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Chest pain, lightheadedness, done heart scan, stress test, GERD, taking Omeprazole, no hearburn. More tests?

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I've had a couple instances of a quick sharp pain near the upper center of my chest, along with what felt like a skipped heart beat. The pain also shot from my chest to my head. Both times I felt a little lightheaded for a few minutes afterward. I've had recent heart scans and stress test, all OK. I've been diagnosed with GERD, but am taking Omeprazole, and don't have heartburn. Do I need more tests, if so, what kind.
I'm 38, 5'11", 150lbs.
Posted Fri, 27 Apr 2012 in GERD
Answered by Dr. Rakhi Tayal 3 hours later

Thanks for writing to us.

Pain in the center of the chest with a feeling of skipped heart beat can be due to a problem like cardiac ischemia even if your blood pressure and other parameters are normal. The symptoms of heart attack include squeezing type of chest pain with sweating and nausea/vomiting. The predisposing factors include smoking, stress, obesity, hypertension, diabetes, increased cholesterol, etc.

Although it is less likely to develop with normal heart scans and stress test, it would be better if you could get the following investigations done to rule out cardiac related problems.
1. Troponin -T and CPK-MB
2. ECG in all leads with a rhythm strip in lead 2
3. Echocardiography
4. Tread mill test
5. Thallium scan (Myocardial perfusion scintigraphy)

The other possibilities that need to be ruled out with the help of your physician are muscular pain, GERD, Pleuritis, etc.

The pain also could be due to musculoskeletal inflammation - This can be diagnosed if the pain increases on specific movements or on direct pressure on the affected area. Such pain can respond to medications like Ibuprofen 400 mg taken three times a day. This generally resolves within a week. ‎

Pneumonitis Or Pleuritis : Here the pain increases on XXXXXXX breaths and is associated with symptoms like cough, expectoration of mucus or purulent sputum, etc.

GERD: This condition too presents with the similar symptoms as described by you and usually subsides after taking Antacids or proton pump inhibitors group of drugs.

Panic attacks: This is a condition that is seen in hyperthyroid patients with anxiety related symptoms. This can also present with chest pain, breathlessness and other generalized symptoms. This condition can also be confused with cardiac problems.

It is important to rule out the exact cause after physical examination and investigations. Hence, please see your Primary Doctor for complete examination and the treatment would follow accordingly.

I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.

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