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Getting chest pain with acid reflux and anxiety attacks. What should I do?

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Practicing since : 2010
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(Please see attachment for a Word document of the below info - it may be easier to read).

A few times a year, I get pain in my chest and neck that lasts for about 5 days. The symptoms might match pleurisy, peritonitis and pericarditis, but I’d like a physician’s opinion regarding possible diagnosis and whether this requires further exams to rule out something serious.
A few times a year I get a condition with pain in chest and lower throat area when taking a deep breath or exerting myself. It feels worse (especially in my throat) when I lie down. The pain in my chest is like XXXXXXX pressure, and the pain in my throat feels like tissue is inflamed or sore. If I refrain from movement then I don't experience pain – I only feel the pain in my chest and throat if I breathe or move around. At it's worst, it's uncomfortable to walk -- anything that raises my heart rate causes pain. I have no headaches or other issues.
The pain lasts for a total of about 5 days. The 1st day is mild, the pain peaks the 2nd and 3rd day, and the 4th and 5th days are mild.
•     I'm 35 yr old, 5'11", 165 lbs, healthy Caucasian male.
•     I drink approx 2-3 days/week, between 1-4 alcoholic drinks/night
•     Non-smoker
•     No medications (occassionally I will take a Tums)
In the past, I had several years struggling with acid reflux and IBS, but a gluten-free diet has eliminated pretty much all IBS and reflux symptoms (I tested negative for Celiac). I used to have chronic panic/anxiety attacks, but I do not have them anymore.
My most recent medical evaluation was approx 6 months ago. The doctor found no issues. I told him that I was concerned over the several years that I struggled with acid reflux, but he checked my throat with a flashlight and saw no signs of disease.
•     What are the possible diagnoses for the chest pains?
•     My most recent bout has passed. Is it still important to visit the doctor?
•     Does it appear that this condition could be indicative of a serious disease?
•     Is there any way I can prevent further onset of this condition?
Posted Tue, 14 May 2013 in General Health
Answered by Dr. Sunil 5 hours later

Thanks for posting your query in detail.

As you have history of Acid reflux and panic attacks, the possible cause of chest and throat discomfort can be the same (Acid reflux & Panic attacks/anxiety).

In GERD or acid reflux heartburn, chest and throat pain/discomfort are common but if your doctor has examined for it and did not find anything then you should be evaluated for anxiety and panic attacks.
You should visit your psychiatrist for further evaluation and management.

Less likely it can be indicating serious disease and retrosternal goiter and oesophageal cancer should be ruled out.

You should avoid ALCOHOL that may trigger acid reflux and panic attacks. Avoid junk food, spicy food, carbonated drinks. Do not go to bed in 2 hours of taking food. Use extra pillow while sleeping to raise head. Keep yourself calm, exercise,yoga and meditation can help you.

Hope I have answered your query, If you have any further question I will be happy to help.

Wish you good health.

Dr Sunil
Above answer was peer-reviewed by
Follow-up: Getting chest pain with acid reflux and anxiety attacks. What should I do? 2 hours later
I should not have included the information on acid reflux and anxiety attacks, as you seem to have fixated on that, and I'm quite sure it has nothing to do with those issues -- both those issues have been resolved for a couple of years now.

Again, I haven't had a panic attack or chronic acid reflux for a couple of years now. Anyway pain I had with acid reflux was very different than the pain that I had for this issue. I do not require advice on how to avoid acid reflux, as it is no longer a problem. I do not believe that this issue has anything to do with acid reflux -- the pain is very different.

As I mentioned, the symptoms I experience mimic pleurisy, peritonitis or pericarditis. Have you ruled those conditions out?

Honestly, I feel like you haven't carefully read over my issue, and instead you have fixated on acid reflux and anxiety, two conditions that I have not experienced in some time.
Answered by Dr. Sunil 24 minutes later

Thanks for writing back.

I understand your concern; however I did not consider pleurisy, peritonitis or pericarditis because:

1. Peritonitis is a sever and tender condition. You would not allow anyone to touch the area and muscles would become rigid by simple touch. Besides this, it is unlikely that peritonitis would resolve spontaneously.
2. Pleurisy is a stabbing in nature and is usually accompanied with fever, cough and sputum or shortness of breath. These symptoms are likely to be present with chest pain if it were to be pleurisy.
3. Pericarditis pain is aggravated by leaning forward can be accompanied with shortness of breath.

Since the pain lasts for few days to recur again and it the throat and chest, the description well fit the characteristics of acid reflux / oesophagitis.

If you are still in doubt, then I would encourage you to visit your physician and get a few tests done - complete blood count; X-ray chest, ECG and upper GI endoscopy.

Hope this clarifies. I shall be glad to explain further if you are not satisfied/have any doubts.

Dr. Sunil
Above answer was peer-reviewed by
Follow-up: Getting chest pain with acid reflux and anxiety attacks. What should I do? 2 hours later
Thank you for your reply. I may not have explained my symptoms in enough detail. My pain was indeed aggravated by leaning forward or lying down. Also, anything that accelerated my heartbeat (such as walking or getting up from a seated position) caused shortness of breath and pain in chest and neck.

In other words, whenever I could feel my heart beating more (typically by light activity such as walking at a leisurely pace), the pain would increase. The pain was not at all similar to the type of burning pain I used to experience with acid reflux.

With this additional information, do you think it could indeed be pericarditis? Is it typical for pericarditis to resolve within several days? Are there any clues as to whether it is viral or bacterial?

Thank you for your help. I may indeed see a doctor for tests.
Answered by Dr. Sunil 20 hours later

Thanks for writing again.

As I have explained earlier it is less likely to be a pericarditis but can not be completely ruled out without examination and investigations.

Pericarditis usually resolves in few weeks (upto 6 months or more) and in most cases cause is either unknown or a viral.

You can take over the counter pain killers to relieve pericarditis pain. Disease can be completely ruled out by chest x-ray, ECG, ECHO and upper GI endoscopy.

Hope it helps.

Take a good care.

Dr Sunil
Above answer was peer-reviewed by
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