Which tests are recommended in an ex-smoker with chest pain?

Well done indeed! Stopping smoking is the best gift you have given yourself and your family this New Year! You probably feel a better sense of smell and taste. By now more oxygen is reaching your heart and muscles easily and your immune function and circulation are getting better.

However it will still be a while before risk of heart disease drops significantly (up to 2 to 5 years) and will take longer (up to 10 to 15 years) to approach that of a non-smoker. Chest pain is of course a concern especially as you have smoked for almost a decade now and is a significant risk factor for coronary artery disease.

Essentially the lining of the blood vessels (in the heart and elsewhere) do not function normally due to ingredients in cigarette and thereby the “bad” cholesterol can enter the walls of the blood vessels leading to blockages.

The blockages can cause slowing of blood flow and when the blood flow is not able to meet the demand of the heart muscles when walking or exercising one develops chest pain or chest discomfort.

Also while you will be wheezing and coughing less in a few months it will still take some time for the lungs to be healthy and upto 10 years for the risk of lung cancer to drop significantly. In the interim you may have also developed some airway disease ( ie causing the wheeze) and this can still cause discomfort in the chest.

And as my colleague mentions checking your dentition, looking for other risk factors like Diabetes and hypertension is also important. And yes, lung function tests will be useful too. At this moment while ECG and stress test have been described as normal one has to be mindful that these tests do not exclude Coronary artery disease completely. ECG can be normal in 50% even with serious blockage of the heart and the treadmill stress test can be falsely negative in a fifth of patients with coronary artery disease.

I would suggest that the most important test you might need now is a CT coronary angiogram (non invasive) and ensure that both the lungs and coronary vessels can be imaged to exclude any significant heart or lung disease in view of your symptoms and background history available above.

An Invasive coronary angiogram can be considered if the cardiac risk is very high but to determine this you will need a full consultation. We will need to enter all your risk factors in a risk chart to see what the individual Cardiovascular risk is for yourself to determine the way forward. Good luck and I hope you continue to stay on the pathway to good health!

Thanks for your question and well done for giving up smoking! Together with excessive alcohol intake, hypertension and poor fitness, smoking is one of the biggest risk factors for health.

The only thing I would add to the excellent answers you have already received, it perhaps consider a CARDIO-PULMONARY EXERCISE TEST (CPET). This is either in the form of a cycle or running test and will essentially allow the physician who is looking after you to assess your physiology. Sometime after you have been a smoker for a while, it might be a respiratory, cardiac or muscle limitation to your capabilities and a CPET can certainly help establish where the limitations lie.

I hope this adds to what you have already found out.

BW
Dr Dinesh

Great question, and congratulations on giving up smoking! I'm sure this is a question on many smokers minds too.

First of all, chest pain should never be viewed trivially.

Do follow up closely with your doctor on what to do next for your chest pain. Even though your ECG and exercise tests are normal, there are other cardiac screening tests that he may recommend, such as:

• Angioplasty/angiogram
• Cardiac MRIs to look at blood vessels
• Echocardiograms (an ultrasound scan of your heart)
• Blood tests to rule out an on-going heart attack

A way to treat a patient with chest pain is an angiogram/angioplasty - this is an invasive test to determine if there are any significant blockages in your arteries. It involves putting a needle in your wrist, and injecting some dye into the blood vessels supplying your heart.

Significant blockage of these important blood vessels can cause chest pain, and a sudden heart attack. This remains one of the biggest killers of ex-smokers.

An angiogram is the most definitive way for a doctor to tell you that your chest pain is not likely to be of a concerning nature.

Here are some other health screening tests that your doctor may consider, given that you are an ex-smoker:

1. Lung function tests, eg. spirometry

Most doctors would request for lung function tests to check how well or poorly your lungs are performing.

These can be performed at your annual check ups, and is the best way to diagnose COPD (chronic obstructive pulmonary disease). Spirometry requires you to blow into a machine so that doctors can determine how well air flows into and out of your lungs.

When you quit smoking, your lung function will stop deterioriating. Some – but not all – of the damage will also begin to heal.

2. Chest X-ray or CT Scan

X-rays and CT scans are imaging tests that can reveal problems in your heart, lungs, or blood vessels supplying your heart.

