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Title : WATCH: Let's Talk About 'Chest Pain' by Dr. Willie T. Ong
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WATCH: Let's Talk About 'Chest Pain' by Dr. Willie T. Ong

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WATCH: Let's Talk About 'Chest Pain' by Dr. Willie T. Ong

To help diagnose the possible cause,
here is a guide using the mnemonic “PQRST”:








P – Provokes. If the pain occurs with
deep breathing, then the problem could be in the lungs. If the pain occurs with
movement of the chest, then it could just be a minor chest wall pain. However
if the pain occurs with exertion, such as after climbing a flight of stairs,
then it could be coming from the heart.






Q - Quality. Is the quality of the chest
pain pricking in character? If so, then it’s probably harmless. If it’s a
burning acidic sensation, then it could be hyper acidity. But if it’s a heaviness, like someone placed a heavy bag on your chest, then this could be heart
pain (called angina).






R - Region. Where is the pain located?
If it’s in the right side of the chest, it is usually harmless. If it’s in the
left or far left area, then it’s also probably benign. But if it’s in the
center or slightly below the rib cage, then it could be from the heart.



Another tip is to ask the person to use
one finger to point exactly where the pain is located. If the person can point
to a specific area, then this pain is NOT coming from the heart. Heart pain is
deeper, more generalized and cannot be located at one point.






S – Severity. How bad is the pain? Usually, 

the more severe the pain, the more serious it is.






T- Timing. The usual duration of pain
coming from 

the heart is between 5 to 15 minutes.






Check For Risk Factors:






If the patient
is young (below 25), looks healthy and can go about his or her daily
activities, then the chest pain is probably benign.






However, if
the patient is an older man (especially 50s and above), a smoker, and has
medical conditions (like high blood pressure, high cholesterol or diabetes),
then we should carefully investigate for heart disease.














Non-heart Causes of Chest Pain:











1.     
Harmless
chest wall pain – The cause is unclear
but may be due to anxiety and stress. No treatment is necessary, just
reassurance to the patient.






2.     
Minor
chest injury – Some people have a minor injury (like a “strain”) on the rib
cage. This can be due to exercise, unusual sleeping position or frequent
coughing. Again, no treatment is necessary.






3.     
Lung
causes such as pneumonia and asthma – Treatment is towards curing the primary
lung problem.






4.     
Gastritis
and peptic ulcer – Too much acid from the stomach can occasionally regurgitate
upwards towards the esophagus. This typically causes a burning pain at the
middle to lower chest area.
















More Serious Causes:






1.     
Coronary heart disease –Angina is the term used to
describe chest pain arising from the heart. Angina occurs when the heart muscle
lacks oxygen because of clogged arteries. If left untreated, this can lead to a
heart attack.






Initial tests
to rule out coronary heart disease include a (1) ECG, (2) 2D-Echocardiogram,
and (3) Treadmill Exercise Test for selected patients. See your doctor.



2.     
Aortic dissection – The chest pain is typically described
as severe, tearing and can be felt penetrating to the back area. Aortic
dissection is a medical emergency.








When To See A Doctor:






Based on our
description above, you should be more concerned about chest pain if (1) the symptoms
are suggestive of coronary heart disease and (2) if you have some of the risk
factors for heart disease (older age, smoker, overweight, etc.). Good luck.

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