Why persistent, albeit mild, chest pains should not be ignored

Not all chest pains are equal, but all chest pains should not be ignored - especially if it is persistent, recurrent or severe.

"Persistent pain or pressure in the chest" can be a Covid-19 emergency symptom, according to Harvard Medical School.

It's important to seek medical help immediately if you experience any sort of chest discomfort during this pandemic. It's better to know the cause than stay in the dark.

"Covid-19 infections or other chest infections, such as pneumonia, can sometimes mimic a heart attack in terms of chest pains and breathing problems," shared 46-year-old cardiologist Dr Peter Ting. 

"Statistically, young people are less likely to develop coronary heart diseases as compared to older folks as it is a degenerative disease. However, we are seeing more in their 20s to 30s having heart attacks due to increasing risk factors such as smoking, stress, (insufficient) sleep and (excessive) spirits."

Other less life-threatening but equally worrying diseases can include inflammation of the oesophagus, rib cage, gall bladder and epigastrium (upper abdomen).

Chest pain often misconstrued

According to Dr Ting, who is also the Medical Director at StarMed Specialist Centre, heart-related issues often overlap with gastroesophageal problems.

Sharing similar sentiments is Dr Shanker Pasupathy, 48, a gastrointestinal specialist.

"Chest pain is just a location of pain. It may not be a heart problem. It is often misconstrued due to the proximity of the organs. I have seen people who had pain in the chest area dismissing it as stomach issues, and it turned out to be symptoms of a heart issue. Vice versa, people have done all kinds of heart tests which all turned out negative, and when we did an endoscopy, we found out that it was a gastro-related issue."

Due to their similar symptoms and the proximity of the organs in the affected region - the central chest area or the epigastrium (the area slightly below the chest) - it is sometimes quite difficult to differentiate between a cardio and gastro problem. Chest pains are often non-specific and require further evaluation to tease out the underlying cause.

Persistent, recurrent or severe pain

"We're not asking you to rush in and see a specialist every time you have a chest or abdominal pain, but I think it's normal to see the general practitioner and more people should be doing that," said Dr Pasupathy, who has been a doctor for 25 years.

He added that people should seek a second opinion if symptoms still persist despite one to two rounds of treatment.

Another rough rule of thumb on when to have your problem evaluated early is when the pains are persistent, recurrent or severe. If the pain is intolerable and causing near-fainting spells, nausea or cold sweat, or if the pain, despite being mild, keeps recurring over a few days without resolving, or if you have risk factors that predispose you to chronic diseases, it is probably wise to seek consultation soon.

"If we are missing one of the severe causes of chest pain, it could progress very quickly and be life-threatening. Late treatment can lead to heart damage, heart failure or even death," said Dr Ting.

Treatments in time of Covid-19

Despite the circuit breaker measures in Singapore, Dr Ting and Dr Pasupathy, two leading specialists at StarMed Specialist Centre, are still open for consultations, tests and immediate treatments if needed. It is vital to know if your chest pain is just a soft symptom that comes and goes, or whether you have symptoms that point towards a more sinister diagnosis.

Dr Ting shared: "We focus on quick evaluation - the patients will first be assessed and evaluated; if the suspicion (of something worse) is very high, we may decide to go for invasive procedures immediately, but most times we adopt a non-invasive approach where we can evaluate a patient with coronary heart disease without using ionising radiation from CT scans."

Dr Pasupathy added: "Further investigations include looking at blood work to check a patient's blood count, kidney and liver functions, or an endoscopy if it's a heartburn issue, which takes 15 to 20 minutes, including sedating. By and large, all of this can be done within one to two hours. It's quick."

Tests at StarMed are typically organised and carried out very quickly despite cross-disciplinary consultations and examinations, with the results coming back within the same day. No need for endless waiting to formulate the best plan for the patient moving forward.

With StarMed being an all-in-one diagnosis and treatment centre, specialists can quickly evaluate chest pains and get clarity to exclude some of its more severe causes. It is all done in a setting that is outside of a regular hospital, which reduces the risk of exposure to the coronavirus.

StarMed Specialist Centre is located at 12 Farrer Park Station Rd. 

This article is brought to you in partnership with StarMed Specialist Centre.