Chest Thumping

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Did you know that having chest pain could represent something serious happening to your body? Depending on the severity and duration of the chest pain, it may be caused by something life-threatening that needs to be checked immediately.

POSSIBLE CAUSES OF CHEST PAIN
Most of the time, chest pain is due to benign conditions that will disappear on their own. Common reasons for chest pain include musculoskeletal pain, gastritis, and in the COVID era, inflammation of the heart or lung lining. These non-life-threatening conditions usually disappear gradually with time, and do not need specific treatment or require only minor treatment. However, the real concern lies in potentially dangerous chest pain, such as that indicative of a heart attack.

HEART ATTACK
A heart attack is the sudden blockage of the heart artery. There is a complete occlusion of the heart artery supplying blood to the muscles of the heart. This immediately leads to the heart muscles receiving no oxygen supply from the blood. If the occlusion is not treated promptly, the muscles of the heart will be permanently damaged. Heart attack may also lead to sudden cardiac death if the amount of heart muscles affected is large.

DIFFERENTIATING A BENIGN CHEST PAIN FROM A HEART ATTACK
Benign chest pains like musculoskeletal pain feel like a sharp poking pain. It is usually localised to one spot, and can be made worse or triggered by taking a deep breath or coughing. The chest wall is usually painful when you put pressure on it.

On the other hand, chest pain resulting from a heart attack is typically characterised by a central, dull or pressing sensation of chest tightness. This discomfort may radiate to the left arm and jaw. The pain is often intense, accompanied by cold sweats, feelings of extreme illness, and nausea or vomiting. In severe cases, fainting may occur and there is a risk of cardiac arrest.

TREATING A HEART ATTACK
A heart attack needs immediate medical attention. The longer the delay in treatment, the greater the risk of irreversible damage. Within a few hours (<12 hours), when the muscles of the heart are not getting blood supply, the muscles will be permanently damaged. Seeking help immediately upon the experiencing of suggestive symptoms is paramount. The gold standard treatment is coronary angioplasty, which swiftly unblocks the artery to restore blood flow.

CORONARY ANGIOPLASTY
Coronary angioplasty is a minor procedure where we unblock the artery with ballooning and stenting. This can be done quickly and completed within an hour.

The procedure is performed through the artery in the right hand, requiring only local anaesthesia at the wrist. A small, soft tube is inserted into the artery, which can be gently guided to the heart artery.

This facilitates the delivery of small balloons and stents to clear the blocked artery. Importantly, no surgical incision is necessary for this procedure. Furthermore, recovery is typically immediate, with patients able to use their hand shortly after the procedure. They can usually resume walking almost immediately, particularly when the procedure is performed in a non-emergency setting.

PREVENTING A HEART ATTACK
Heart attacks stem from atherosclerosis, the gradual narrowing of arteries due to cholesterol buildup. This process usually starts as early as the 4th decade. Being gradual, one may not feel any symptoms during the initial period. However, it is important to treat this condition early to reduce the chances of the blockage becoming severe and leading to a heart attack.

EARLY DETECTION OF CHOLESTEROL BUILDUP
Early detection of artery blockages is possible through outpatient tests. One common method is the stress test, where either physical exercise on a treadmill or medication-induced elevation of heart rate helps to reveal blockages. By utilising electrical tracing or imaging modalities like ultrasound scans, we can identify blocked arteries. Additionally, a CT scan offers a more precise examination, directly revealing early stages of arterial disease.

MANAGING RISK FACTORS
Prevention of early cholesterol buildup to the heart artery (which may lead to a heart attack) can be done by managing one’s risk factors. The classical risk factors include:

We can start with managing our lifestyle through the modification of our diet and exercise regime. Adopting a Mediterranean diet is particularly beneficial as this form of diet focuses on minimally processed and plant-based foods. This dietary approach emphasises increased intake of fruits, vegetables, whole grains, nuts and seeds, providing essential nutrients and antioxidants. It is also advisable to limit or avoid red meat, sugary foods and beverages, processed meats, and refined grains.
 
 
In terms of exercise, it is recommended to aim for at least 150 minutes of moderate-intensity activity per week. Examples of such activities include brisk walking, water aerobics, cycling, dancing, mowing the lawn and hiking.
 
 
If lifestyle modifications alone cannot adequately control risk factors, medication may be necessary to manage them effectively. These interventions can significantly slow down the progression of cholesterol buildup in the arteries, thereby reducing the risk of experiencing a heart attack.
 
 
 
 
 
 
SEEKING MEDICAL ATTENTION
 
It is important to seek medical attention if you experience the following symptoms:
  • Chest pain induced by physical exertion that is new or uncharacteristic.
  • Recent shortness of breath after physical activity.
  • Swelling of the feet and ankles.
  • Feelings of dizziness or fainting.

Besides observing for the above symptoms, it is also particularly prudent to seek medical advice if you have multiple cardiovascular risk factors, such as smoking, diabetes mellitus, hypertension, hyperlipidemia, or a significant family history of heart artery blockages.

SEEKING HELP FROM THE EMERGENCY DEPARTMENT

You should visit the Accident & Emergency (A&E) Department immediately if you, or someone you are with, have a sudden severe pressing chest pain accompanied by cold sweats, shortness of breath, fainting and radiation of pain to the arm and jaw that does not disappear after a few minutes.

KNOWING CPR
In the event of a heart attack, the heart may suddenly stop beating and this can lead to fatality. Knowing cardiopulmonary resuscitation (CPR) is paramount to enhancing survival chances. Immediate CPR administration is critical when such an event occurs, as survival rates decline by 10% with every passing minute of inaction. On the other hand, CPR coupled with appropriate defibrillation can significantly increase a victim’s survival prospects from 0% to 30%.

Learning CPR and defibrillation techniques is something anyone can do, and it is essential for possibly saving the lives of your loved ones. Make sure to explore the many CPR and defibrillation courses offered throughout the year at institutions like the Singapore Heart Foundation and the Singapore Emergency Responder Academy. They provide easy-to-follow guidance on how to perform these life-saving procedures correctly.

CONCLUSION
Always keep an eye out on chest pain, whether it is yours or someone you care about. While most cases are harmless, it is important to not ignore symptoms that could signal a serious problem needing urgent attention and treatment.

 

@PRIME

Author

  • Dr. Tan Svenszeat

    Interventional Cardiologist,
    Orchard Heart Specialist
    Mb BCh BAO (Ireland), LRCP & SI (Ireland)
    MRCP (UK), FAMS (Cardiology)


    Dr Tan Svenszeat is a seasoned Interventional Cardiologist in Orchard Heart Specialist Clinic specialising in managing occluded coronary arteries. Dr Tan attended the University College Dublin in Ireland and was conferred with MB BCh BAO medical degree by the National University of Ireland in 2004.

    He subsequently completed his residency in Internal Medicine and obtained his post graduate MRCP (UK) London in 2009. With over a decade of experience, he has treated numerous patients facing major heart attacks, performing emergency ballooning and stenting procedures.

    With a commitment to excellence in cardiac care and a passion for educating future medical professionals, Dr Tan continues to make contributions to the field of cardiology.

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