My chest hurts when I walk fast. 30 years old

As people's health awareness increases, more and more people are exercising by running or brisk walking every morning. However, some people can run five kilometers a day without any problem, while others feel chest pain when they walk fast. A 30-year-old's heart feels like a 60-year-old. This situation should be taken seriously. As the pace of life quickens, heart aging caused by lack of exercise has become common and may even induce heart disease.

Rheumatic heart disease, also known as RHD, refers to heart valve disease caused by rheumatic fever activity affecting the heart valves. It manifests as stenosis and/or insufficiency of one or more valves in the mitral valve, tricuspid valve, and aortic valve. Clinically, stenosis or insufficiency often exist at the same time, but one of them is usually predominant. There are often no obvious symptoms in the early stages of the disease, but in the later stages, there are manifestations of heart decompensation such as palpitations, shortness of breath, fatigue, cough, lower limb edema, and coughing up pink foamy sputum.

Clinical manifestations

Due to lesions in the heart valves, the heart may have problems transporting blood. For example, valve stenosis increases the resistance to blood flow. In order to pump out enough blood, the heart has to work harder to dilate and contract. This increases the intensity of the heart's work, reduces its efficiency, and makes the heart easily fatigued, which can eventually lead to cardiac hypertrophy. For example, when the mitral valve stenosis reaches a certain degree, the left atrial pressure increases, leading to increased pressure in the pulmonary veins and pulmonary capillaries, resulting in pulmonary congestion. Pulmonary congestion can easily cause the following symptoms: ① dyspnea; ② cough; ③ coughing up blood, and some people may also experience hoarseness and difficulty swallowing. Common heart valve diseases in clinical practice are as follows:

1. Mitral regurgitation

Patients with rheumatic mitral regurgitation often have only mild symptoms. Symptoms worsen when there is rheumatic activity, infective endocarditis, or chordae tendineae rupture. 75% of patients with mitral regurgitation develop atrial fibrillation, which can increase left atrium pressure. Excessive left ventricular volume is another important cause of mitral regurgitation and palpitations and shortness of breath in patients. In the later stages of the disease, there may be pulmonary edema, hemoptysis, and right heart failure.

2. Aortic stenosis

Patients with aortic valve stenosis may be asymptomatic during the compensatory period, while patients with severe stenosis of the valve orifice often experience fatigue, dyspnea (exertional or paroxysmal), angina pectoris, dizziness or syncope, and even sudden death.

(1) Angina pectoris: Angina pectoris occurs in 20% to 60% of patients, and the pain increases with age and the severity of the valve orifice. The presence of angina pectoris indicates that aortic valve stenosis is already quite serious. Angina pectoris can occur after exertion or at rest, indicating that it is not necessarily related to exertion and physical activity.

(2) Dizziness or syncope: About 30% of patients experience dizziness or syncope, which can last from as short as 1 minute to as long as more than half an hour. Some patients also have Adams-Stokes syndrome or arrhythmia. Dizziness or syncope often occurs after labor or when the body is bent forward, and sometimes is induced at rest by sudden changes in body position or sublingual nitroglycerin for the treatment of angina pectoris.

(3) Dyspnea: Exertional dyspnea is often a manifestation of heart failure, often accompanied by fatigue and paroxysmal increases in venous pressure. As heart failure worsens, paroxysmal nocturnal dyspnea, orthopnea, and coughing up pink frothy sputum may occur.

(4) Sudden death Sudden death occurs in 20% to 50% of cases. In most cases, there may be repeated angina pectoris or syncope before sudden death, but it can also be the first symptom. Its occurrence may be related to serious and fatal arrhythmias, such as ventricular fibrillation.

(5) Excessive sweating and palpitations. These patients sweat a lot. Due to increased myocardial contraction and arrhythmia, they often feel palpitations. Excessive sweating often occurs after palpitations, which may be related to autonomic dysfunction and increased sympathetic nerve tension.

3. Tricuspid stenosis

The clinical manifestations of tricuspid stenosis may be less obvious or confused with the symptoms of mitral stenosis due to the co-existence of mitral stenosis. Patients are more prone to fatigue and often complain of discomfort or pain in the right upper abdomen and general edema. The palpable pulsation of the jugular vein often gives the patient a fluttering discomfort in the neck. In addition, due to gastrointestinal congestion, patients often complain of loss of appetite, nausea, vomiting or belching. A small number of patients may also experience syncope, periodic cyanosis or discomfort behind the sternum, and may have difficulty breathing.

4. Tricuspid regurgitation

Symptoms of tricuspid regurgitation without pulmonary hypertension are relatively mild. When pulmonary hypertension and tricuspid regurgitation coexist, cardiac output decreases and symptoms of right heart failure are obvious. It may manifest as fatigue, generalized edema, abdominal effusion, and distension and pain in the right hypochondrium and right upper abdomen caused by hepatic congestion. There is a pulsating sensation in the veins of the neck or abdomen, which is more obvious during physical labor or emotional excitement. Sometimes there may be eye pulsation, and some patients may have mild jaundice. In many patients with tricuspid regurgitation, as the disease progresses, pulmonary congestion caused by coexistent mitral valve disease may decrease, but weakness, fatigue, and other symptoms of decreased cardiac output become apparent.

5. Combined valvular disease

There are several combinations of combined valvular diseases: the same cause affects two or more valves, the most common of which are mitral valve and aortic valve or other valvular diseases caused by rheumatism; others are infective endocarditis that can simultaneously invade the mitral valve, aortic valve, tricuspid valve or pulmonary valve.

The lesion originates from one valve and may affect or involve another valve as the disease progresses, leading to relative stenosis or insufficiency. For example, rheumatic mitral stenosis can cause pulmonary hypertension, which can overload the ventricles, causing right ventricular enlargement and leading to tricuspid regurgitation. Two or more causes affect different valves, such as rheumatic mitral valve disease complicated by infectious aortic valvulitis. The impact of combined valvular disease on cardiac function is comprehensive. Multiple valvular lesions have a worse prognosis than single valvular lesions. The effect of surgical treatment is often worse than that of simple valvular disease.