QUESTION: I am writing on behalf of my husband as he is too lazy to do so. He is 38 and was diagnosed with hypertension two years ago. He was prescribed medication and was told to exercise and lose some weight. A few months ago, he stopped exercising and taking the meds.
He has also gained some weight and continues to smoke despite trying to stop with me last year.
I have changed our diet, yet he still comes home with his car full of take-away boxes. He is a car salesman and is under tremendous stress at work. We have three young children and seldom take holidays any more.
For some time now I have noticed that my husband suffers from chest pain. He always denies it is anything serious and it passes spontaneously. On occasion, I have found him taking a deep breath and holding his hand over his chest, but as soon as he sees me he makes light of it.
Just last week, while we were in the mall, he said he had some discomfort in the mid-chest area. He sat down for a few minutes and it went away. He said it was probably indigestion, but my concern is growing as these episodes seem to be occurring more regularly.
First, should I be concerned? How do I know when the chest pain is serious enough to take him to hospital? Is there anything else I can do?
I lost my younger brother at the age of 46 due to a heart attack and I don’t want to lose my husband too.
ANSWER: Your concerns are warranted and you make some serious and valid points. First, I do think it is time your husband takes responsibility for his own well being. The decision to look after one’s self and be proactive about health issues is a huge responsibility. Fathers often don’t consider the anxiety that surrounds a spouse who is left behind with children to care for.
Chest pain requires a detailed medical history and a clinical examination by a doctor. There are subtle hints in each individual’s account that guide our investigations and possible diagnosis.
Types of pain
Chest problems range from minimal discomfort to crushing pain. Words used to differentiate are: a pressurised feeling on the chest, a sharp stabbing pain at rest or with movement and even a tight band wrapped around the chest. Clinicians are taught to distinguish between these types of pain with careful assessment and a very detailed history.
Origin of pain
The origins of chest pain are multiple, with different key features. The character of the pain is useful: dull ache, sharp ice-pick pain, burning pain, a throbbing or simply something just “doesn’t feel right” kind of pain. These descriptions help in deciding if the pain comes from nerve or muscle, or even organs. The best description of angina pectoris, commonly angina, remains the one of “an elephant sitting on your chest”.
Cause of atypical chest pain:
* Pulmonary embolus: blockage of the main artery of the lung or one of its branches.
* Pneumonia or pleuritis: inflammation of the lining surrounding the lungs.
* Oesophagus spasm: irregular, unco-ordinated and sometimes powerful contractions of the oesophagus.
* Gastritis and reflux disease.
* Disc lesions of the spine.
* Arthritis.
* Costochondritis: inflammation of the rib cartilage joints.
Warning signs of heart-related chest pain
This usually starts with a heavy compression sensation over the central chest area which can radiate typically into the left jaw and into the left arm.
This pain is often worsened by exercise or exertion.
The accompanying symptoms that add to the urgency of evaluation are sweating, pallor, nausea and vomiting with cold and clammy hands and feet.
Message for chest pain sufferers
* Don’t ignore the pain – it tells you something.
* Commit to checking your vitals and going for an assessment.
* A stress ECG is useful in screening for patients at risk of angina or early ECG signs of blocked or narrowed coronary arteries.
* The work-up for atypical chest pain should include a stress ECG, gastroscopy and a chest X-Ray.
* Remember that diabetics can have massive heart attacks with minimal pain.
* The blood test done for heart muscle damage should be repeated within six to eight hours, even if the initial test was negative.
What to do in an emergency
If the pain is of sudden onset with features of diaphoresis (the person is cold, clammy and pale):
* Alert an emergency response and call an ambulance.
* Give 300mg of aspirin immediately.
* Help the person to a safe resting position.
*l If it is a known cardiac patient, ask if they have emergency medication or Nitrolingual (a pump spray used to help the heart work more easily).
* Monitor blood pressure and pulse, if possible.
* Ask for anyone who knows CPR.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus