Good evening, Doc. My name is Irvan, and I am 30 years old. In 2013, I did a check up at Adventist Penang Hospital. I was diagnosed with secundum ASD (Atrial Septal Defect), with a 2.4cm hole. In 2018 I did another check up in Penang and the hole got bigger, at 2.8cm. That time I didn’t feel anything. But, this week I have been feeling my breath is tight. I plan to undergo surgery. Is my tightness of breath due to my ASD? What should I prepare for my surgery? I want to undergo this surgery in Singapore or KL. I am afraid, Doctor, because this is related to my heart. I want to ask for your input, what should I prepare for this surgery? Is this kind of surgery dangerous? Please give me information, Doctor. Thank you
The size of the ASD hole is considered to be large, hence there is a lot of shunting of blood. The right ventricle or the right side of your heart is also noticed to be enlarged. Your tightness of breath may be due to the ASD. As you are a young patient, there is nothing much to prepare for the surgery.
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Doctor, my mother is 69 years old and she has pneumonia. I want to ask, how dangerous is this condition? Can it be cured? What is the best treatment for it?
Pneumonia is an infection of the lung and can be caused by different types of organisms such as viral, bacterial or even fungal. Older people have a higher risk of getting pneumonia. Antibiotics can be very effective for many types of bacteria that cause pneumonia and most patients will recovery. However, patients who have multiple medical problems with pneumonia, can sometimes be admitted to ICU for treatment of pneumonia and this puts them at higher risk of death. With the current COVID pandemic, it will also be good to have a COVID test to exclude it as a cause of pneumonia.
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Doctor, it has been around 1 month. I feel my chest is tight and I find it hard to breathe. Sometimes my heart beats fast. Usually it happens at night before I go to sleep. What is the likely cause? Is this a heart problem?
If you feel chest tightness with difficulty breathing and sometimes your heart beats fast, it may be a signal from your heart telling you that something is wrong with the heart. This is especially so if the discomfort is associated with exertion and climbing stairs. Your symptoms are fairly classical for patients with coronary artery disease (CAD), though other issues such as valvular heart disease can also cause similar symptoms. It will be best for you to seek medical advice fairly soon.
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When I breathe normally, it doesn’t hurt, but when I take a deep breath, I feel something stabbing my heart. Why is this so, Doc?
Chest pain is a non-specific symptom. Not all patients with chest pain have heart disease and not all heart disease will present with chest pain. Interestingly men and women can present with different symptoms when they have heart disease. Men can present with chest pain accompanied by shortness of breath or even sweating. However women tend to present with nausea, heart burn like feeling and cold sweat or unusual tiredness.
Other causes of chest pain can be due to Musculo-skeletal exertion, especially after carrying heavy weights, lung infection (pneumonia), pneumothorax or even a fracture. If you have chest pain accompanied by other symptoms such as shortness of breath, sweating or discomfort in arms, please seek medical help.
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My father was hospitalized once because the doctor said there is mucus in his lungs - it is likely due to his smoking habit. Two days ago, he suddenly complained about pain in his chest. But then, it recovered by itself. I am worried it will happen again. Is this a heart attack? What examination should he undergo?
Your father has risk factors of age and smoking. As you have rightly mentioned, it will be good that he seek medical help to rule out any heart diseases that can cause pain in his chest. Typically an ECG and a CXR will have to be done to look out for any enlarged heart and to rule out other causes of chest pain. Depending on the cardiologist, he may order a CT coronary angiogram or put your father on a stress test such as a treadmill.
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Doctor, I feel chest pain everyday. Also, I feel like there is some dirt in my chest that causes me to dry cough everyday. What condition is this?
If you feel chest pain daily, it is better that you seek the local medical help. Your chest pain may be due to your chronic dry cough or it may be something else happening in the lungs.
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Doctor, my child often cries and complains about pain in his chest. 10 minutes later, the pain is relieved. This happens quite often. What condition is this?
While we all think that chest pain can be an issue related to the heart, it can also be due to conditions or diseases affecting the respiratory system, the muscles, bones and the gut.
Chest pain in children is very different compared to the adults. Less than 2 percent of chest pain in children is related to heart conditions. The heart conditions to look out for are congenital anomalies of the heart or its blood vessels.
Respiratory conditions such as an infection or asthma can also cause a sudden onset of chest discomfort. There is also a need to exclude trauma such as an accident or collision with friends while playing as a cause of pain in the chest.
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Doctor, my child has suffered from excessive coughing for years. We took her to a doctor to examine her lungs, but the doctor said there was no problem. Sometimes she coughs so hard until she vomits. What should I do?
Many conditions can result in coughing as a symptom. It can be due to respiratory infection, asthma, stomach acid reflux or congenital malformation of structures of the airway or lungs. Sometimes it can also be environmental if it is polluted or she is around family members who smoke a lot.
It is not usual for a child to have excessive coughing for years. I will look out for any production of phlegm, colour of the phlegm, fever, wheezing sound when the child breaths or any difficulty with breathing. If this persists, your child may have to consult a specialist and have more detailed investigations such as a CT scan of her chest.
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Doc, can coronary heart disease be permanently cured or will the patient have to be dependent on certain medications or treatment all his life?
Coronary artery disease can be controlled and slowed down by treating the modifiable risk factors. The major modifiable risk factors for the development of coronary artery disease are: control of hypertension, diabetes mellitus and high cholesterol. There is also a need to reduce cigarette smoking.
The minor modifiable risk factors include weight control, lifestyle changes with regular exercises and controlling the stress we experience in life.
Unfortunately coronary artery disease cannot be permanently cured, just like having hypertension and diabetes mellitus. But with a more disciplined lifestyle, it may be prevented or the progression can be controlled.
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Doctor, I feel a burning sensation now in my chest everytime I smoke. I have been smoking for almost 25 years now. Honestly I am worried about cancer. But so far as I know the symptom of cancer is coughing. I don’t cough. I just feel something hot in my chest. What condition is this?
Smoking causes different types of cancer. As shown in the attached poster from CDC (Centers for Disease Control and Prevention), US, smoking is associated with cancers throughout the body. Not all these cancers will present with symptoms of coughing. If you feel that whenever you smoke and there is a burning sensation in your chest and this is out of the ordinary, then it may be a good idea for you to have your body checked out.