Chest Practices

Tightness, pain and lumps in your chest could be signs of heart- or breast-related problems.

When should you be worried about chest pain? Is it a heart issue, or an unknown breast condition? As chest pain is a common symptom experienced by women, it is important to know how to take preventive measures and when to seek emergency help.

What are the features of heart-related chest pain?

1) Tightness, or a pressure discomfort; 2) Pain at the front of the chest (sternum) or upper middle abdomen (epigastric), especially if it radiates or travels to the front of the neck, under the chin or jaw, to the shoulders or to the side of the arms; 3) If the discomfort is triggered or worsens with physical or emotional stress.

Women also tend to have more subtle and atypical symptoms that include inexplicable breathlessness, unexplained weakness or fatigue, and cold sweat and/or nausea.

What risk factors increase the likelihood of the chest pain being heart-related?

Although heart disease can happen at any age, classic risk factors include diabetes mellitus, hypertension, high cholesterol and a family history of early onset heart disease. Like men, common causes of heart disease include coronary artery disease, chronic uncontrolled hypertension and valve disease. Common risk factors for coronary artery disease and hypertension include smoking, a sedentary lifestyle, and an unhealthy diet that includes excess sugars, carbohydrates, salt, and trans fats.

Interestingly, women are more likely to suffer from stress cardiomyopathy, also known as Takotsubo or Broken Heart syndrome, which is triggered by emotional or physical stress. Post-menopausal women are more prone to developing heart disease, as well as women who started menstruating before 10, or after 17 years of age. Women with polycystic ovarian syndrome are also at a higher risk. Pregnant women with gestational hypertension, gestational diabetes, and preterm delivery (before 37 weeks) also fall within this group. Breast cancer therapy (chemotherapy and radiation treatment) can also damage the heart and should be considered a risk factor for heart disease.

When should I seek urgent care?

Newly onset chest pain should be reviewed by your cardiologist. More urgent review is required if the symptoms are more frequent, occur suddenly, are severe, or occur at rest or with minimal effort. If there is cold sweat, nausea or unusual fatigue that accompanies the pain, then get an emergency review at the nearest A&E.

If the person has risk factor(s) for heart disease, the threshold for a review by the cardiologist should be lower as they should see one as soon as symptoms appear.

How do I reduce my risk of developing a heart condition?

Increase your physical activity and adopt a healthy diet. Reduce your intake of sugar, carbohydrates, salt and trans fats, while increasing your intake of fresh foods, vegetables and other foods rich in dietary fibre would help reduce your heart disease risk.

What causes breast pain and how you differentiate it from heart-related chest pain?

Some women are aware of breast discomfort during their menstrual cycles. This is cyclical pain from hormonal changes, and is considered normal.

Another common, but unrecognised problem is simply that your bra is poorly fitted, leading to poor breast support. When the bra is too tight, the pain is felt under the bust, or over the shoulder straps. When the bra is too loose, the weight of the breasts will cause a pulling pain in the upper outer parts of the breasts.

It may also be due to a skin infection, muscle ache, or, referred pain from another area (e.g. heart, bones of the spine/shoulder/rib cage).

Breast pain is almost never due to breast cancer, as it is not the cancer that causes the pain. However, if you experience pain in the left breast/chest area and are unsure of the origin, it is safe to touch, examine the breast, and massage it to check if there are any lumps.

If I find a lump in my breast, should I be concerned?

Most breast lumps are benign, and may be due to hormonal changes (fibrocystic changes), or other conditions such as fibroadenomas, cysts, lipomas, angiomyolipomoas, etc. Only a mammogram and a follow-up biopsy can confirm whether or not the lump is truly benign.

Early breast cancer usually does not have any symptoms. However, if you experience any of the following symptoms, you should see a specialist early for further evaluation:

  • Painless lump;
  • Unusual nipple discharge (e.g. bloody/greenish/yellowish fluid; not milk);
  • Retracted nipple;
  • Persistent rash around the nipple;
  • Dimpled/puckered skin;
  • Swollen/thickened skin.

What if the lump is nearer the armpit region?

Several conditions may cause a lump in the armpit. It could be accessory breast tissue (normal variant of extra breast tissue), lymph node enlargement, or even skin conditions such as a lipoma (fat lump) or a sebaceous cyst (oil cyst). Of course, only a specialist can confirm or allay your fears.

How often should I get a mammogram?

For most women, yearly screening is recommended for those aged 50 and above. If you are at a higher risk, yearly screening may start as early as 40 years old. This is the best way to detect early breast cancer, whether or not there are any symptoms. Some specialists will recommend a supplementary ultrasound as well. There may be some discomfort but it is important for the breast tissue to be compressed for a clearer image.

 

This article is co-authored by Dr Gerard Leong, Medical Director and Senior Consultant Cardiologist at Gerard Leong Cardiology Clinic, and Dr Tan Yia Swam, Clinical Director and Consultant Surgeon at Thomson Breast Centre.