you for your question. Chest pain due to heart burn (gastro-oesophageal reflux) can sometimes be difficult to differentiate from chest pain due to angina (or coronary artery disease). Chest pain due to reflux may feel like a burning or tight sensation associated with abdominal bloating that occurs in the stomach as well chest area. It is often associated with meals (or after meals) and can leave a sour taste in the mouth.

Chest pain due to heart disease usually has a squeezing, tight character (like a band around the chest) that may be associated with feeling out of breath and sweating. It may occur after exertion, working, exercise and may last for minutes.

However, it is sometimes still difficult to distinguish them. Hence I will also advise you to consult your doctor if you still experience recurrent symptoms and he can further stratify your risk for heart disease and consider performing a cardiac stress test.

Question by maggiesimmk

Dear Dr Chia My Mum died of heart attack at age 74 and my younger brother at age 53. I had my chest pain and tightness and limb numbness about 2 years ago but it lessened after I stopped work. After medical check up, I was diagnosed with "reflux". Under the above condition, what is my risk level of having a heart attack in future and what should I do to safeguard myself. Thanking you in advance for your professional advice.

Answered by Dr Stanley Chia, Senior Consultant, Department of Cardiology, and Director, Residency Programme, National Heart Centre

Having a family history of premature heart attack (1st degree male relative before age 55 or 1st degree female relative before age 65) will increase your risk of heart disease.

This is however only one of the many risk factors that contribute to the development of heart disease. Other significant risk factors include

• advancing age,
• male gender,
• smoking habit,
• high blood pressure,
• high cholesterol level,
• diabetes mellitus,
• diet and
• frequency of exercise.

Hence you can consult your doctor who can provide an assessment of your future risk of heart disease based on these risk factors. I would also advise you to have an active lifestyle, adopt a healthy diet and a good work-life balance which will all help to protect you from future heart disease.

Ref: T12