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When Should A 37-year-old Male Worry About Chest Tightness?
Question: when should a 37 year old male worry about chest tightness? He said it has been tight all day. He tried Tums, walking around, lying down, BP was 142/97 and heart rate 118 at a Walmart Pharmacy. He is otherwise healthy but has had spleen removed due to cyst. No nausea, no headache, no arm pain, jno jaw pain
He is probably under a bit of stress due to grad school, wedding plans, job hunting
He is probably under a bit of stress due to grad school, wedding plans, job hunting
Brief Answer:
he should worry at all times
Detailed Answer:
Hello,
chest tightness can be caused by both mild and serious diseases. Anxiety is - as you've mentioned - a common cause of chest tightness. Anxiety does not cause any immediate consequences though. Heart related chest tightness is a very serious symptom that cannot be excluded on the ground that a patient was under psychological stress. Complete assessment of the patient is required to exclude it as a misdiagnosis may even cost the patient's life.
The doctor should try to assess the risk for a cardiovascular event by evaluating the symptoms, the patient's risk depending on elements of his medical history and order the right tests to exclude it. Chest tightness on the centre of the chest with nausea and/or vomiting, radiating to the jaw, left shoulder, arm, sometimes the fingers, the back, etc and associated with cold sweats and perhaps symptoms of faintness, palpitations, etc are all symptoms of an acute coronary event. Worsening with physical activity is very much in favor of a heart attack. Chest discomfort that moves around or comes and go within a few seconds or other atypical symptoms are against an acute coronary event. A patient who smokes, is overweight or obese, has a sedentary lifestyle, unfavorable lipid profile or has other aggravating factors like diabetes mellitus, hypertension, etc is a first class candidate for an acute coronary event and that has to be seriously taken into account on the occasion of every chest symptom.
An ECG is not sufficient to exclude a heart attack. Heart enzymes (troponin mostly) is when taken a few hours after the suspected cardiovascular event (6 hours are enough).
No response to to tums probably (but not definitely) means that the symptoms have not been caused by an acid-related gastrointestinal disorder.
Other potential causes include a multitude of diseases that wouldn't make much sense to list here (like pericarditis, chest-wall disorders due to injury, viral or inflammatory disorders, etc). Clinical examination, some basic tests and the patient's history should be sufficient to exclude them.
So in conclusion, chest tightness is always worrisome unless the patient has an established history of anxiety-related disorders and the symptoms are very well-known to him. Otherwise thorough investigation is required.
I hope you find my comments helpful!
Please let me know if you need more information or any clarification.
Kind Regards!
he should worry at all times
Detailed Answer:
Hello,
chest tightness can be caused by both mild and serious diseases. Anxiety is - as you've mentioned - a common cause of chest tightness. Anxiety does not cause any immediate consequences though. Heart related chest tightness is a very serious symptom that cannot be excluded on the ground that a patient was under psychological stress. Complete assessment of the patient is required to exclude it as a misdiagnosis may even cost the patient's life.
The doctor should try to assess the risk for a cardiovascular event by evaluating the symptoms, the patient's risk depending on elements of his medical history and order the right tests to exclude it. Chest tightness on the centre of the chest with nausea and/or vomiting, radiating to the jaw, left shoulder, arm, sometimes the fingers, the back, etc and associated with cold sweats and perhaps symptoms of faintness, palpitations, etc are all symptoms of an acute coronary event. Worsening with physical activity is very much in favor of a heart attack. Chest discomfort that moves around or comes and go within a few seconds or other atypical symptoms are against an acute coronary event. A patient who smokes, is overweight or obese, has a sedentary lifestyle, unfavorable lipid profile or has other aggravating factors like diabetes mellitus, hypertension, etc is a first class candidate for an acute coronary event and that has to be seriously taken into account on the occasion of every chest symptom.
An ECG is not sufficient to exclude a heart attack. Heart enzymes (troponin mostly) is when taken a few hours after the suspected cardiovascular event (6 hours are enough).
No response to to tums probably (but not definitely) means that the symptoms have not been caused by an acid-related gastrointestinal disorder.
Other potential causes include a multitude of diseases that wouldn't make much sense to list here (like pericarditis, chest-wall disorders due to injury, viral or inflammatory disorders, etc). Clinical examination, some basic tests and the patient's history should be sufficient to exclude them.
So in conclusion, chest tightness is always worrisome unless the patient has an established history of anxiety-related disorders and the symptoms are very well-known to him. Otherwise thorough investigation is required.
I hope you find my comments helpful!
Please let me know if you need more information or any clarification.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
is there a need to consider that he does not have a spleen?
Brief Answer:
No
Detailed Answer:
No. The spleen removal may predispose him to certain types of infections but that's all there is to it. Investigation for the tightness s still required.
Kind Regards!
No
Detailed Answer:
No. The spleen removal may predispose him to certain types of infections but that's all there is to it. Investigation for the tightness s still required.
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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