Heart disease in young people
Living life in the fast lane is nothing new. There is always a temptation to take short cuts when it comes to our health. Many people eat the wrong type of food at the wrong times, drink too much and fail to get enough exercise.
Add to the fact that modern lifestyles encourage people to work long, often unsociable hours, and it's easy to see why even young, seemingly healthy individuals end up suffering chest pains. The stress-filled, non-stop environment that is Hong Kong makes it a prime location for such problems.
While chest pains in the young are very rarely related to heart issues it is vitally important that the first warning sign is taken seriously. After all it's far better to be safe than sorry and if there is an underlying problem your doctor should be able to alert you to the potential dangers ahead and help you prevent it from becoming a serious issue.
Chest pains in young people are far more likely to be connected to issues relating to muscles, bones and cartilage, nerves or the lungs. Still we need to rule out a heart problem, as coronary heart disease patients are getting younger, due mainly to a Western diet, stress, and sedentary lifestyles.
Looking at a case history highlights one of the problems faced by young executives striving to be a success in the competitive corporate world. Mr Yeung (not his real name) is a young banker working in an investment bank. He works more than 12 hours a day, and has no time for exercise.
One day after a big fight with his girlfriend over the issue of whether they should get married, he suffered very bad chest pains which took away his breath. He passed out in front of his distraught girlfriend.
After being rushed to hospital in an ambulance, an ECG was done which showed a change of acute myocardial infarction.
An urgent echocardiogram showed poor contraction over some parts of his heart muscle with increased heart chamber size. Blood tests showed the presence of elevated cardiac enzymes.
He was moved into a cardiac catheterisation laboratory to look for coronary artery problems, which may have required intervention. But Yeung's angiogram turned out to be perfectly normal.
So what caused the attack?
Yeung was found to be suffering from "takotsubo disease", also known as "broken heart syndrome". Doctors also refer to it as "apical ballooning syndrome" or "stress cardiomyopathy". The disease, which can mimic a heart attack, may be caused by the heart's reaction to a surge of stress hormones.
Although it's an uncommon condition, it usually happens in patients such as Yeung - young and in good health - who present symptoms that resemble acute myocardial infarction. Except there's no blockage of the coronary artery.
The symptoms of broken heart syndrome are treatable, and the condition usually reverses itself. The first instances of this syndrome were in Japan. It is usually triggered by significant emotional or physical distress. The name takotsubo was given after the shape of heart showed ballooning in one of the heart chambers, resembling the bottle used for catching an octopus.
While the underlying cause is not clear, a stress-induced catecholamine surge is generally involved, and is thought to be a contributing factor.
While more than 95 per cent of patients make a complete recovery, the ongoing treatment for patients would normally involve supportive medicine to improve the heart function and prevent complications.
As for Yeung, he made a full medical recovery after four weeks with normal ECG and echocardiogram results.
The story has a happy ending as his relationship with his girlfriend blossomed as he recovered, and they are planning to get married later this year.
Dr Anders Leung is a Hong Kong-based specialist in cardiology