Understanding Cardiovascular Disease and How to Respond

Dr Lam Chiu Wah (Cardiology)

When you suddenly experience chest pain, or feel as though a heavy stone is pressing on your chest, it is natural to panic and wonder: "Could this be a heart attack, or is it another condition?" Amid the stress and fast pace of modern life, cardiovascular disease is increasingly affecting younger people. However, chest discomfort can have many causes, including acid reflux. From a medical perspective, this article explains the characteristics of different types of chest pain and the correct way to respond in an emergency, helping you protect your cardiovascular health through early recognition and action.

Why Does Chest Pain Occur? Understanding Its Link to Cardiovascular Disease
The heart is like the body’s engine, while the coronary arteries act as dedicated fuel lines that deliver blood and oxygen to the heart muscle. Over time, a high-fat diet, lack of exercise and ageing can cause low-density lipoprotein (LDL) cholesterol and fatty deposits to accumulate on the inner walls of the arteries, forming plaques. This process gradually narrows the arteries and is medically known as coronary atherosclerosis—commonly described as blocked arteries.

When an artery narrows by more than 50%, or even 70%, blood flow to the heart can be significantly reduced. A person may not notice any obvious symptoms at rest. However, during vigorous exercise, emotional stress or heavy lifting, the heart needs more oxygen. If the supply cannot meet this increased demand, the heart muscle becomes ischaemic, causing chest pain known as angina. If a plaque suddenly ruptures and a blood clot forms, completely blocking the artery, it can cause a severe acute myocardial infarction (heart attack), which may be life-threatening.

How Can You Tell Different Types of Chest Pain Apart? Warning Signs Based on Location and Sensation
Not all chest pain is related to blocked arteries. Acid reflux, muscle strain and nerve pain can also cause chest discomfort. The location and nature of the pain, together with its triggers, can help provide an initial indication of the possible cause. The table below compares the common characteristics of chest discomfort:

Feature	Chest pain caused by blocked coronary arteries (angina/heart attack)	Chest pain caused by non-cardiac conditions (e.g. digestive or muscular problems)
Location of pain	Usually centred in the middle or left side of the chest; the pain may spread to other areas (referred pain)	May occur on the right side, either side of the chest or in the upper abdomen; the pain is usually localised
Where the pain may spread	Inner left arm, shoulder, neck, jaw or back	Usually does not spread
Nature of pain	Pressure, heaviness as though a large stone is pressing on the chest, tightness, or a choking sensation	Sharp pain, a burning sensation (acid reflux) or pulling pain
Triggers and aggravating factors	Worsens during exercise or emotional stress; may improve with rest or sublingual nitroglycerin	Worsens when a particular area is pressed, during deep breathing or coughing, or when lying down after a meal

However, many people with heart disease do not experience obvious or typical symptoms. If in doubt, seek medical attention promptly.

Recognise Life-threatening Warning Signs: Symptoms of an Acute Heart Attack
If your chest pain involves intense pressure and is accompanied by any of the following symptoms, seek emergency medical assistance immediately. Do not delay:

Sudden, profuse cold sweats
Severe shortness of breath or breathlessness
An irregular, abnormally fast or abnormally slow heartbeat
Dizziness, dimming vision or even a brief loss of consciousness
Severe nausea and vomiting

What to Do About Sudden Chest Pain and Recommended Examinations
If you experience severe chest pain of unknown cause, the first priority is to remain calm. Do not force yourself to continue any activity. Sit or lie down and rest immediately. If you have been diagnosed with coronary heart disease and have doctor-prescribed nitroglycerin for sublingual use, take it immediately as directed. If the pain does not improve with rest and medication, call an ambulance at once.

Professional Cardiac Examinations: Prevention Through Early Detection
Symptoms alone cannot reliably determine whether an artery is blocked. A cardiologist may recommend the following examinations to establish an accurate diagnosis:

Resting and exercise electrocardiogram (ECG): Provides an initial assessment of the heart’s electrical conduction system and signs of myocardial ischaemia during exercise.
Echocardiogram: Examines the structure of the heart, the opening and closing of the heart valves, and the heart’s pumping function.
CT coronary angiogram: A non-invasive examination that accurately assesses calcification and narrowing in the coronary arteries.
Cardiac catheterisation: A catheter is inserted through the wrist or groin and guided to the heart to directly assess blocked arteries. If necessary, coronary angioplasty can be performed during the same procedure.

Conclusion: Safeguard Your Heart Health
Chest pain should never be ignored, as it may be the body’s warning signal. Early detection and management of blocked arteries can help reduce the risk of death from acute cardiovascular events. In addition to maintaining a balanced diet, exercising regularly, and quitting smoking, regular and targeted heart health examinations are an important part of protecting cardiovascular health.

Frequently Asked Questions (FAQ)

If I frequently experience chest pain, does it necessarily mean I have heart disease?
Not necessarily. Although heart disease is an important consideration, indigestion, acid reflux, muscle strain, costochondritis and even anxiety can all cause chest pain. However, as a precaution, if the pain recurs or is accompanied by a feeling of pressure, consult a doctor promptly to rule out the risk of blocked coronary arteries.
Can younger people also develop blocked arteries?
Yes. In recent years, cardiovascular disease has increasingly affected younger people. A high-fat, high-sodium diet, lack of exercise, work-related stress and smoking can all accelerate vascular ageing. People in their 30s and 40s who have a family history of cardiovascular disease or the "three highs"—high blood pressure, high blood glucose and high cholesterol—are also at increased risk.
What does it feel like when people describe chest pain as "a heavy stone pressing on the chest"?
This is a typical symptom of myocardial ischaemia or angina. A person is usually unable to identify a single point of pain. Instead, they may experience widespread dull pain, heaviness, tightness, or a choking sensation in the centre or left side of the chest, as though a heavy stone were pressing on the chest and making it difficult to breathe.
If I suspect a heart problem, which examination should I have first?
A clinic or hospital will generally begin with a basic electrocardiogram (either a resting or exercise ECG) and blood tests, such as cardiac enzyme and cholesterol tests. If the initial assessment indicates a higher risk, the doctor may arrange an echocardiogram or a cardiac CT scan to further assess and confirm whether the arteries are narrowed or blocked.
If an artery is only mildly narrowed, can the condition be reversed?
Severe arterial calcification or established plaques generally cannot be completely reversed naturally. However, if the condition is detected early—for example, when narrowing is mild—strict lifestyle changes, including quitting smoking, following a low-fat diet, and exercising, together with doctor-prescribed medication such as cholesterol-lowering and antiplatelet medicines, can help control plaque progression and reduce the likelihood of surgery being required.