3. Diabetes screening

Smokers are at an increased risk for Type 2 diabetes.

People who smoke less than a pack of cigarettes a day have about a 44% increased risk of developing diabetes compared to nonsmokers, according to a 2007 Swiss study published in the JAMA.

Diabetes tests include:

• Fasting blood glucose level, which measures blood sugar when you haven’t eaten in 8 hours
• Oral glucose tolerance, which measures blood sugar levels 2 hours after you drink a sugary liquid
• Hemoglobin A1c (HbA1c), which shows average blood glucose levels over 3 months

4. Dental check-ups

Smokers are more likely to suffer from tooth loss; however, your risk reduces within 10 years of quitting.

Because mouth and throat cancers are also associated with cigarette use, ex-smokers should see their dentist at least 2 x a year for checkups.

5. Vitamin D blood test

Cigarette smoking can also result in bone loss and a higher risk of leg and hip fractures.

Regular exercise and sufficient calcium and Vitamin D levels can reduce these risks.

Advice to improve your health after quitting smoking

Paying extra attention to other heart disease risk factors can help to prevent problems down the road.

This includes:

• Improving your blood pressure
• Improving cholesterol levels, and
• Controlling blood sugar levels
• Lowering saturated fat in your diet
• Exercising regularly and losing excess weight

Hope this helps!

Great question, and congratulations on giving up smoking! I'm sure this is a question on many smokers minds too.

First of all, chest pain should never be viewed trivially.

Do follow up closely with your doctor on what to do next for your chest pain. Even though your ECG and exercise tests are normal, there are other cardiac screening tests that he may recommend, such as:

• Angioplasty/angiogram
• Cardiac MRIs to look at blood vessels
• Echocardiograms (an ultrasound scan of your heart)
• Blood tests to rule out an on-going heart attack

A way to treat a patient with chest pain is an angiogram/angioplasty - this is an invasive test to determine if there are any significant blockages in your arteries. It involves putting a needle in your wrist, and injecting some dye into the blood vessels supplying your heart.

Significant blockage of these important blood vessels can cause chest pain, and a sudden heart attack. This remains one of the biggest killers of ex-smokers.

An angiogram is the most definitive way for a doctor to tell you that your chest pain is not likely to be of a concerning nature.

Here are some other health screening tests that your doctor may consider, given that you are an ex-smoker:

1. Lung function tests, eg. spirometry

Most doctors would request for lung function tests to check how well or poorly your lungs are performing.

These can be performed at your annual check ups, and is the best way to diagnose COPD (chronic obstructive pulmonary disease). Spirometry requires you to blow into a machine so that doctors can determine how well air flows into and out of your lungs.

When you quit smoking, your lung function will stop deterioriating. Some – but not all – of the damage will also begin to heal.

2. Chest X-ray or CT Scan

X-rays and CT scans are imaging tests that can reveal problems in your heart, lungs, or blood vessels supplying your heart.

3. Diabetes screening

Smokers are at an increased risk for Type 2 diabetes.

People who smoke less than a pack of cigarettes a day have about a 44% increased risk of developing diabetes compared to nonsmokers, according to a 2007 Swiss study published in the JAMA.

Diabetes tests include:

• Fasting blood glucose level, which measures blood sugar when you haven’t eaten in 8 hours
• Oral glucose tolerance, which measures blood sugar levels 2 hours after you drink a sugary liquid
• Hemoglobin A1c (HbA1c), which shows average blood glucose levels over 3 months

4. Dental check-ups

Smokers are more likely to suffer from tooth loss; however, your risk reduces within 10 years of quitting.

Because mouth and throat cancers are also associated with cigarette use, ex-smokers should see their dentist at least 2 x a year for checkups.

5. Vitamin D blood test

Cigarette smoking can also result in bone loss and a higher risk of leg and hip fractures.

Regular exercise and sufficient calcium and Vitamin D levels can reduce these risks.

Advice to improve your health after quitting smoking

Paying extra attention to other heart disease risk factors can help to prevent problems down the road.

This includes:

• Improving your blood pressure
• Improving cholesterol levels, and
• Controlling blood sugar levels
• Lowering saturated fat in your diet
• Exercising regularly and losing excess weight

Hope this helps!