Chest pain

Chest pain is one of the symptoms we take most seriously at Asian Hospital. The reason is simple: a heart attack does not announce itself with classic textbook symptoms in everyone. Sometimes it presents as "just acidity" or "just a pulled muscle" — until it isn't. We would rather see 10 patients with anxiety chest pain than miss the one with an MI.

What causes chest pain

Common causes, in rough order of seriousness:

• Heart-related — angina, heart attack (MI), pericarditis. Usually pressure-type or squeezing pain, often with sweating, breathlessness, jaw/arm radiation.
• Lung-related — pneumonia, pulmonary embolism, pleurisy. Usually sharper, worse on deep breathing, may come with fever or breathlessness.
• Digestive — acid reflux, gastritis, oesophageal spasm. Often burning, related to meals, may come with belching.
• Musculoskeletal — costochondritis, muscle strain. Reproducible by pressing on the chest wall.
• Anxiety-related — panic attacks. Often tightness with tingling around the mouth or fingers.

A doctor's job is to figure out which one — and they do it with a combination of history, ECG, blood tests (troponin), and sometimes ECHO or imaging.

What to expect at our OPD / casualty

For new chest pain, our standard workup is: ECG in the first 10 minutes, vital signs check, history + examination, then troponin if the picture is at all suggestive of MI. The decision tree from there is well-defined and we follow it tightly — door-to-balloon time in MI cases is the single number our cardiac team obsesses about.