By Dr. Ngô Chí Hiếu*

Chest pain can take various forms and be caused by different conditions. Chest pain may be serious, especially if it is caused by a heart or lung problem, so it is important to seek medical advice immediately if you experience it.

Typical signs and symptoms

Chest pain related to a heart condition may have the following qualities:

• Sharp or dull pain, sometimes described as a burning sensation or a crushing tightness of the chest. Pain may radiate to the neck, jaw, back or down one or both arms. In some cases, pain may extend to the stomach area.
• Pain lasting several minutes, which comes and goes and may be related to physical activity, stress or exposure to cold weather.
• Weakness and dizziness, cold sweats or heart palpitations.

Chest pain caused by other problems may show the following symptoms:

• Chest pain associated with trouble breathing – severe pain when inhaling deeply or coughing. This may be caused by pulmonary embolism (a blood clot in the lungs), pleuritis (inflammation of the tissue surrounding the lungs), or a collapsed lung.
• Pain with nausea, vomiting or difficulty swallowing. This may be caused by heartburn, anomalies in the esophagus, gallstones, gallbladder inflammation or pancreatitis.
• Pain and tenderness when pressing on the chest and pain that worsens or improves when changing position, which may be caused by inflammation of rib cartilages, broken ribs or sore muscles.
• Heart palpitations and chest pain, occasionally caused by anxiety or panic attacks.
• Heartburn and a burning sensation in the stomach area, both of which can be caused by either a stomach problem or a heart condition. The latter is more common in women.

When to seek medical advice

As chest pain can be caused by many different serious conditions, you should seek medical advice to diagnose the cause. Get medical attention immediately if you experience any of the following symptoms, as they may be signs of a heart attack:

• Chest pain spreading to the arms, neck, jaw or back.
• Sudden chest pain with shortness of breath, especially when resting.
• Nausea, heartburn or abdominal pain.
• Sudden dizziness, palpitations, rapid breathing, drowsiness, confusion, pale skin or cold sweats.
• Very low blood pressure or very slow heart rate.

What serious heart issues can cause chest pain?

• Heart attack – This occurs when blood flow is blocked in the coronary arteries, which supply the heart muscle with oxygen.
• Angina – Poor blood flow to the heart due to a narrowing of the coronary arteries, especially during exercise, can cause angina.
• Aortic dissection – When the inner layers of the aorta (the main artery leading from the heart) separate, blood gets in between the lawyers and the aorta can rupture.
• Pericarditis – The inflammation of the sac that contains the heart, this condition causes a pain that often gets worse when inhaling or lying down.

How is a diagnosis made?

• Electrocardiogram (ECG) helps the doctor to diagnose a heart attack that has occurred or is in process by recording the electrical activity of the heart through skin electrodes.
• Blood tests can reveal the levels of various enzymes produced by the heart muscle.
• Chest X-rays help check lung condition, heart shape and the status of major blood vessels.
• CT scans look for blood clots in the lungs or examines the aorta.

Your doctor may prescribe additional tests such as:

• Echocardiography, a heart ultrasound, to show the heart’s shape and whether the heart valves are functioning properly.
• Stress Test – an ECG taken during physical exercise will show whether there is any narrowing of arteries to the heart.
• Coronary angiography, to determine whether the coronary arteries are clogged.

Treatments for chest pain

Drugs that may be prescribed to treat chest pain, depending on the cause, include:

• Vasodilators
• Aspirin
• Clot-dissolving drugs
• Blood thinners
• Medication regulating stomach acid production
• Medication to deal with anxiety

Minimally invasive and open surgery for heart conditions

Depending on the cause of your chest pain, a doctor may recommend:

• Angioplasty and stent placement – if the chest pain is caused by a narrowing or blockage in one of the coronary arteries, the doctor may insert a small tube into a blood vessel on the wrist or groin. The doctor will then open the blockage with an inflatable balloon and insert a metal stent into the artery to hold it open.
• Open heart bypass surgery – a piece of another blood vessel is taken to bridge the closed section of the coronary arteries.
• Dissection repair – aortic dissection may need emergency repair; this can be done by open surgery or by inserting a covered stent via the groin vessel.

No one treatment is applicable in every case. Ask your doctor which one is best suited for you.

Steps to prevent these problems

Factors that could cause a blockage or narrowing of the heart arteries include:

• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Lack of exercise
• Stress or depression
• Smoking
• Excessive alcohol consumption
• Unhealthy diet

Improving diet and exercise and quitting smoking will help lower your risk of heart-related conditions. Regular health checkups are recommended to see whether you are at risk and to learn what you can do to improve your health.

If you have any questions or concerns, please ask your doctor for advice. — Hanoi French Hospital

* Dr. Ngô Chí Hiếu is a clinical and interventional cardiologist with years of international training and experience. Together with his colleague, French clinical cardiologist Dr. George Cloatre, he brings state of the art knowledge and treatment for cardiovascular conditions to our customers.

If you have any questions or want to book an appointment with our doctors, please call us at 84 – 24.3577.1100 or email us at contact@hfh.com.vn.