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

I have been getting random chest pains over the last 3 months. I was an ex-smoker for 10 years who has quit smoking for 1 month. The doctor has said that my resting ECG and exercise ECG are normal. Are there any other recommended tests 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!

444 views 18 Jan 2019
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