HEALTH MATTERS: A look at exercise-induced chest tightness, what it meansDr. Wynne answers the question: Our teenage son who is active in sports has been complaining of chest tightness when he exercises. I’m worried about my son. What are your thoughts?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. Our teenage son who is active in sports has been complaining of chest tightness when he exercises. My father also complained of chest tightness for several days before he suffered a heart attack, although he is doing fine after he had a stent inserted. I’m worried about my son. What are your thoughts?
A. You are quite right that exercise-induced chest tightness is a symptom that warrants further evaluation, although I’ll bet that your son’s symptoms are not because of a blockage of an artery going to the heart muscle (as happened with your father).
First, regarding your father — blockages of the arteries going to the heart typically cause symptoms when the heart needs a lot of blood supply to furnish it with needed oxygen and nutrients, such as during exercise. The associated discomfort typically is described as a pressure-type feeling. Thus, exercise-induced chest tightness in an adult certainly suggests a blockage. But an otherwise healthy teenager is quite unlikely to have major blockages — he’s just too young. So the chest tightness likely is caused by something else.
By far the most common cause that we see in teenagers is exercise-induced asthma (see my answer above) that can produce symptoms similar to a blockage. But having him evaluated is important, because in rare cases we see other more serious problems (such as an abnormal origin of one of the coronary arteries caused by a congenital malformation).
One of the more useful tests in evaluating this situation is called a cardiopulmonary exercise test, where we can demonstrate exercise-induced asthma. Another test that we sometimes do is an echocardiogram or cardiac ultrasound to visualize the origins of the coronary arteries. But bring your son in so a precise diagnosis can be established, and your concerns put to rest.
Q. Our 20-month-old granddaughter had a cold and then developed difficulty breathing. The doctor heard wheezes in her chest and prescribed medication and breathing treatments. She is better now, but we wonder — does she have asthma?
A. It is impossible to tell. We don’t diagnose asthma after a single episode of wheezing, since many other conditions can cause wheezing besides asthma. One particular type of viral infection (respiratory syncytial virus or RSV) is a common cause of lung infection and wheezing in children. Asthma, on the other hand, is a chronic condition marked by recurrent episodes of inflammation and narrowing of the smaller breathing tubes, called bronchioles, in the lungs.
While the treatment of the wheezing is the same, treatment of the underlying condition may differ. One big problem in diagnosis is that viral infections can trigger wheezing in children whether or not there is an underlying asthma condition. Thus, in the case of your granddaughter, time will tell — hopefully, the wheezing was just caused by a viral infection and won’t recur. But if she has recurrent episodes of wheezing, then asthma as the underlying cause becomes more likely.
Because small children aren’t able to cooperate with the breathing test that typically is used in the diagnosis and management of asthma, diagnosis may have to wait until she is 6 years of age or so. But whether her wheezing is because of a virus or underlying asthma, we have a variety of generally effective treatments available.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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